Why Do Dementia Patients Stop Eating?

Dementia profoundly impacts an individual’s ability to perform daily activities, with eating being one of the most affected areas. As dementia progresses, patients may experience a decline in appetite or face challenges in managing their nutritional intake. 

I have been a Registered Dietitian working with patients with dementia for over a decade now.  Understanding why dementia patients stop eating is crucial for caregivers and healthcare professionals to provide appropriate support and interventions.

Here I’ll give you my advice on what to do when answering the question, why do dementia patients stop eating?  Understanding what’s behind it, and having some tips on how to encourage eating will help not only quality of life, but peace of mind as well.

elderly woman sitting with her arms crossed refusing to eat a spoon being offered to her.

Understanding Dementia and Eating Difficulties

Dementia’s progression leads to significant changes in a person’s cognitive and physical abilities, directly impacting their eating habits. Cognitive decline can result in forgetting meal times or the process involved in eating, while physical challenges may include difficulty in chewing or swallowing food. 

This complex interplay necessitates a careful approach to meal planning and assistance.  No two people with dementia will progress exactly the same, and there will be different nutrition plans that are needed for both.

Here are the top 10 ways that someone with dementia’s eating is affected.

  • Memory Loss: Individuals may forget to eat or think they’ve already eaten, leading to skipped meals and potential nutritional deficiencies.
  • Reduced Appetite: Changes in the brain can make food less appealing, diminishing the desire to eat and risking inadequate nutrition.
  • Difficulty with Utensils: Impaired motor skills can make using utensils challenging, causing frustration and possibly leading to decreased food intake.
  • Swallowing Problems: Dementia can affect swallowing muscles, increasing the risk of choking or aspiration pneumonia.
  • Lack of Recognition: Advanced stages may result in not recognizing foods or being unable to communicate hunger, complicating mealtime.
  • Changes in Taste and Smell: Deterioration in taste and smell can alter food preferences, leading to a rejection of foods once enjoyed and nutritional imbalance.
  • Mood Swings and Behavioral Changes: Emotional disturbances can affect eating patterns, with individuals sometimes refusing food or needing encouragement to eat.
  • Oral Health Issues: Dementia can lead to neglect of oral hygiene, making eating painful and difficult due to problems like gum disease or cavities.
  • Distraction and Confusion: A busy or unfamiliar environment can be overwhelming, leading to disinterest in eating or inability to focus on the meal.
  • Altered Perception of Hunger and Thirst: Individuals may not recognize when they are hungry or thirsty, leading to dehydration and malnutrition.

Reasons for Poor Appetite in Dementia Patients

If someone with dementia has poor appetite, this is something different.  Appetite is a craving for food, while dementia affects more the ability to eat.  

Several factors affect appetite, here are the 6 most common reasons.

  • Neurological Changes: Dementia can cause changes in the brain areas responsible for appetite regulation and the perception of hunger and satiety. This can lead to decreased appetite or, in some cases, increased appetite with poor regulation.
  • Altered Taste and Smell: The senses of taste and smell often decline with dementia, making food less appealing and reducing the desire to eat. This sensory change can significantly impact appetite and nutritional intake.
  • Mood and Emotional Changes: Depression, anxiety, and other mood disorders are common in individuals with dementia and can suppress appetite. Emotional distress can make meal times challenging and unenjoyable.
  • Cognitive Impairment: The cognitive decline associated with dementia can lead to confusion and forgetfulness about eating routines or the process of eating itself, affecting the ability to recognize hunger cues.
  • Medication Side Effects: Many medications prescribed for dementia symptoms or other coexisting conditions can affect appetite, either reducing it or, less commonly, increasing it.
  • Physical Difficulties: Problems with chewing, swallowing, and using utensils can make eating physically challenging and uncomfortable, discouraging food intake.

Why Do Dementia Patients Stop Eating?

Ultimately though the question begs, why do dementia patients stop eating?  Because eventually they do seem to.  From what I have observed in my 10 years in clinical practice with dementia patients, is that nutrition is typically the last thing to go for them.

Each case will be individual, but dementia patients eventually stop eating from a combination of factors.  We typically see a person with dementia stop eating in the later stages of dementia.  It starts to affect the area of their brains that control eating behaviours.  

If someone does stop eating due to being in the later stages or even final stages of dementia, there is not a lot that can be done.  But if they are still in the earlier stages, and have simply slowed down eating.  Here are some frequent causes that should be investigated.

