Nutrition Guide for Persons with Dementia

What Is Dementia?

Dementia is a leading cause of death and disability with approximately 472,000 Australians living with the condition as of 2021. Without significant medical intervention, this number is projected to increase to over 1 million cases of dementia by the year 2058 as the population in Australia and across the world ages.

Dementia becomes more likely as we age, however it is not a normal part of ageing. Dementia describes a collection of symptoms which leads to changes to how you think, feel and perform your daily activities. People living with dementia may experience problems remembering information, keeping track of their belongings, or behavioural changes. Living with dementia can also directly or indirectly impact your nutrition, as it can influence your appetite, make you forget to eat meals or impact your taste preferences and hunger and satiety cues.

Maintaining a nutritious, wholesome diet for a loved one or client receiving dementia care is important to maintain a healthy weight, and provide the body all the nutrients it needs to remain as healthy and active as possible. Poor nutrition is common among older people, and especially those living with dementia, so paying extra attention to their intake is particularly important.

Impact of Dementia on Nutrition Habits

Dementia can influence a person’s nutrition status by changing their thoughts and behaviours surrounding eating and meal times. Accepting the change from independently choosing, preparing and consuming food to needing help with meals can be emotionally challenging for you and the person you care for, so knowing what to expect can help you to be as prepared as possible.

The impact of dementia on your loved one’s eating patterns and nutrition will vary based on your unique personal circumstances. However, common nutritional effects of dementia include loss of appetite, forgetting to eat, excessive or insatiable appetite, unusual food cravings, forgetting how to chew and swallow food, or not recognising the food and drinks you serve to them.

Over time, these dietary changes can lead to becoming nutrient-deprived, underweight or overweight, which can increase the risk of secondary health conditions, including further progression of dementia symptoms.

Nutrition in Late-Stage Dementia

In later-stage dementia, or as people continue ageing, it is common to experience a significant drop in appetite and associated weight loss. Loss of coordination, further loss of memory, and oral health, including poorly fitting dentures as a result of weight loss, can exacerbate poor nutrition habits and lead to serious deficiencies. If your loved one’s dementia has progressed to a stage where it is too difficult to maintain a healthy weight with food alone, options like liquid or tablet nutritional supplements, or tools to assist with chewing and swallowing can help.

Supplementation should be tailored to the individual, ideally with the support of a qualified nurse or medical professional with experience and expertise in nutrition and dementia care to ensure your loved one is getting all the nutrients they need to thrive.

Nutritional Guidelines for People in Dementia Care

Ensuring a well-balanced, nutritious diet is important for everyone, but particularly for persons living with dementia. Some emerging research suggests that improvements to your diet can even reduce your risk of acquiring dementia, or slow its onset for people already diagnosed with the condition. Nutritional needs and guidelines for people with dementia are similar to general healthy eating principles for adults, however if your loved one or client is older, there are some additional factors to consider to ensure proper nutrition. 

As we age, our bodies require an increased intake of calcium in order to maintain bone density and musculoskeletal health. This is particularly important to avoid injuries from falls, as well as the onset of osteoporosis.

It is also very important for older people, particularly with health conditions including dementia, not to become underweight.

In fact, it is actually better to carry a little extra body weight in later life, as long as this doesn’t progress to obesity, which is a risk factor for many health conditions common in older Australians. This is because underweight older people are at increased risk of illnesses like infections, and without sufficient body fat stores, may take longer to recover than other people. 

The Australian Government’s Eat for Health guidelines recommend that both you and your loved one enjoy a wide variety of foods each day, including plenty of fresh or frozen fruit and vegetables, legumes or beans, grains and cereals, lean meats, fish or tofu, calcium sources like cheese and yoghurt, and plenty of water. Discretionary foods, such as sweets, soft drinks and processed snack foods, should be limited or substituted for more nutritious options, and alcohol should ideally be limited to a few drinks per week.

The Mediterranean-DASH Intervention for Neurodegenerative Delay (the MIND diet)

The MIND diet is a dietary approach that is thought to prevent or reduce decline in brain function, including for people already living with dementia. The MIND diet is a combination of principles from the Mediterranean diet, and the Dietary Approaches to Stop Hypertension, or DASH diet which have been associated with better brain health.

Whilst it shares principles with the former two dietary approaches, it does have some key differences. For example, the MIND diet emphasises consuming plenty of berries, whereas other diets simply encourage consuming fruit. This is because the nutrients in berries have been linked to reduced cognitive decline, but fruit consumption in general has not. The MIND diet encourages regular consumption of the following key foods for optimal brain health.

1. Leafy green vegetables such as spinach, kale and salads, at least six servings per week.
2. All other non-starchy vegetables such as capsicums and carrots, at least once a day.
3. Fresh or frozen berries, including strawberries, raspberries and blueberries twice a week.
4. Nuts, of any variety, five servings per week.
5. Olive oil for use in cooking.
6. Whole grains, like oats, brown rice and quinoa, three servings per day.
7. Fish, especially those rich in omega-3 fatty acids like tuna and salmon, once a week.
8. Beans, lentils and other legumes should be included in at least four meals per week.
9. Poultry, including lean chicken and turkey can be enjoyed twice a week. Note that cooking method is important here, fried chicken is not recommended on the MIND diet.
10. Small amounts of wine, especially red wine, is included in the MIND diet. However, seek medical advice to ensure that alcohol is suitable for your loved one’s individual circumstances.

