My mother, who has Alzheimer’s, loves chocolate. She always has, as far back as I can remember. Beverly would never buy herself just one chocolate bar, opting for the entire box instead. She went through phases. For a long time, it was Hershey Bars, which she liked to eat soft and nearly melted. When she switched to Peanut Butter Cups, she preferred them icy cold from the freezer.
These days my mother’s chocolate of choice is Kit Kat Bars, and beware the wrath of Beverly if you deny her that pleasure. We tried. That was before we had come to understand the world of Alzheimer’s disease. Her doctor said she needed to cut back because it wasn’t good for her and she was gaining weight. I told everyone, “If you take Mom shopping, don’t let her buy a lot of Kit Kats. Steer her away from the candy aisle. Doctor’s orders.”
I became the fall guy. If anyone had a problem she/he could call me and I’d talk to my mother. I started getting calls right away. The last straw was when she had a foot-stomping tantrum at the grocery store checkout counter. “Let her buy them,” I told her frazzled caregiver. “Today and any day.”
With two exceptions — chocolate and fresh vegetables, food in general has never held much interest for my mother. Breakfast is always the same: a cup of plain yogurt and a glass of cranberry juice. Ask her what she’d like for lunch or dinner and she’ll often answer that she doesn’t want anything. It took us a while, but we finally learned that when someone has Alzheimer’s or another form of dementia, you can’t argue about why a candy bar is not a healthy food choice and you can’t ask open-ended questions like, “What do you want to eat?”
What to do
So much for knowing what not to do. I turned to Susan Kezal, director of dining and nutrition services at Fallbrook Woods, a memory care facility in Portland, for advice on what to do:
Susan explained that as the disease progresses, people with Alzheimer’s sometimes reach a point where food and eating no longer matters. “They’re not thinking about nutrition and they’re not getting feelings of hunger and thirst,” she said, “so food doesn’t remain an important factor. The people taking care of folks need to be one step ahead and as clever as possible.”
Susan’s tips for making mealtimes easier
- Serve meals on brightly colored plates. Studies show that people with Alzheimer’s are more likely to eat and drink when the tableware is a bright color — especially red, which is what they have at Fallbrook.
- Keep the noise down. Don’t have the TV blasting during mealtime. It’s distracting.
- Don’t disrupt the person while he/she is trying to eat. It’s also distracting.
- Keep menu choices to a minimum — two at the most.
- If the person is overwhelmed by even two choices, don’t offer any. “You might just say, for instance,” suggests Susan, “‘ here is your favorite macaroni and cheese. It’s delicious. Enjoy it.’ Put it in front of them. You’re giving them a polite directive; you’re not asking questions they won’t be able to answer and you’re using a kind voice and kind gestures.”
- If the person argues about the food you serve, don’t show any emotion. “People with dementia are very responsive to other people’s emotions,” Susan warns. “Just smile and say, ‘That’s ok, I have something else,’ and offer a backup plan, whatever that may be.”
- Make a milkshake or smoothie. “You can whip up something nutritious in the blender and refrigerate it for a couple of days. When it’s homemade it can also feel like a little gesture of love.”
- Don’t be alarmed if the person stops using silverware. “People will tend to use a spoon for quite a long time and then may resort to using their fingers. It’s important for us to remember this is the disease, not the person. The bottom line is if she’s eating that’s the most important thing.”
- Prepare on-the-go foods for someone who, because of dementia, can’t stop moving. Imagine filling an ice cream cone with shepherd’s pie. Susan has done it before. “The mashed potato was on the top, like ice cream,” she describes. “The person took it and ate it. They went from the potato to vegetables in the middle to the meat at the bottom. They ate the whole thing.”
- Forget breakfast, lunch, and dinner. Get calories in when you can. You may want to check with the doctor first, especially if the person had diabetes.
- Don’t forget liquids. Offer a few ounces as often as you can, especially in hot weather. Water and fruit juices are great; sodas and high sugar drinks are not.
- Don’t let the person eat alone. Keep an eye out for problems with chewing or swallowing. A runny nose, for instance, can be the first sign of a swallowing issue.
Other Possible Causes
Sometimes a loss of appetite is caused by something other than dementia, so before jumping to conclusions, the Alzheimer’s Association has a list of other causes to consider.
- Poor-fitting dentures. Eating may be painful, but the person may not be able to tell you this. Make sure dentures fit and visit the dentist regularly.
- Medications. New medications or a dosage change may affect appetite. If you notice a change, call the doctor.
- Not enough exercise. A lack of physical activity will decrease appetite. Encourage simple exercises, such as going for a walk, gardening or washing dishes.
- Decreased sense of smell and taste. Food may not smell or taste as good as it once did.
Did you know?
As people age, and even more so if they have dementia, they start to lose their taste buds. Susan says the sweet taste buds are usually the last ones to go. I had no idea. If you are trying desperately to entice someone with dementia to eat, her suggestion is to try adding a little maple syrup, cinnamon, and sugar, or powdered sugar to the food to stimulate the taste buds. How about some Kit Kat shavings? I do plan to try some of Susan’s suggestions with my mother.
The caregivers at Advantage Home Care are trained and skilled in the planning and preparation of nutritious, well-balanced meals, as well as in how to make mealtimes easier for someone with dementia. They can also do the food shopping.
Do you have any mealtime tips to share? We are always interested in finding out what has worked for other people.
The Advantage Home Care blog is written by Diane Atwood.