Tips to help manage nutrition and hydration in dementia

Ensuring that people eat and drink enough is essential when looking after somebody living with dementia. Dianne Smith, Matron for Dementia at University Hospitals of Morecambe Bay NHS Foundation Trust, has put together a list of tips to help manage nutrition and hydration in dementia.

  • Give choices or use prompts and pictures to support choices
  • Consider tiredness and regular attempts for meals, little and often
  • Finger foods and snacks available in different rooms, not always sat at the table
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  • Ensure the food doesn’t go cold if it’s warm
  • Always have a drink on hand in different rooms to prompt, and use a clear glass so the content can be seen, perhaps with a coloured straw to catch attention
  • Always offer the person the drink, put it in their line of sight and initiate having a drink
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  • If there are difficulties chewing or swallowing, try naturally soft/easy chew food such as scrambled egg or stewed apple before considering pureed food
  • Encourage involvement in the preparation, peeling potatoes, laying the table
  • Encourage and gentle reminders to eat, talk about what the food is and reminisce about foods/preferences from their life
  • A relaxed atmosphere whilst eating perhaps with music and with others/family to make a positive social experience
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  • Make food look and smell appealing with different tastes, colours, and smells
  • Ensure any opportunities for them to eat – don’t stick to ridged meal times, allowing night-time snacks
  • Give them what they like – small portions, little and often
  • Try different foods/drinks – smoothies and milkshakes
  • Try stronger flavours – sweet and savoury
  • If they just eat pudding and not a main meal, don’t stop them – all calories are vital
  • Add cream to milk puddings
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  • Use a spoon instead of knife and fork, offer finger foods, consider adapted cutlery, high-sided plates for scooping, two-handed non-spill cups, coloured plates for easier visibility of food
  • Good oral hygiene, teeth cleaning, soft, moist food is easier to chew, let the person eat where it’s comfortable for them, make sure they are sitting upright
  • Foods high in fluid can help with hydration, such as soup, gravy, jelly, ice cream
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  • Try not to rush them, and maintain as much independence as possible
  • Look for nonverbal cues such as body language and eye contact as a means of communication
  • Wait until the person is calm before offering food/drink – you can leave it and try later
  • Remember the person isn’t being “difficult” there is always a reason for behaviours that seem a challenge
  • Consider things like are they in pain, especially if they are agitated, constipation causes nausea and bloating, are they on any new medication, do they need the loo?
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  • For sweet preference try fruit or naturally sweet vegetables e.g. sweet potato, carrot, parsnip or add honey or sugar to foods
  • Use herbs and spices to enhance taste, try sweet sauces or chutneys with savoury dinners
  • Try foods the person has never eaten before explore other tastes
  • Don’t worry if the person eats unusual food combinations such as dinner and pudding on the same plate, it won’t do any harm!
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  • Check the temperature of the food/drink that it’s not too hot, sometimes the ability to judge temperature is lost
  • Remove items from view that the person may put in their mouths thinking it’s food
  • If the person is overeating ensure they are distracted by other things, divide the portions into two and offer the second one only if they ask
  • Fill the plate with colourful salad or vegetables and offer snacks of bitesize fruit pieces
  • Offer the person a drink rather than more food – it might be that’s what they want
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  • Eating/drinking with the person is not just a social activity, but it reminds them what to do by copying you
  • Make the environment appealing to all the senses, familiar sounds of cooking, smells and sights, such as a pretty tablecloth or flowers on the table
  • Keep the table clutter free
  • Background noise is distracting or intimidating, soothing music is therapeutic
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  • Be led by the person on what they want to eat and where to sit
  • Well-lit eating area and colourful food is helpful and appetising – a verbal description of the food/drink is helpful to re enforce what it is
  • Plain colours of crockery (not white) – primary colours are best, avoid patterns
  • Try not to worry about the mess and don’t rush the person
  • Post it notes on the fridge and microwave are a helpful reminder when someone lives alone
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  • If the person lives alone, consider ready meals that can freeze and microwave
  • Meal delivery such as farm foods ensures the person always has a hot meal supplied
  • Online shopping is an option for housebound people or a carer to prepare meals and give drinks ensuring they are eaten
  • Written or pictorial instructions on where food is kept and how to warm up ready meals is useful
  • Provide a diary of the day on the wall with written instruction as to where/what the meal is and the time

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