  • Cognitive Decline: As dementia progresses, the ability to recognize hunger cues, remember to eat, or recall how to chew and swallow food can diminish. This cognitive decline directly impacts the ability to maintain regular eating habits.
  • Sensory Changes: Alterations in taste, smell, and perception can make food less appealing or unrecognizable as something to eat, leading to decreased interest in food.
  • Motor Skill Impairment: The loss of coordination and fine motor skills can make the act of eating—using utensils, chewing, swallowing—challenging and frustrating.
  • Communication Difficulties: The ability to express needs or preferences for certain foods or to indicate hunger can be lost, making it hard for caregivers to provide appropriate meals.
  • Psychological Factors: Depression, anxiety, and other mood changes common in dementia patients can suppress appetite and interest in eating.
  • Physical Health Issues: Coexisting health conditions, such as dental problems, infections, or chronic illnesses, can cause pain or discomfort that discourages eating.

What are the Risks with Not Eating?

When a person with dementia does not eat properly, it can lead to several serious health risks. These include malnutrition, where the body doesn’t get the nutrients it needs to function correctly. Weight loss is another common issue, which can weaken the person’s overall health. Muscle loss may also occur, reducing their strength and mobility.

This can affect their ability to perform daily activities and increase the risk of falls. Here’s a simple list of risks associated with not eating in individuals with dementia:

  • Malnutrition
  • Weight loss
  • Muscle loss
  • Decreased mobility
  • Increased risk of falls

Ensuring adequate nutrition is crucial for managing dementia and supporting overall health.

What if They Don’t Start Eating Again?

While I always encourage exhausting trying all nutrition strategies to encourage someone with dementia to eat again, ultimately they will stop in the final stages of dementia.

Many people question me whether they should start Artificial Nutrition (AF) or Tube Feeding (TF) in order to keep them alive longer. Research currently does not support that AF or TF keeps someone in the final stages of dementia alive longer.

Research also does not support that this increases their quality of life, or reduces suffering. If you want to know more about the final stages of life in the elderly, especially those with dementia, read The Secrets of End of Life Eating Habits.

Strategies to Encourage Eating

elderly woman accepting a spoonful of food from someone helping her.

Thankfully if someone is still in the early to middle stages of dementia, there are many nutrition strategies that we can try to improve their eating.  It may take trying a few different options before truly finding one that works.

I highly recommend working with a Dietitian to get to the root cause of why someone with dementia has slowed down eating or stopped altogether.  A Dietitian that works with people with dementia will be key!

But here are my top 15 recommendations for strategies to try to encourage a person with Dementia to eat!  Also, if you want specific foods to try, I recommend reading; 15 Best Foods for Dementia Patients to Eat!

  • Simplify Meal Choices: Offer simple meal options or a plate with fewer food items to avoid overwhelming them.
  • Enhance Food Appeal: Improve the visual appeal of meals with colorful foods and contrast to make the plate more attractive.
  • Increase Mealtime Assistance: Provide gentle, patient assistance with eating, guiding them through the process if necessary.
  • Reduce Distractions: Create a calm, quiet eating environment by minimizing background noise and visual clutter.
  • Maintain Routine: Serve meals at consistent times every day to establish a predictable routine.
  • Adapt Utensils: Use adaptive eating utensils designed for easier handling, or opt for finger foods if utensils become too challenging.
  • Modify Food Texture: Adjust the texture of food to make chewing and swallowing easier, such as offering soft foods or thickening liquids if necessary.
  • Encourage Self-Feeding: Promote independence by encouraging self-feeding as much as possible, offering assistance only when needed.
  • Ensure Comfortable Seating: Make sure the dining area is comfortable and accessible, with supportive seating.
  • Use Cues and Reminders: Gently remind them about meal times or guide them to the dining area if they forget or lose track of time.
  • Personalize Meals: Tailor meals to their taste preferences, including favorite foods, to stimulate appetite and interest in eating.
  • Monitor Oral Health: Regularly check for and address any oral health issues that could make eating painful, such as denture problems or sore gums.
  • Stay Hydrated: Offer regular sips of water or other fluids throughout the meal to aid swallowing and digestion.
  • Engage Socially: Encourage family meals or eating with others when possible to create a more engaging and social atmosphere.
  • Be Patient and Positive: Maintain a positive, encouraging attitude during meals, offering praise and reassurance to create a stress-free dining experience.

Remember, though it can be incredibly stressful when someone with dementia stops eating, there are things to try!  Don’t get discouraged if you try 1 or 2 things and it doesn’t work.  Continue to try to understand why they have stopped, and bring it back to person-centred care.

