Eating Well with Dementia

Molly Robinson is a rising star on social media, where she shares helpful advice as the Dementia Dietitian. Drawing on more than 18 years of experience as a Registered Dietitian Nutritionist and personal experience supporting her grandmother living with Alzheimer’s disease, Robinson helps care partners and families of people living with dementia create supportive eating environments for their loved one that can boost hydration, improve nutrition and increase enjoyment during mealtimes.

Here, Robinson offers tips for supporting a person living with dementia in eating well at home.

Q: What are some common challenges people living with dementia experience at mealtimes?

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A: One of the most common challenges that a caregiver or family might notice may be the changing of preferences. I've often seen situations where a person will like a certain type of food or maybe they've eaten really healthfully their entire life, and then things completely change and they no longer are drawn towards those foods. They don't seem to accept them as well, and their preferences become the opposite of what they enjoyed earlier in life.

Of course, being a dietitian, I do promote having a well-balanced diet and nourishing the body with as much healthy food as possible. However, with dementia, because acceptance does seem to decrease for a lot of folks, I think it's important to relax expectations and not to worry that as a caregiver you're not fully nourishing or getting all the healthy, or right, foods into your loved one. I know we want to provide the best as caregivers, but given dementia, sometimes the best food is the food best accepted by the person. So sometimes that looks like sweet foods or things they really desire but may not be labelled as healthy.

"Providing that structure for a person with dementia can help set the foundation of consistent nutrition."

– Molly Robinson

Q: What environmental supports can care partners provide to promote successful mealtimes?

A: Having a schedule for meals and snacks for the day is vital. Operating on a routine is important in a lot of different aspects of care, including nutrition. For most people the routine would include three meals and three snacks for the day, but that might look a little bit different for some people. I think we have to be flexible. Maybe someone would like several smaller meals or snack size meals throughout the day.

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Sometimes family members ask their loved one if they are hungry or rely on them to see if they want to eat, instead of just stating: it's breakfast time, it's lunchtime, it’s snack time. It’s best not to rely on them to answer, “yes, I want something to eat.” Just go ahead, don't ask, just do. Providing that structure for a person with dementia can help set the foundation of consistent nutrition.

A hydration schedule is also important, as is thinking outside of the box. The person with dementia may not be drinking a lot with meals, as sometimes that interferes with food intake. If a person is filling up on the liquid, then they may not be as interested in the food, or vice versa, where the food is being eaten and they're leaving out the drink. Observing what's going to work best for your loved one is important with hydration. Maybe the person responds best to someone just handing them a glass as a reminder or maybe [to] drinking together – saying, “Gosh, I'm really thirsty. I'm going to have a drink.” If they're in the recliner enjoying watching some TV, do they seem to respond better to being able to access a drink just sitting beside them throughout the day? Hydration looks a little bit different for everybody.

Q: What relational supports can care partners provide?

A: It’s important to consider that a distraction is the most common struggle at mealtime. We have to think about what works for the person. Does having more people at the table, or less, work better for your loved one? Often just two people at the table works best. By sitting down and demonstrating without even encouraging verbally, the person may pick up on the cues that you're taking a drink or you're enjoying your meal. I think that type of social support is something familiar for people and can encourage more intake at meals.

"Having your loved one talking with you or listening to soft music as you're preparing the meal helps to simulate that appetite ahead of time."

– Molly Robinson

Q: How can care partners promote independence at mealtimes?

A: Encouraging as much independence as possible is important, and that might look different for everybody. In early dementia, maybe independence is still being able to have some level of involvement in preparation or planning of meals. Maybe the family or caregiver is supporting independence by helping to build the menu or to do the shopping.

I've worked with a family recently — the father (who lives with dementia) liked to just go to the store to do the shopping. And that was not only a source of exercise, but he was being involved and he felt useful because he was able to seek something out on the shelf and get that into the cart. When people can no longer plan or cook, maybe they can still set or clear the table, or help to do dishes.

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As dementia progresses, that independence in self-feeding tends to be a little confusing for some. Maybe they're not quite understanding what to do with the utensil and sort out the mechanics of being able to load the fork and bring it to the mouth. We can remove that hurdle by offering some hand-held foods or finger foods. That seems to be a very early and common intervention that is successful with people with dementia.

Colour contrast also helps folks. If we have a white plate with all white food, for example, potatoes and chicken blending into the white plate, that doesn't always visually make sense to a person with dementia. So having the vibrant red or green plate and attractive food can enhance what they're able to see, but also what they are accepting.

And lastly, remember it could look like a blend of independence and assistance at meals. While you might be helping to feed the person with the utensil, consider, could they still hold their cup? While it looks different for everyone, hanging onto as much of that independence as possible is very important.

Q: What activities based around food support good meals?

A: Being present in the kitchen and helping with activities that stimulate senses, such as peeling fruit or vegetables, or whatever they're capable of doing, can be a good start to mealtimes. Cooking something that smells delicious and having your loved one talking with you or listening to soft music as you're preparing the meal helps to simulate that appetite ahead of time. That interaction and social connection can create better meals.