My Dementia Patient Refuses to Eat: What Do I Do??

Patients with Dementia refusing to eat is a common issue that happens in the later stages of the disease.   The refusal to eat is not the person, it’s the disease.  Dementia strongly affects the brain in ways that are difficult to understand.  

Implementing nutrition interventions that address a dementia patient refusing to eat can improve their nutrition status, prevent malnutrition, and improve quality of life.  

Focusing on person-centred care will help to address nutrition concerns by implementing nutrition interventions specifically for the person.

In this article, we will discuss how dementia affects nutrition status in elderly people and provide a nutrition care plan for long-term care dietitians to manage the nutrition side effects.

What is Dementia?

Dementia is a devastating progressive disease that will eventually be the death of patients.  There are a few different types of Dementia, Alzheimer’s Disease is the largest majority of those diagnosed.

Dementia is essentially anything that is observed as a decline in cognition that is significant enough to interfere with independence and daily functions.  Dementia also goes in stages, and it is usually caught in the mid-to later stages of the disease.  

The typical lifespan of someone diagnosed with Dementia will be about 6.7 years.  But because it is diagnosed in the mid-to late stages, the life span can be less than 2.6 years.  

How does Dementia Affect Nutrition?

Dementia impacts nutrition in a significant way, a few areas that we commonly see hit the hardest are:

Swallowing difficulty

Loss of independence at meals

Loss of interest in eating and drinking

Increased fatigue during a meal

Malnutrition

Dementia is more common in elderly people and can lead to malnutrition due to changes in eating habits, difficulty chewing and swallowing, and forgetfulness.  So let’s look a little deeper at each of the issues.

1. Changes in Eating Habits

Dementia can cause changes in taste and smell, leading to a loss of appetite or a desire for specific foods. Some patients may develop an aversion to foods they once enjoyed or become fixated on a particular food item. Additionally, dementia may cause a person to forget to eat or how to prepare meals, resulting in reduced food intake.

2. Difficulty Chewing and Swallowing

Dementia can lead to difficulty chewing and swallowing, resulting in a reluctance to eat solid foods. This can lead to a preference for softer foods, while we do recommend liberalising the diet, safety is still important.

If you have a patient dealing with Dysphagia, you can read this article to learn how to manage the condition.

3. Forgetfulness

Dementia can affect memory, leading to forgetfulness about meals or a lack of awareness that they haven’t eaten. Constantly asking them if they’ve eaten can cause increased agitation and irritability.  

We need to find the balance between offering food and fluids, and understanding that the disease distorts their memory.

Nutrition Interventions for Dementia Patient Refusing to Eat

1. Offer Nutrient-Dense Foods

To maximise nutrient intake, offer nutrient-dense foods such as whole grains, lean proteins, fruits, and vegetables. These foods provide essential vitamins and minerals and can help prevent malnutrition.

At times when a patient has Dementia, one of the first steps that you need to look at is liberalising diets.  Liberalising diets can open up a wide array of foods and fluids that you can offer.  If you want to find more information on how to liberalise diets, you can read this article.

You can also look at fortifying foods to increase the calories and protein in foods.  This can include:

Adding protein powder, butter, cream, cheese, sugar packets and more.  The focus is to honour their preferences, try to get input if you can.  If the patient is unable to tell you, check with their loved ones as to what they think they would want.

2. Modify Food Texture

Modifying food texture can help individuals with chewing and swallowing difficulties to consume a well-balanced diet. Softening or pureeing foods or using thickening agents for liquids can improve safety and make food easier to swallow.

We do see as Dementia progresses that a significant amount of people will be on a modified texture diet.  Try to work with the kitchen to make the food look as appetising as possible.  

3. Encourage Snacking

Encouraging snacking between meals can supplement nutrient intake and help prevent weight loss. Offer snacks that are easy to prepare and consume, such as nuts, fruit, cheese, or yoghurt.

If you want some great snack ideas for different diet textures, different diets, and more, you can read this article!