That means making a plan that the individual will like.  Try giving them their favourite foods, speak gently to them, keep the eating environment calm.  I have found success with many of these strategies, and I’m sure you can too!

Managing Hydration

We can’t forget to talk about hydration, as many people with dementia struggle to get enough fluids throughout the day.

Ensuring adequate fluid intake is crucial for dementia patients, who may not always recognize their thirst. Dehydration can exacerbate confusion and constipation, further complicating their condition. 

Offering fluids throughout the day, in addition to water-rich foods, can help maintain hydration levels. For example, cucumbers and watermelons are excellent choices, with a cup of watermelon providing around 45 calories and 11 grams of carbohydrates, and also being a refreshing way to boost water intake.

People with dementia tend to gravitate towards sweet items, so having watermelon can be a great option.  If you find they’re leaning towards sweets too much though, you can find my strategies to encourage different options in the article; Dementia and Eating Sweets: A Dietitian’s Advice.

Creative approaches, like flavoured waters or herbal teas, can make drinking more appealing. A slice of lemon or a sprig of mint can enhance the taste of water, encouraging more frequent sips. 

Also incorporating soups and broths into meals can provide both hydration and nutrition. A cup of chicken broth, for instance, can offer comfort and warmth, with roughly 15 calories and 1 gram of protein, making it a light yet effective way to contribute to daily fluid intake.

Monitoring signs of dehydration, such as dry mouth or decreased urine output, is vital. Caregivers should aim for clear or light yellow urine as an indicator of proper hydration. Adjusting the type and frequency of beverages offered can ensure that hydration needs are met, supporting overall health and well-being.

When to Seek Professional Help

Recognizing when to seek professional help is important  in managing a dementia patient’s nutritional and hydration needs. If a patient’s weight drops significantly or if they consistently refuse food and drink, it may be time to consult a healthcare provider. A dietitian can offer tailored advice on meeting nutritional requirements, considering the patient’s preferences and challenges.

A dietitian might recommend high-calorie supplements or specific diets to ensure the patient receives adequate energy, protein, and other nutrients. They can suggest practical strategies, such as fortifying foods with powdered milk to increase protein and calorie intake without increasing volume. 

Speech therapists are also very important, especially if swallowing difficulties are a concern. They can assess the patient and provide exercises or techniques to make swallowing safer and easier, reducing the risk of aspiration. 

Early intervention by professionals can significantly improve the quality of life for dementia patients, ensuring they receive the nutrition and hydration they need.

Final Thoughts

Caring for a dementia patient’s nutritional needs requires patience, creativity, and a deep understanding of their individual challenges and preferences. It’s a dynamic process, with strategies that may need to be adjusted as the disease progresses. 

Remember, the goal is to ensure the patient remains as comfortable and healthy as possible, even if traditional eating and drinking habits change.  Incorporating nutrient-dense foods in forms that are easy to consume can make a significant difference.

Ultimately, the journey with dementia is unique for each individual and their caregivers. Staying informed, seeking professional advice when necessary, and maintaining a flexible approach to mealtime can help manage the challenges that come with feeding difficulties. 

Remember, you’re not alone in this journey, and support is available to help navigate these complex issues.

Frequently Asked Questions

Does dementia always lead to eating difficulties?

Not all dementia patients experience eating difficulties, but it is a common issue as the disease progresses. Factors like cognitive decline, physical health changes, and sensory alterations can impact appetite and eating habits.

How can caregivers manage their stress and emotions when a loved one stops eating?

Caregivers should seek support from healthcare professionals, support groups, or counseling services. Learning about dementia and its impact on eating can also help caregivers understand and cope with these challenges. Practicing self-care and setting realistic expectations are crucial for managing stress.

Are there any specific foods that should be avoided or encouraged for dementia patients?

This ultimately depends on their nutrition problems. But generally foods high in protein, fiber, and water rich to keep them hydrated. Foods high in antioxidants, omega-3 fatty acids, and fiber are generally encouraged to support brain health and digestion. Tailoring food choices to the individual’s needs, preferences, and any swallowing or chewing difficulties is key.

How do you know when it’s time to consider alternative feeding options?

When conventional feeding methods fail to meet nutritional needs, cause distress, or pose a safety risk, it may be time to discuss alternative options with a healthcare provider. Signs include significant weight loss, recurrent aspiration pneumonia, or severe swallowing difficulties.

Michelle saari dietitian
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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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