Eating and drinking with dementia

Dementia often has an impact on a person’s appetite and ability to eat and drink. Read our advice on some of the changes you might notice and how to support the person you care for.

How dementia affects eating and drinking

A person with dementia may experience problems with eating and drinking due to changes in the brain and other health issues.

Memory, concentration and food recognition

Dementia can affect a person’s memory. This can affect their diet, because they might forget to eat or drink, or forget they have already eaten. They may also forget where their food is stored or what they have in the cupboard, fridge or freezer.

Problems with concentration may also mean that a person with dementia becomes distracted while eating and does not finish their food.

Changes in the brain may also mean that the person struggles to recognise familiar foods. This may put them off eating because the foods may seem strange or unappealing.

Loss of appetite

Poor appetite and weight loss are common as dementia progresses. There may be other medical reasons why a person loses interest in food and drink. These include mouth pain and dental problems, constipation, infections or medication side effects. If you are concerned that the person you care for may have health or dental issues affecting their appetite, please speak to their GP or dentist for advice.

Mental health issues like depression can also cause reduced appetite or overeating. Encouraging social interaction and gentle exercise or movement may help with depression. You can also talk to the person’s GP about a referral for therapy, which can be helpful for some people living with dementia and depression.

Changes in taste and smell

People living with dementia may experience changes in their sense of taste and smell. They may find certain colours, textures or smells off-putting, even if the food was a previous favourite. Or they may start to enjoy certain foods that they previously disliked – an increasingly sweet tooth is common. There may also be changes to lifelong eating and drinking preferences – for example, suddenly wanting sugar in tea or coffee when they have always taken their drinks sugar-free.

The changes in taste that often come with dementia, along with other factors like a loss of appetite, may make it more difficult for the person to stick to specific diets such as diabetic, coeliac, religious or cultural diets. It is helpful to learn about any rules, routines, or restrictions so you can support the person in following them.

Cravings, overeating and rigid food patterns

Some types of dementia, such as frontotemporal dementia, can cause a person to overeat and to crave a lot of sweet foods. This can lead to weight can and, if proper mouth care is not practiced, dental issues.

Other types of dementia, such as semantic dementia, can lead a person to have rigid food habits where they only want to eat one or a few specific foods.

Chewing, swallowing and coordination difficulties

A person with dementia might have difficulties with chewing or swallowing. They might also have coordination problems that make it hard to use cutlery or drink from a cup or glass.

If the person you care for has difficulty swallowing or often coughs or chokes when eating, soft or pureed food may be easier for them to eat. However, please consult a speech and language therapist (SLT or SALT) first, as purees may lack nutrients. An SLT can suggest soft food options with added nutrients. They can also show the person exercises to strengthen the muscles used in swallowing. And give posture tips to make swallowing easier and reduce the chance of food going down the windpipe.

You can ask the person’s GP to make a referral to an SLT. While you wait for an appointment, keep offering food that you know the person likes and can manage.

The person’s GP may also review medications and how these are administered so they are easier to take. For example, changing a large tablet for syrup or a tablet that dissolves on the tongue may be discussed.

If the person has problems with coordination and holding cutlery or cups, you can buy adapted items that are easier to hold. Cups with handles and lids may also help to avoid spills.

What foods are best for someone with dementia who has chewing or swallowing problems?

If a person with dementia needs to eat pureed food because of chewing or swallowing difficulties, be aware that this can be less nutritious and may lead to weight loss. To make sure they get enough nutrients, you could try:

• mixing skimmed milk powder with milkshake powder and full-fat milk to create a high-nutrient drink. Choose milkshake powders that are fortified with vitamins
• offering protein or meal replacement drinks

However, it is best to talk to an SLT for expert, tailored recommendations on meals for people with dementia and chewing or swallowing difficulties.

Why do people with dementia sometimes refuse to eat or drink?

There are various reasons why a person with dementia might refuse to eat or drink. It may be due to a combination of reasons, including changes in taste or loss of appetite. They may also avoid eating if they are tired, anxious, or agitated, or if the environment is overstimulating.

As dementia progresses and a person is nearing end of life, they usually start eating and drinking less. They may not want to eat or drink at all. This is part of the natural progression of dementia when someone is nearing the end of their life. This can be very upsetting for family and friends, but it is a recognised part of the dying process. Interventions such as a feeding tube or drip are unlikely to benefit at this stage. They may cause distress, so it is often better to focus on offering food and drink for comfort and enjoyment rather than for nutrition.

Read more about end of life and find support

Health risks linked to poor diet in dementia

Not eating and drinking enough can increase the risk of dehydration, weight loss, urinary tract infections (UTIs) and constipation. These can increase confusion in a person with dementia, increase the risk of delirium, and make the symptoms of dementia worse.

Dehydration

Most people should aim to drink six to eight glasses or mugs of fluid a day, but a person with dementia may not always recognise when they are thirsty or be able to communicate their thirst.

You should therefore ensure that drinks are always available and offered regularly.

Constipation

Poor diet, especially a lack of fibre or water, can cause constipation. Try to encourage the person with dementia to eat five portions of fruit and vegetables and drink six to eight glasses of water a day. Gentle exercise like walking can also help ease constipation. If the person is struggling with constipation, you could try giving them a laxative. These are available over the counter at a pharmacy. However, if they are still constipated after seven days of taking a laxative, consult a GP in case there is an underlying problem.

