Poor appetite and dementia

How can dementia affect a person's appetite?

A person with dementia may lose interest in food. They may refuse to eat it or may spit it out. The person may become angry or agitated, or behave in a challenging way during mealtimes. 

If a person isn’t eating enough, it can lead to weight loss and less muscle strength. They may also feel tired and weak. This can make them frailer and less able to recover from infections or viruses. 

What can cause poor appetite?

• Physical difficulties – such as problems with chewing and swallowing or constipation.
• Depression – loss of appetite can be a sign of depression. Depression is common in people with dementia. There are effective treatments for depression, including medication and other therapies. If you suspect that the person you are caring for has depression, consult the GP. 
• Communication – the person with dementia may have problems communicating that they’re hungry, that they don’t like the food they have been given or that it’s too hot. Or they may be unsure what to do with the food. They may communicate their needs through their behaviour. For example, they may refuse to eat or hold food in their mouth. You could try giving them a choice of food, or using prompts and pictures so they can choose the food they would like. 
• Pain – the person may be in pain or discomfort, which can make eating difficult. They may have problems with their dentures, sore gums or painful teeth. Dental care, oral hygiene and regular mouth checks are important. 
• Tiredness and concentration – tiredness can cause people with dementia to not eat or give up partway through a meal. It can also lead to other difficulties such as problems with concentration or with co-ordination. People with dementia may have difficulties focusing on a meal all the way through. It’s important to be aware of this and support the person to eat when they are most alert. 
• Medication – changes to medication or dosage can result in appetite changes. If you think this may be the case, speak to a pharmacist or the GP.
• Physical activity – if the person is not very active during the day, they may not feel hungry. Encouraging them to be active will be good for their wellbeing and may increase their appetite. Equally, if the person is very active or restless – for example, walking about or fidgeting – they may use extra calories and may be hungrier than usual or lose weight more quickly. 

What can help to encourage appetite? 

• Knowing the person will help, as everyone has their own needs, routines, likes and dislikes.
• Make food look and smell appealing. Use different tastes, colours and smells. The aroma of cooking – for example freshly baked bread – can stimulate someone’s appetite.
• Try not to overload the plate with too much food – small and regular portions often work best. Consider serving half portions to keep hot food from going cold and losing its appeal. 
• Give the person food they like. However, remember that a person’s food preferences can change as their dementia progresses. 
• Don’t stop someone eating dessert if they haven’t eaten their savoury meal. They may prefer the taste of the dessert.
• Try different types of food and drink with varying temperatures and textures, such as milkshakes or potato wedges.
• Give the person gentle reminders to eat, and remind them what the food is.
• Don’t assume the person has finished because they’ve stopped eating. 
• If the person is agitated or distressed, don’t put pressure on them. Wait until they are calm and less anxious before offering food and drink.
• Use eating and drinking as an opportunity for activity and social stimulation. It may be an opportunity to talk about food from their childhood, and this could help to encourage their appetite. They could also help with preparing the food.
• If the person doesn’t want to eat meals at set times or at a table, make finger foods available such as sausage rolls, falafel, samosas, spring rolls, sandwiches, slices of fruit and vegetables so they can snack on these instead. Some full meals could be served as finger foods, for example roast dinner, as long as they’re presented in easy-to-hold pieces.
• Look for opportunities to encourage the person to eat. For example, if they’re awake for much of the night then night-time snacks may be a good idea.
• If the person refuses food, try again a bit later. Remember that these reactions are not a deliberate attempt to be ‘difficult’, or a personal attack. 
• If they continue to refuse food and you’re concerned about the effect of this on their health, speak to a pharmacist or the GP.