Dementia Patient Not Eating: Practical Strategies for Caregivers

As a family caregiver for someone with dementia, you face new challenges every day. One of the most common concerns is a decline in appetite. This can be frustrating and upsetting, but it's important to understand the reasons behind these changes. How does dementia affect appetite? And how can you help your loved one stay healthy?

How does dementia impact appetite?

Dementia is a steady decline in cognitive function that affects a person's daily life. It's not a disease but rather a group of symptoms progressively worsening. Alzheimer's disease is the most common form of dementia, but there are many others.

People with dementia experience many symptoms, including memory loss, difficulty concentrating, problems with language, and changes in behavior. These changes significantly impact a person's ability to eat and maintain good nutrition.

Common challenges and complications

One of the most common symptoms of dementia is a loss of appetite. This can be caused by several factors, including:

• Cognitive impairment: As cognitive abilities decline, patients may forget to eat, forget they have already eaten, or lose the ability to recognize hunger cues.
• Sensory changes: Dementia can alter taste and smell, making food less appealing or causing patients to lose interest in eating altogether.
• Difficulty swallowing (dysphagia): Many individuals with dementia develop trouble swallowing, which can make eating uncomfortable or dangerous.
• Medication side effects: Some medications prescribed for dementia or related conditions can cause side effects such as nausea, dry mouth, or changes in taste.
• Depression and anxiety: Emotional changes, including depression and anxiety, can lead to a decreased interest in food and eating.
• Physical discomfort: Dental issues, gastrointestinal problems, or other physical discomforts can make eating painful or difficult.
• Environmental factors: Changes in the eating environment, such as unfamiliar settings or distractions, can disrupt eating habits.

These challenges often lead to poor nutrition in dementia patients. Malnutrition weakens the immune system, making people with dementia more susceptible to infections. Not eating leads to muscle weakness and fatigue, making it even harder for people with dementia to care for themselves. 

What to do if a dementia patient doesn't eat?

To encourage dementia patients to eat, create a calming routine with a set meal and snack times in a familiar setting. Minimize distractions by turning off electronics during meals and consider offering smaller, more frequent meals and snacks throughout the day.

Make mealtime visually appealing with colorful plates and attractive food arrangements. Allow your loved one to participate in meal prep with simple tasks like setting the table.

Offer a variety of foods with different textures and temperatures, such as soft options or finger foods, to find what works best. Use seasonal ingredients and incorporate favorite cultural dishes to keep meals interesting.

Later stage considerations

In later stage dementia, additional strategies may be necessary. Providing a calm and quiet atmosphere becomes even more important, as your loved one may be more easily agitated or distracted.

Ensure that food is easy to chew and swallow, and consider consulting with a speech therapist to address any swallowing difficulties. You might need to offer pureed foods or thickened liquids if swallowing becomes a significant issue.

Adaptive utensils or cups can help maintain some level of independence. Pay close attention to your loved one's body language for signs of discomfort or preferences, as verbal communication may be limited.

If weight loss or malnutrition is a concern, consult with a healthcare provider about nutritional supplements or appetite stimulants to ensure they receive adequate nourishment.

Feeding tubes can become a consideration in the later stages of dementia if a person is unable to eat enough to maintain adequate nutrition and hydration. However, the decision to use a feeding tube is complex. It should involve carefully considering your loved one's overall health, quality of life, and personal wishes or advance directives.

How long can a dementia patient go without eating?

A dementia patient can typically go a few days without eating before it becomes critical, but this depends mainly on their overall health and hydration status.

While some people may manage longer periods without food, it is very important to monitor them closely and seek medical advice if they refuse to eat for more than a day or two, as prolonged lack of nutrition can lead to severe health complications.

When to call a doctor

If your loved one with dementia isn't eating, consider calling their doctor in the following circumstances:

1. Significant weight loss: If they are losing weight rapidly or showing signs of malnutrition, such as weakness, fatigue, or changes in skin condition.
2. Dehydration: If they are not drinking fluids and show signs of dehydration, such as dry mouth, decreased urination, dark-colored urine, or dizziness.
3. Persistent refusal: If they have consistently refused to eat for over a day or two.
4. Choking or difficulty swallowing: If they are having trouble swallowing or frequently coughing/choking while eating.
5. Changes in behavior or mood: If they become unusually agitated, depressed, or show a sudden change in behavior that might indicate discomfort or underlying medical issues.
6. Health conditions: If they have underlying health conditions (e.g., diabetes, heart disease) that could be exacerbated by not eating.
7. Pain or discomfort: If they appear to be in pain or discomfort while trying to eat, such as holding their mouth, grimacing, or avoiding certain foods.
8. Other symptoms: If there are additional concerning symptoms, such as fever, vomiting, diarrhea, or other signs of illness.

The doctor may recommend a medical evaluation to rule out underlying issues and provide guidance on managing their nutrition and health.

Treatment

If another medical condition prevents your loved one from eating, the medical staff will treat the underlying condition. Your loved one may need medication, surgery, or other treatment, depending on the condition. 

Dehydration is a significant concern. The doctor may recommend oral rehydration solutions or intravenous fluids if necessary. Depending on the severity of the situation, the doctor might suggest dietary modifications, thickened liquids, or even a feeding tube for late-stage dementia patients who struggle to eat or swallow safely.

A note from Givers

Watching your loved one refuse food can be stressful. Do your best to make meals enjoyable. Work with their doctors to maintain nutrition and hydration. Through thoughtful care and a focus on familiar flavors and textures, food can remain a source of comfort and connection for you and your loved one on their journey with dementia.