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Nutrition Tips for Family and Caregivers of a Person with Late-Stage Dementia

17 December 2023

Later stages of dementia usually require the presence of another person to care for the patient in preparing meals, laying the table, and eating, as well as helping the patient during the night.

Nutrition recommendations personally adapted to the patient’s personal taste and physical abilities can benefit the patient and improve his or her well-being. It is advisable to ensure that the patient is sitting comfortably to eat, the food is to his or her liking, and in any case, the caregiver must not force feed the patient or insist on certain types of food.

Here are some recommendations on how to behave before, during, and after meals, as well as general recommendations for nutrition at the advanced stage of dementia.

  • Focus on the person’s quality of life rather than being strict with the quantities of sugar and salt in the food
  • Flavor the food according to the patient’s personal preferences
  • Ensure sufficient fluid intake throughout the day
  • Check the temperature of food to ensure it is neither too hot nor too cold.

  • Make sure the patient is as alert as possible. It is advisable to promote alertness, for example, through conversation, music, touch, etc.
  • Make sure the patient is in a position closest to sitting. It is especially important to make sure the head is upright and not slumped forward.
  • Arrange meals in a regular and appropriate spot. It is advisable to eat in the kitchen, dining room, garden, or any place comfortable and suitable for eating.
  • Try to keep the environment as calm and relaxing as possible. A cozy chair and a wide table, with height and design adapted to the patient; silence, or music according to the patient’s preferences; pleasant lighting, and agreeable room temperature, etc.
  • Prepare the person’s favourite meals: it is important that food served to the patient is the food he or she likes
  • Check the patient's preferences: if they prefer to eat with or without dentures, allow it. It is important to make sure they use their glasses or hearing aid during the meal
  • Make sure the mouth is moist: it is possible to drip a few drops of sugar water.
    If necessary, saliva production can be stimulated with a teether, used by babies when teething. Biting promotes saliva production and preserves the motility of the muscles of the mouth
  • Adapt food’s texture to the patient’s abilities: food can be diced with a food processor, blender, manual blender, grater, etc.
  • Recommended number of meals per day: it is important to serve at least six meals per day

  • Do not force feed the older adult or open his or her mouth against their will
  • It is important that you talk to the patient pleasantly and calmly, and explain clearly what is planned, for example, “now we are going to eat ice cream”
  • It is important to maintain eye contact during the meal to encourage interpersonal communication between the patient and the caregiver
  • It is essential that you pay attention to verbal reactions, facial expressions, and body language in response to food. This way you will be able to identify enjoyment and tranquility, as well as pain, anguish, or discomfort
  • Always speak pleasantly and calmly to alleviate fears and concerns. At advanced stages the patient may not be in a state that he or she understand the stages of eating; the patient may not recognize items and be alarmed seeing a spoon approaching their mouth
  • Adapt food texture to the patient’s medical condition and his or her swallowing ability. For example, if there are chewing issues, you can substitute hard and solid food (for example, apple, beef, cucumber) with soft and easy to chew food (meat ball, cooked fish, cooked vegetables)
  • It is important you pay attention to changes in the chewing and swallowing abilities, and if there has been a deterioration in these abilities, it is recommended to serve ground and thick food, such as apple puree, blended food, or dairy pudding
  • Allow for a rest between each spoon of food and remind the patient to swallow
  • If the patient is coughing during the meal, refer to the family doctor, and if necessary, to a speech therapist, to assess the patient’s swallowing abilities

  • It is important to maintain general and oral hygiene: clean the mouth of food debris and rinse the dentures (if there are any).
    It is recommended to use a soft toothbrush and a tooth paste the patient is used to
  • Oral cavity should be cleaned gently and carefully to avoid vomiting or injury
  • Do not lay the patient down immediately after the meal: it is recommended to wait 30 to 45 minutes from the end of the meal until lying down to allow food to digest and avoid food entering the trachea and lungs

  • Improving quality of life through nutrition: focus as much as possible on improving the patient’s quality of life and their personal taste and not on being strict with sugar or salt consumption or dieting. At this stage of life and illness, the goal is to allow the patients eat the food they like and enjoy
  • Flavored food, sweet or spicy: generally, it is preferable to serve flavored food, in a variety of tastes: spicy, sweet, sour, according to the patient’s personal taste. Flavored food stimulates appetite, keeps a person alert, and encourages swallowing. However, if there are oral sores, avoid spicy, or sour foods
  • Share and choose together: you can try and share with the patient the food choices from a list of options, according to his or her general condition
  • Fluid intake: it is essential to maintain fluid intake throughout the day.
    Please note: at later stages of dementia, you can serve sweetened drinks to encourage drinking
  • Eating and drinking aids: in some situations, special eating and drinking aids, adaptive to the patient, may be required. Consult an occupational therapist and a speech therapist about adapting aids and safety rules for eating and drinking
  • It should be noted: if liquids cause coughing, it is recommended to consult a speech therapist about adding a thickener to liquids (it can be purchased at the pharmacy)
  • Food and drink temperature: it is important to make sure food served is neither too hot nor too cold. Hot food may cause burns, and cold food may cause contractions to the muscles of the mouth. Moreover, hot and cold food may cause pains due to gum inflammation, cavities, and dentures

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