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Eating Problems and Warning Signs in Advanced Stages of Dementia

Nutritional Risk Screening
10 April 2025
Nutritional Risk Screening

The worsening of dementia may be expressed by forgetting the act of eating or experiencing challenges in comprehending verbal instructions. Consequently, you may have to adjust the food components and eating patterns accordingly.

Warning signs that may indicate difficulties with swallowing or eating:

  • Coughing while eating
  • Deterioration of existing conditions of pain, mouth problems, and indigestion issues such as constipation
  • An increased intake of medication may cause appetite loss and swallowing difficulties
  • Mouth dryness
  • Teeth problems

In advanced stages of dementia, the patient may find it difficult to express pain verbally. Therefore, it is essential to be attentive to the signs, and initiate examinations and treatment even without any specific complaints from the patient.

If you observe symptoms such as food being stuck in the throat, recurrent respiratory diseases, unexplained high fever, weight loss, coughing during eating or drinking, breathing difficulties while eating, retaining food in the mouth, refusal to eat or swallowing difficulties, it is crucial to consult the family doctor immediately.

The worsening of dementia is gradual and differs among individuals. There are certain individuals who, despite being capable of eating independently, may require reminders and assistance in serving food.

In some cases, dementia makes people forget how to eat independently, or causes difficulties in comprehension of verbal instructions (“eat please”).

In these situations, you may have to adjust the food components and the eating patterns accordingly.

Warning signs that may indicate swallowing or eating difficulties

If a person with dementia is coughing during meals or right after it, they may have a swallowing problem.

In this case, it is essential to consult with your family doctor and obtain a referral to an ear, nose, and throat (ENT) or a speech therapist’s examination

In advanced stages of dementia there may be a deterioration of conditions such as pain, mouth problems and indigestion problems such as constipation. At the same time, the patient may experience a decreased ability to express pain or discomfort. Therefore, it is essential to initiate examinations and treatment of these problems even without any specific complaints from the patient

In advanced stages of dementia there is an increased intake of medications, including those that affect behavior or serve as painkillers. These medications have side effects that may cause decreased alertness, appetite loss and swallowing difficulties

Mouth dryness is a common condition and a prevailing side effect of various medications. Mouth dryness may cause swallowing and eating difficulties, teeth damage, fungal infections, and even speech impairment

To prevent mouth dryness, ensure sufficient liquid intake, mouth hygiene, and consult your family doctor

People with dementia, like anyone else, may suffer from toothaches, but at advanced stages of dementia they may find it difficult to express it verbally. The difficulty in verbalizing pain may lead to a delay in diagnosing and treating the problem. This deterioration can cause pain, chewing difficulties, refusal to eat, weight loss, agitation, withdrawal, and other behavioral changes.

How to prevent deterioration of your tooth health

  • Create a personalized treatment plan for the person with dementia with their dentist
  • Be attentive to signs such as a broken or loose tooth, unsuitable dentures, or small ulcers in the mouth
  • Pay attention to any behavioral change appearing during or after the meal and may indicate tooth problems.

Additional factors that affect eating at advanced stages of dementia

  • Changes in cognitive function and alertness levels
  • Decrease in the taste, smell, and hearing senses
  • Swallowing difficulties: as the disease progresses, nerves and muscles involved in the eating and swallowing process are damaged. Swallowing difficulties may affect nutrition, and lead to food entering the lungs, accompanied by coughing, choking during meals, recurrent pneumonia, and even an increased risk of mortality.

Symptoms of swallowing difficulties

  • Food that is stuck in the throat
  • Recurrent respiratory diseases such as pneumonia
  • Unexplained, high fever
  • Unexplained weight loss
  • Coughing and throat clearing during eating or drinking
  • Change in breathing or an effort to breath during swallowing
  • Retaining food in the mouth
  • Food that remains in the mouth after swallowing
  • Refusal to eat

When one or more of these factors appear, they can indicate a swallowing problem.

It is advisable to immediately seek a thorough examination and appropriate treatment from your family doctor.

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