4. Maintain Mealtime Structure

Maintaining a regular mealtime routine can improve patient appetite and intake. Offering three main meals and two to three snacks per day can help provide structure and promote adequate nutrient intake.

Most long term care homes have regular and planned meal times so this isn’t too difficult to handle.  Though snack times can be a source of trouble.  The Dietitian should ensure that the patients are receiving the snacks that they are being offered.  This may require the patient receiving assistance with opening packages, being offered eating assistance, the care plan should be tailored to the individual patient.

5. Monitor Hydration

Dehydration is a common issue in elderly people with dementia, as they may forget to drink fluids or have difficulty recognizing thirst. Offer fluids regularly throughout the day and monitor urine output to ensure adequate hydration.

Again, we want to honour their preferences.  If they enjoy having a cup of coffee everyday, we can offer coffee more frequently during the day.  If caffeine causes some increased agitation, perhaps switching to a decaf option can help.

In Conclusion

Dementia can lead to malnutrition due to changes in eating habits, difficulty chewing and swallowing, and forgetfulness. Long-term care dietitians can help manage nutrition side effects by offering nutrient-dense foods, modifying food texture, encouraging snacking, maintaining mealtime structure, and monitoring hydration. 

With a proper nutrition care plan, individuals with dementia can maintain their health and quality of life.  A Dementia patient refusing to eat doesn’t have to mean the end of care, it just means changing the nutrition care plan to go with the patient’s current status.

Building a Dementia Nutrition Care Plan: For Dietitians!

1. Nutrition Assessment: 

The first step is to assess the patient’s nutritional status, including their dietary habits, food intake, weight changes, and overall health. This can be done using tools like the SGA- Subjective Global Assessment tool.  This is the number tool that I recommend Dietitians use when trying to diagnose Malnutrition.

If you want a long term care nutrition assessment form with a built in SGA, click here to see one.

A significant number of patients with Dementia will be diagnosed with malnutrition.  This is something that Dietitians should constantly be assessing.  Ensure that at minimum annually you are performing an SGA on your patient.

If you know as the Dietitian that your patient has malnutrition, you can start to build a nutrition care plan that addresses the nutrition concerns.  

If you want to know more about building a Malnutrition nutrition care plan, you can read this article.  The article will give you multiple PES statements as well!

2. Nutrition Diagnosis: 

Based on the assessment, the dietitian will diagnose any nutritional problems that the patient may have, such as malnutrition or inadequate nutrient intake.

Always use standardised language when providing a nutrition diagnosis.  This allows for consistency in care.  If you are fortunate enough to have an NCP-Terminology book, it can guide you exactly what falls into each nutrition diagnosis category.

3. Nutrition Intervention: 

The next step is to develop individualised nutrition interventions to address the patient’s specific needs. This may involve modifying their diet to ensure they are consuming enough calories and nutrients, encouraging them to eat smaller, more frequent meals, or recommending supplements as needed.

I always recommend trying a food first approach with your nutrition interventions.  But nutrition supplements can be a great addition to a nutrition care plan.

If your facility (along with every other facility in the nation) is having difficulty getting nutrition supplements, read this article.  It will give you some great nutrition supplement recipes so you can have an in-house recipe and not rely on an inconsistent supply.

4. Nutrition Monitoring and Evaluation: 

The dietitian will monitor the patient’s progress regularly and adjust the nutrition plan as needed. They may also work with the patient and their caregivers to identify and address any barriers to following the plan.

In your nutrition care plan, make sure that you have exact timelines of when you’re going to reevaluate your patient.  Also ensure you have detailed what you’re going to be monitoring.

5. Nutrition Goals: 

The final step is to evaluate the nutrition goals that were set from the nutrition interventions. This may include improvements in the patient’s weight, nutrient intake, and overall health, as well as improvements in cognitive function and quality of life.
If you want to see more about nutrition care plans for Dementia, you can read this article.

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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.

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