With dementia, the person eventually loses all of the abilities they once possessed and the knowledge that they had acquired over time. Since using utensils and eating politely are acquired skills, they are lost in dementia. Using a fork and knife, for instance, takes practice and we are typically age 6, 7, or older by the time we have mastered all of the fine nuances of eating a meal and utilizing utensils properly. When we are young, we are fed by another person, then we learn how to drink from a bottle unassisted, then a cup or glass, then we learn how to use a spoon, then we master abilities that require more coordination and fine motor skills, such as cutting with a fork and knife or carving a turkey.
It is not surprising that as many as 80% of people with dementia have difficulty with eating and drinking. 50% are no longer able to feed themselves in the later stages of the disease (Ensell & Matheson, 2009). Furthermore, mealtime is an opportunity for individuals with dementia to socialize, feel useful, and embrace culture; if the mealtime experience is unenjoyable or challenging, this may prevent the person from engaging meaningfully with others and could lead to isolation or depression. See the tips below for providing help to individuals at different stages of dementia.
Tips for Early Stage
- Provide reminders on when to eat.
- If the person lives alone, clean out their refrigerator regularly. Make sure spoiled foods are not kept or consumed.
- Drop off pre-made meals or utilize a Meals on Wheels service.
- Be aware of safety concerns in the kitchen. Supervision may be required, even at an early stage.
- Declutter the kitchen area. Too much clutter can cause confusion and agitation.
- Consider assistive devices, such as a rocker knife, that might help the person to remain independent longer. Consult an Occupational Therapist for specific suggestions.
- Be mindful of the person’s likes and dislikes and life-long habits related to eating.
- Try to stick to a regular routine.
Tips for Middle Stage
- Serve finger foods or serve the meal in the form of a sandwich
- To avoid spilling, serve food in large bowls instead of plates or use plates with rims or protective edges.
- Consult with an Occupational Therapist to help promote independence. Specific assistive devices may be recommended.
- Consult with a Speech Therapist/Pathologist if there are chewing or swallowing challenges.
- Avoid foods such as nuts, popcorn, and raw carrots, which may be hard to chew and swallow.
- Serve soft foods such as applesauce, cottage cheese and scrambled eggs. Serve thicker liquids such as shakes, nectars, and thick juices. You may also purchase powders that can thicken liquids in order to assist with swallowing.
- Try to stick to a regular routine.
- Help the person maintain good oral hygiene.
- Be alert for signs of choking. Learn the Heimlich maneuver in case of a choking incident.
Tips for Late Stage
- Weight loss, malnutrition (Sharp & Shega, 2009) and loss of appetite are considered hallmark signs that the person is entering the last stages of the disease. In the Late Stage, the person may eat less and have difficulty swallowing.
- Consult with a Speech Therapist/Pathologist if there are chewing or swallowing challenges.
- Consult with an Occupational Therapist to help promote independence. Specific assistive devices may be recommended.
- Gently place the person’s hand on or near an eating utensil.
- Show the person how to eat by demonstrating.
- Try hand-over-hand assistance.
- Give the person plenty of time to eat. Keep in mind that it can take a person an hour or more to finish.
- Be conscious of physical illnesses or disabilities that may affect their eating.
- Help the person maintain good oral hygiene.
References
Ensell, C., & Matheson, N. (2009). Mealtime behaviours in people with dementia in the absence of dysphagia. Acquiring Knowledge In Speech, Language & Hearing, 11(2), 92-96.
Hansen, T. (2011). Measuring elderly dysphagic patients’ performance in eating – a review. Disability & Rehabilitation, 33(21), 1931-1940.
Logemann, J. A., Gensler, G., Robbins, J., Lindblad, A. S., Brandt, D., Hind, J. A., & … Gardner, P. (2008). A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease. Journal Of Speech, Language & Hearing Research, 51(1), 173-183.
Sharp, H. M., & Shega, J. W. (2009). Feeding Tube Placement in Patients with Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists. American Journal Of Speech-Language Pathology, 18(3), 222-230.
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