What resources and strategies can help a person with dementia eat safely and maintain adequate nutrition?

Resources to Help a Person with Dementia Eat

Provide caregiver education, optimize the dining environment, ensure adequate staffing for mealtime assistance, and remove all dietary restrictions to support safe eating and adequate nutrition in persons with dementia. 1

Caregiver Education and Training

All caregivers—both family members and healthcare professionals—should receive structured education on nutritional care issues specific to dementia. 1

• Informal caregivers (family/friends) should be educated through group sessions with follow-up by health professionals or individual sessions with a dietitian, covering topics such as recognizing changes in eating capacity, managing swallowing difficulties, and strategies to encourage adequate intake. 1

• Healthcare professionals—including nursing staff, housekeepers, kitchen workers, therapists, and physicians—require training on recognizing nutritional problems, dealing with day-to-day eating challenges, appropriate assisting strategies, and managing the dining environment. 1

• Education programs have shown improved dietary intake, nutritional status, health-related quality of life, and decreased decisional conflicts, though results vary depending on baseline knowledge and disease severity. 1

• Trained volunteers can provide effective eating support as an alternative when adequate professional staffing is unavailable, provided they receive proper training on assistance techniques. 1

Environmental Modifications

Meals should be provided in a functional dining room with an atmosphere that stimulates eating and drinking. 1

• The dining space should be easily accessible with adequate room for mobility aids (wheelchairs, walking frames) and space for family members or staff to eat alongside the person with dementia. 1

• Environmental factors to optimize include:

  • Enhanced lighting and visual contrast to help identify food 1
  • Creating a more home-like environment rather than institutional settings 1
  • Playing music during mealtimes to create a calmer atmosphere 1
  • Minimizing distractions such as excessive noise or visual clutter 1
  • Using pleasant food aromas to stimulate appetite 2

• Food service modifications such as family-style dining (serving directly at the table) or buffet-style service have shown improvements in eating behavior, increased independence, and higher dietary intake. 1

• Social modifications including shared mealtimes with others promote increased interactions, communication, and more active eating participation. 1

Adequate Staffing and Mealtime Assistance

Sufficient qualified staff must be available to meet the eating and drinking support needs of persons with dementia during meals and snacks. 1

• Staffing needs include: time to regularly offer suitable drinks, supervise mealtimes, build personal relationships, and provide flexible support that varies day-to-day based on individual needs. 1

• Adequate staff must also assist with toileting to prevent persons with dementia from limiting fluid intake to avoid incontinence. 1

• Increased nursing time during meals has been associated with improved eating behavior, dietary intake, and nutritional status, though evidence is limited. 1

• Toward end of life, nearly all persons with dementia require some level of eating and drinking assistance. 1

Food and Nutrition Strategies

Remove all dietary restrictions immediately and provide food according to individual preferences without quantity limitations. 3, 4

• Institutions should have a structured food facility using high-quality, sustainable ingredients with meal choice and between-meal snacks available. 1

• Menus must be revised regularly (especially in long-term care) to avoid boredom and take advantage of seasonal products. 1

• Offer appealing meals with variety and attractive food, snacks, and drinks with options to choose from to support adequate intake. 1

• Flexibility is required to adapt food and fluid offers to individual needs and abilities, necessitating close cooperation between kitchen, dietetic, and nursing staff. 1

• If dietary intake is insufficient, provide oral nutritional supplements (ONS) between meals, which produce mean weight gain of 3.43% and BMI increase of 1.15 kg/m². 3

Screening and Monitoring

Persons with dementia shall routinely be screened for malnutrition and dehydration using validated tools. 1

• Screening should occur at dementia diagnosis regardless of other diagnoses and including overweight/obese persons, given the high risk of malnutrition in this population. 1

• Repeat screening every three months and additionally when changes in general health, eating/drinking ability, or eating/drinking behavior occur. 1

• The Mini Nutritional Assessment (MNA) short-form is widely used and validated for older adults with dementia. 1

• Regular body weight monitoring and documentation is essential, as weight loss occurs in nearly half of patients with mild to moderate dementia and predicts mortality. 3

Practical Mealtime Strategies

Reduce auditory and visual distractions during mealtimes to enhance focus on eating. 5

• Provide written cues to help the person perform mealtime activities when cognitive deficits interfere with eating sequences. 5

• Eliminate clutter and fall risk hazards in the eating environment to ensure safety and reduce confusion. 5

• Use routine seating arrangements to provide familiarity and reduce anxiety during meals. 2

• Leverage community-based nutrition program providers such as home-delivered meal services to support adequate nutrition at home. 5

Common Pitfalls to Avoid

• Never implement dietary restrictions in persons with dementia, as these are contraindicated and potentially harmful, worsening nutritional status without benefit. 3, 4

• Avoid appetite stimulants (dronabinol, megestrol acetate) due to limited evidence and potential for harm. 3, 4

• Do not supplement vitamins or nutrients (omega-3, vitamin E, B vitamins, selenium) for cognitive improvement unless documented deficiency exists. 3

• Recognize that eating problems develop in 86% of patients over 18 months and predict mortality, making early intervention critical. 3