Strategies for Mealtime Success: Compassionate Caregiving Tips for Alzheimer's

Supporting a friend or family member with Alzheimer's disease through mealtimes can lead to tension during what otherwise could be an enjoyable, bonding activity. Thankfully, there are ways that caregivers can bring a sense of calm and comfort to these shared meals, reducing stress for all.

This blog, curated by The Bristal Assisted Living team, explains why meal refusal is common for those living with memory loss. We also share tips to help your friend or family member eat well and have a more positive experience.

Why Do Individuals Living with Dementia Sometimes Refuse to Eat?

A few mealtime challenges that are common for people living with Alzheimer’s disease or other types of dementia include:

Diminished appetite

Your friend or family member might not recognize their body's hunger signals anymore, or they might be taking medication that reduces their appetite. Changes in the brain can also affect taste and smell, making food less appealing. Furthermore, their metabolism may slow down, causing them to feel full quickly or not feel hungry at all.

Oral health problems

Individuals living with Alzheimer’s may experience weight loss, and if significant enough, the change may lead to a problem with their dentures fitting correctly. Cognitive decline can also make activities of daily living (ADLs) like brushing their teeth or having good oral hygiene more challenging.

Tooth pain, chewing discomfort, or halitosis (bad breath) may be hard to communicate and lead to a lesser desire to eat.

Difficulty with coordination

Hand-to-eye coordination and motor skills usually decline as Alzheimer’s progresses, making mealtime physically and emotionally difficult. Having difficulty with both the fine motor coordination required to manage utensils or gross motor tasks like chewing and swallowing may lead to feelings of frustration and reluctance around eating.

Anxiety and agitation

For all of the aforementioned reasons, the multistep process of eating may be overwhelming and aversive to the individual with memory loss. Your friend or family member may become anxious or agitated when struggling to communicate their preferences and needs, being presented with too many options or foods they no longer enjoy, the unfamiliar, the monotonous, or handling a change in routine.

Mealtime Strategies for Success

Fortunately, simple adjustments to the dining atmosphere and to mealtime activities can encourage a more peaceful and enjoyable dining experience for everyone. Here are a few to consider:

1. Eliminate distractions:

Create a quiet dining environment. Turn off the TV, minimize background noise, and reduce foot traffic around the dining area to help keep the focus on eating. Also, consider aspects of your friend or family member's dining routine prior to their diagnosis.

If dinnertime was always accompanied by a certain television show before, having that playing softly in the background may help ease them into feeling hungry. Depending on their preference, soft background music is an additional option for eliminating distractions at mealtime. Providing a calm, consistent environment for meals can help decrease agitation and encourage eating.

2. Pay attention to visuals:

Simple, contrasting colors can help differentiate the food from the plate, making it more visually appealing and easier to recognize for someone with visual perception difficulties. Use a placement to create a clear boundary surrounding their eating space. You can also add variation to the visual plating itself, like putting food such as mashed potatoes on a dark plate for better contrast.

3. Give one item at a time:

Serve one part of the meal at a time. Once they have finished one part, add the next one to their plate. This helps individuals focus on one item and the task at hand, which can minimize confusion and stress.

Try serving nutrient-rich foods first in case you cannot keep their interest long enough to finish an entire meal. Provide only the utensils needed with each food item to keep things simple.

4. Adapt your serving pieces and utensils:

Specialized serving dishes and cutlery designed for those with grip and motor control issues can empower individuals to eat independently. Ergonomic utensils, plate guards, and non-slip mats can significantly enhance their dining experience.

If your friend or family member is still unable to eat independently, finger foods can be another option. Cut food into bite-sized pieces and avoid nuts, hot dogs, sausage, celery, raw carrots, and popcorn to help prevent choking.

5. Model eating behavior:

Sometimes, individuals living with dementia may need cues to start eating. Caregivers can model eating behaviors by showing how to use utensils or by eating alongside them. This mirroring technique can prompt them to mimic the action.

6. Offer favorite and familiar foods:

One final tip for making mealtime go more smoothly is to create menus that contain their favorite foods. They will be more likely to eat if the meal includes foods they have always enjoyed. If they decline to eat something previously preferred, move forward quickly without emphasizing their previous preferences.

There may be myriad reasons they're declining in this moment that may or may not be relevant in the future. The added strain of trying to communicate the particular reason in the moment, especially to a questioning caregiver, may create roadblocks to their enjoyment of that type of food in the future, limiting their options unintentionally.

Finding the right mealtime strategy might take time, so try to be patient and flexible.

Practice Patience and Flexibility

“Quality nutrition is an integral aspect of life for everyone, helping to ensure the body has a balanced mix of nutrients to support health and vitality. For those living with Alzheimer’s or a related dementia, mealtime can be challenging and well-rounded nutrition hard to maintain. Understanding the root of eating difficulties and implementing some of these strategies can lead to more successful, stress-free dining experiences,” says Alaina Hoschke, Registered Dietitian at The Bristal Assisted Living communities.

The Bristal Assisted Living offers a range of therapeutic and mechanically altered diets for residents, including those residents of Reflections experiencing memory loss, to accommodate preferences and dietary needs.

Patience, observation, and a willingness to adapt will ensure your friend or family member receives the nutrition they need while maintaining dignity and independence in their mealtime routines.