Many of us have had a difficult experience… let me stop right there… we DEFINITELY have had a difficult experience surrounding a meal time with someone we love that has dementia. It is inevitable and it can be some of the most frustrating times you encounter. With this in mind we are going to throw you a curveball, a curveball with loads of amazing information.
The curveball is that this Tuesday is going to be a slightly different approach to our regular posts because it will be featuring a post written by an old friend of mine who works as a dietician in Detroit, Michigan. Her name is Heather Petraszko, MS, RDN. It was really fun when she approached me and asked if she’d be able to write a post for DementiaCoping.com. I was so thrilled that she reached out and wanted to speak about something that I know is an issue and so it was an automatic YES! She has plenty of experience and education to support some of the facts and tips that she will be sharing in this post, so get your pens and paper out to jot down a few notes while you read along and be sure to share this with all of your amazing friends and family. Let’s dig in…
For people with dementia and their caregivers, mealtimes can be a very challenging and frustrating experience. Each step from getting food on to the table to ensuring a loved one has eaten enough, can feel like a monumental task. Some days may be relatively easy, and some days you may feel at your wits end.
As a dietitian who specializes in geriatric nutrition, I hear the above concern from families and caregivers on a regular basis. The cognitive and physical changes that occur within the dementia disease process can make everyday activities like eating a meal feel foreign to the person with dementia, and a losing battle for you as a caregiver.
Fear not, there are steps you can take to reduce the stress and frustration that tend to accompany the responsibility of providing meals for a loved one with dementia. As is the case with most other aspects of dementia support and management, patience is one of the best actions to practice when it comes to making mealtimes more enjoyable for everyone involved. Patience in itself can be a challenge, however, if you’re able to keep it in mind, practicing patience can go a long way in avoiding escalating mealtime frustrations. As an example, consider your mother is refusing not one, but all of the dishes you prepared for dinner. As a concerned caregiver, your immediate action is likely to insist that she eat at least a few bites of the nutritious meal you worked hard to prepare. This sort of direction can prove frustrating for your mother, who already feels a loss of autonomy in her daily life. You could take the approach of preparing yet another dish of your mother’s preferred food, however in such case, you’re likely to endure the stress that comes along with spending endless time in the kitchen. In this situation, a patience-based approach could take the form of encouraging, but not forcing your loved one to try the meal you prepared. Should she choose not to at that point, inviting her to sit at the table and enjoy the family’s company is a next step. You can plate a small portion of food and continue to encourage, but not insist that she eat. Taking cues from those around her, she may in fact go ahead and start to eat, but if she doesn’t, saving the meal and reattempting to provide it in another hour or so is suggested. Dealing with meal refusal is a frustrating situation for any caregiver who wants their loved one to consume good nutrition, but the way in which you handle yourself and respond to your loved one can make the difference between a frustrating situation and an outright battle. Choose to act with patience for both yours and your mother’s sake.
Keeping patience in mind, here are my suggestions for dealing with other common mealtime challenges, and ways in which to help make them more enjoyable.
Forgetting that One has Eaten, and Forgetting to Eat.
Dementia leads to changes in short-term memory. It is very common for someone with moderate to severe dementia to ask for food or say they haven’t eaten within minutes of having finished a meal. They may misinterpret fullness cues for hunger, smell food and assume it’s time to eat, or see others eating, and believe that it’s meal time for them as well. In such case, providing reminders that your loved one has already eaten can help alleviate their anxiety about going hungry. Re-direction can also be helpful. Quite often our family members with dementia fixate on certain thoughts or feelings as a means of coping with confusion and uncertainty. A person with dementia may no longer be able to comprehend what they are supposed to be doing next activity-wise, however they are still able to recognize that it’s important to eat, and that one should not go without food. Directing them to pleasurable activities such as watching a television show, taking a nap, going for a walk, or looking at the photos in a magazine can be helpful in reducing this anxiety. If this behavior is a tendency of your loved one, I recommend providing small portions at meal times and setting aside leftovers that can be used as a “second” meal later on. It’s also helpful to avoid clearing plates from the table until everyone has eaten; an empty plate can help provide the reminder that one has in fact eaten.
Memory changes can also cause someone with dementia to forget to eat. This is especially a concern if your loved one lives alone or does not have regular supervision during the day. In such cases, cues, prompts, and reminders become essential. In my practice, I regularly advise adult children, friends and neighbors to call their loved one at typical meal times to remind them to eat. These calls can also serve the benefit of a medication reminder too. Depending on the disease progression, your loved one may need to be simply reminded that’s it’s a meal time, or they may need as much involvement as being coached through how to heat up a prepared meal in the microwave. When you are visiting, I recommend checking through their refrigerator and pantry; while your loved one may deny skipping meals, an accumulation of unused foods says otherwise.