Weight loss and malnutrition

Some of the eating and drinking issues associated with dementia can lead to weight loss, frailty and even malnutrition. Younger people with dementia may also be more physically active and need a higher calorie intake to meet their energy needs.

If you are concerned about weight loss in a person with dementia, please speak to their GP, who can offer advice or refer them to a specialist such as a dietitian.

Understanding weight gain in dementia

Overeating may also cause problems if it leads to weight gain, as this increases the risk of health issues like heart disease, type two diabetes and high blood pressure. It could also affect mobility and balance. Overeating may be a symptom of frontotemporal dementia in particular, which is most common in people aged 40 to 60.

There are also other medical conditions that can cause increased hunger. For example, uncontrolled diabetes can lead to increased hunger. Thyroid disorders (specifically overactive thyroid) increase metabolism and, therefore, appetite. Some medications may also increase appetite.

If the person with dementia is overeating or gaining weight, you could try:

• serving food in a portion rather than bringing out the packet or whole dish
• serving meals on a smaller plate or bowl to make it look like a larger portion
• offering a drink before a meal, which can help fill the stomach and create a temporary feeling of fullness
• replacing sweet or high-calorie foods with healthier alternatives such as fruit or low-calorie jelly
• limiting access to sweet foods by keeping them out of reach or only putting a few items in the cupboard at a time
• encouraging the person to become more active, for example, by walking or joining a suitable exercise class. If the person enjoys running or cycling but you are concerned that they may get lost or confused, see if an exercise buddy could go with them. Seated exercises are good for people with mobility issues
• engaging in other activities together, such as life story work, exercise or crafts, as a distraction from wanting to eat and to reduce boredom and loneliness.

Practical ways to support healthy eating and drinking

Things like environment, setting and timing can all play a part in supporting healthy eating and drinking for a person with dementia.

Create the right environment

A relaxed, familiar and sociable environment may help a person with dementia feel more comfortable when eating and drinking. You could try:

• turning off the TV or radio, which may be distracting, or playing some soothing, familiar music
• if the person has children, keeping to regular family mealtime routines to maintain a sense of familiarity and encourage them to eat. Some people, however, find family meals too noisy and busy and might prefer to eat at a different time
• giving the person lots of time to eat to reduce any pressure on them
• eating with the person, if they enjoy the social side of mealtimes. Seeing you eating may prompt them to eat too, but bear in mind that some people are self-conscious about eating in company
• finding out about lunch clubs or day centres where the person can enjoy a meal in a social situation with other people
• if the person is able and interested, involving them in preparing food.

Be flexible and accommodating

While it is important not to put too much pressure on the person with dementia, these tips may encourage them to eat:
Be flexible about mealtimes, avoiding times when the person is tired or distressed
Offer two meal options you know they like and can manage – this will help them feel more in control without overwhelming them with choices. You could use pictures to illustrate their options
Give small, regular portions rather than large meals
Be adaptable: a person with a sweet tooth might like to eat dessert first, or you could add sweet condiments like ketchup or apple sauce to savoury food
Offer a small snack before a meal to see if that helps the person recognise that they are hungry
Use different tastes, smells and colours to stimulate the appetite

Make food easier to eat

Make it as easy as possible for the person with dementia to eat by:

• offering something easy to eat, such as finger foods or foods that are easy to chew and swallow
• making sure the room is well-lit and describing the food to help the person recognise what they are eating
• using plain coloured plates and cups to make the food stand out
• using adapted cutlery if the person has difficulty using regular cutlery
• offering different shapes and sizes of cup – a cup with a lid or a sports bottle may help if they have difficulty drinking from an open cup or glass

Are any diets or foods particularly good for people with dementia?

It is important to note that there is different nutrition and healthy eating advice for people with dementia. For most younger people, the standard advice is to follow a low-fat, low sugar diet. But older people and those with dementia – including young onset dementia, where symptoms develop before the age of 65 – may need more calories and nutrients. Speak to your pharmacist or GP if you would like any advice on adding supplements to the person’s diet.

Seeking medical advice for eating difficulties

If you are concerned about the impacts of eating and drinking difficulties on the person you care for, speak to the person’s GP. They may be able to suggest things to treat resulting health issues such as constipation. And they can refer you to any other specialists that are needed, such as:

• a speech and language therapist (SLT or SALT) to help with chewing and swallowing difficulties
• a dietitian to suggest diet changes that will help the person with dementia get better nutrition

If you think the person has dental issues that are affecting their eating, then book an appointment with their dentist.

Sources of support

How our dementia specialist Admiral Nurses can help

For any questions or concerns about eating and drinking with dementia, you can contact our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday-Sunday 9am-5pm, every day except 25th December), email helpline@dementiauk.org or book a phone or virtual clinic appointment at a time that suits you.

Downloadable leaflets and practical advice

You may find these resources useful:

• NHS: Eat well
• British Dietetic Association (BDA) Nutrition and dementia resource
• NHS: Malnutrition
• Eating well with dementia: a carers’ guide
• BDA Food Facts Sheets

Dementia UK resources

• Mouth care