How to Avoid Under-Eating

Undereating is common among people with dementia, and can lead to becoming underweight and other health problems. Reasons for undereating can include forgetting how to chew or swallow, loss of appetite, or embarrassment about their eating difficulties in public. Some tips to manage a loss of appetite or undereating can include ruling out medical causes for appetite loss like depression or illness, providing meals at regular times throughout the day to give your loved one multiple opportunities to eat, or providing food in shake or smoothie form for easier consumption. Some people with dementia may forget to eat meals, or falsely believe they have already eaten.

Simple strategies to ensure your loved one eats regularly can include setting alarms or reminders when it is time for a meal or snack and preparing pre-portioned meals ahead of time with labels to track what is being eaten and when.

In some cases, undereating is related to behavioural or emotional challenges, such as anxiety around meal times, not recognising once-familiar foods, or requesting strange or inappropriate food combinations or items. It’s important to stay calm in these situations, and create a relaxed, low-stress environment for meals.

Allow plenty of time for meals, as people with dementia can often need up to an hour to finish eating, and ensure that their food is within reach and easily accessible to allow them to continue grazing on the food at their leisure. If significant weight loss occurs, seek urgent medical assistance. 

Vitamins and Dietary Supplements

If you are struggling to keep your loved one consuming a sufficient and varied diet through food alone, supplements can be a useful tool to help fill any nutritional gaps in their diet. Supplements in pill form can be easily integrated into your loved one’s medication regime, to ensure they are getting all the required vitamins and minerals they need to feel their best.

Nutritional supplements in liquid form are also great options for people struggling to eat enough, as they can be an easily consumed form of calories, protein and other essential nutrients, and do not require any chewing or swallowing of solids which can become difficult for some people with dementia. Always check with your doctor or an Accredited Practicing Dietician to find out which supplements will be the best choice for your loved one.

Difficulty Using Cutlery and Other Dining Tools

Some people with dementia experience a decline in their fine motor skills which, when combined with cognition or memory problems, can make using cutlery difficult and even dangerous. A simple fix for this challenge can be preparing the food in a different way, and serving it as finger food that can be easily eaten with your hands.

This helps protect your loved one’s independence and dignity, and removes the need to be spoon fed. If eating a meal with your loved one, consider preparing both your meals to be enjoyed as finger food, to avoid any feelings of embarrassment or ostracisation of the person receiving dementia care. To reduce disorientation or confusion at meal times, keep place settings simple, serve one item of food at a time and avoid placing unneeded tools like flatware or cutlery on the table, and allow plenty of time for meals. Eating is inherently social, so consider ways to make mealtimes more fun, such as video calling a family member or friend, to make eating a more rewarding and enjoyable experience.

How to Avoid Overeating

Whilst some people with dementia may forget to eat or struggle to eat enough nutritious foods to maintain their wellbeing, some people may experience the opposite problem and experience an insatiable appetite or strong cravings to overeat, particularly less nutritious foods like sweets. If this urge to overeat is indulged over a long period of time, your risk of becoming overweight or obese increases, bringing with it additional complications and health challenges.

It’s important to maintain a healthy weight into older age, to avoid any additional stress on the body and on caregivers. If you are caring for a person with dementia who seems to always be hungry, some helpful strategies include having smaller, more regular meals throughout the day, preparing low calorie snacks like carrot or celery sticks, or keeping certain foods locked away or out of reach.

The urge to overeat sugary or salty foods can sometimes be a way of seeking emotional comfort, so you may also like to explore more social activities like going for walks or playing games, as these can help comfort and engage your loved one in a way that doesn’t revolve around food. 

Meal Delivery Services

Meal delivery or subscription services are useful for anyone who needs support with their diet, due to being time poor or lacking the skills or knowledge to prepare a wide variety of appetising, nutritious, varied meals. Meal services have additional benefits for people providing or receiving dementia care, as they are usually convenient, pre-prepared and of an appropriate portion size to maintain a healthy weight.

They can also be easily labeled or organised to track what meals have been consumed. This can be a useful way to monitor overeating or undereating, whilst alleviating some of the need for nutritional planning, food shopping and preparation. There are a huge variety of meal plan providers on the market, so spend some time browsing price ranges, menus, and delivery areas where you live to find the right option for you.

People who are eligible for National Disability Insurance Scheme (NDIS) or My Aged Care funding may even be able to seek financial support for these types of meal services if it is directly related to their caring needs.

Nutrition for Carers

It’s important to take care of yourself when taking care of someone else. Carers in Australia are at increased risk of health conditions, as they often put the wellbeing of their loved one before their own, including when it comes to eating a healthy diet. The advice in this article can be used as a guide for both you and your loved one, and if you need support in your caring role, don’t hesitate to reach out to Homage to find out more about the high quality dementia care we can offer in your home. You may also like to visit the Australian Government’s Carer Gateway to find out what other supports are available to support you in your caregiving role.