Changes in Food Preferences
Dementia commonly causes individuals to revert back to earlier memories, behaviors and food preferences. You may find that your loved one’s preferred foods have been significantly limited to sweets and snack foods, much like that of a young child. Getting someone with dementia to eat vegetables and protein-rich foods like meats and poultry can pose yet another challenge. You can help by serving small portions of only one or two different foods at a time, as too many options can be very overwhelming. I recommend turning each dish into a different course, for example, start with mashed potatoes, and then once finished, introduce the meat. Your loved one may or may not decide to eat each course, but it’s still important to offer these nutritious foods. In those with dementia, food preferences can change monthly, weekly, or even daily, so while your mother may have turned her nose up at the carrots last week, she may really enjoy them this week. Keeping ready- to-eat healthy snacks in the home is a good idea. Your loved one may have lost the ability to sequence how to peel an orange, but may still be able to recognize that a peeled and diced piece of fruit is edible. Some creativity in the kitchen can also go a long way. Try “sneaking” cooked vegetables and raw leafy greens into fruit smoothies and casseroles to help boost their fiber and nutritional content. Websites such as The Sneaky Chef, and Metro Parent offer recipes aimed at improving children’s intake of vegetables and fruit. Simple Green Smoothies provides ideas for making vegetable smoothies taste like desserts.
Is She Getting Enough?
You can expect those with dementia to experience changes in appetite and overall food intake. This can be very frustrating for caregivers who don’t want to see their loved ones become malnourished. Keep in mind that it’s normal for all of us to experience a gradual decline in appetite as well get older. This is due to factors such as reduced activity levels, loss of lean body mass, and slowed digestion and metabolism. Those with dementia are also living in aging bodies. Focusing on energy- and nutrient-dense foods is key. These are foods that contain a high amount of calories, vitamins and minerals within a relatively small volume such as peanut butter, dried fruit, whole-milk, eggs, and granola cereals. Check out my article on Calorific Foods. You can also boost the calorie content of many foods by adding butter or margarine, cream sauces, jams and jellies, honey and cheese. For those with very poor appetites or who are experiencing significant weight loss, liberalizing the diet to include multiple servings of desserts daily is fine. High-calorie supplements such as Ensure or Boost can also help.
Mealtimes are stimulating activities and can become overwhelming for your loved one with dementia. It’s important to try and make mealtimes as quiet and peaceful as possible. There are things such as the smell of food, beeping of kitchen appliances, and the arrival of other family members to the table that you can’t control, and there are things that you can. Try turning off the television, radio and cell phones, avoid yelling or engaging in arguments as much as possible, and keep all non-meal related items off the table. Allow plenty of time for meals, as much as an hour or more. You can anticipate that your loved one will eat much more slowly than they used to, and require more cues, prompts, and redirection. Being rushed can lead anyone to feel tense, and this is especially true of those with dementia. As much as you can, focus on relaxing yourself. Your loved one not only picks up cues from the environment, but from your attitude and mannerisms as well.
It’s inevitable that you will encounter mealtime challenges as a caregiver for someone with dementia. The difference between how you and your loved one experience such situations is largely determined by your approach. Try experimenting with some of the suggestions I’ve provided as challenges come up, and remember that patience is always a best practice.
That was a post that I wish I had read years ago when my grandfathers were still living at home. The little pieces of the interaction with your loved one with dementia are so integral to be aware of. Again it’s not about being perfect, it’s about trying and doing what you’re doing right now and pushing yourself to try to be better and more effective with your loved one with dementia.
On behalf of all of Dementia Coping Strategies Nation, thank you very much Heather!
It was so much fun working with Heather to make this post possible for you and I really want to know what you thought of this post. If you have questions, concerns or comments leave them below but specifically PLEASE tell me, was this an awesome post? Would you love to see more of these expert written posts coming in and throwing bombs of information?
Heather Petraszko, MS, RDN is a Detroit-based registered dietitian who specializes in geriatric nutrition, sports nutrition, weight management, and foodservice operations. She provides oversight for the nutrition department at a day health program servicing older adults, and works daily with patients and families affected by dementia. Through her blog, A Whole New Fit, www.awholenewfit.com, Heather emphasizes a health-based, sustainable approach to nutrition and fitness. Her personal health journey and her experiences with clients, has led to her work in promoting real food, positive body image, and eating for enjoyment of life. Heather completed her Bachelor of Science degree in dietetics, and her Master of Science degree in Health Education from Eastern Michigan University. When she’s not working, Heather loves to run, lift weights, walk in nature, try new restaurants, and spend time with her family.
Heather Petraszko, MS, RDNwww.awholenewfit.com