Family members and caregivers play an important role in identifying eating-related problems of those with dementia. Mealtimes can be made easier by implementing a variety of strategies that promote independence.

These are six common problems and solutions:

Cognitive issues: include the inability to express needs or desires. Sometimes they forget to eat or are unable to distinguish food from the plate as a consequence of changing visual and spatial abilities.

• Solution: Set an alarm clock or a phone call as a useful reminder for mealtimes. Snacks that don’t need to be refrigerated can be left out where they are easily seen.  Use contrasting plates with placemats.  Remember to keep water or another beverage within sight.  Your loved one might not always be able to tell you when they are thirsty.

Physical problems: include the inability to hold and use utensils; proper posture; fatigue; vision impairment; decreased depth perception; mouth sores; gum disease; dry mouth; poorly fitting or missing dentures; chewing or swallowing problems (dysphagia); and inability to move food inside the mouth.

• Solution: Finger foods can be a nutritious and easy alternative, enabling a continued level of independence. If the person’s head tilts backward, move it to a forward position while allowing them to eat at their own pace.  You can also use double hand-under-hand to simulate the motion of the person feeding themselves.  This often is the most effective approach.

Menu-related concerns: include an overwhelming amount of choices; unappealing food presentations, smells, flavors, or textures; and foods that from the individual’s personal, cultural, or religious preferences.

• Solution:  Keep long-standing personal preferences in mind when preparing food.  Understand that new food preferences usually develop. Simplify mealtime by serving one dish at a time.  Whenever possible, engage the care recipient in the process.  Let them express their likes and dislikes and adjust the offerings accordingly.

Lack of physical activity: can decrease appetite.

• Solution: Encourage simple exercise, such as going for a walk, gardening, or washing dishes.  If your loved one is enrolled in a physical therapy session, try to incorporate the physical therapy suggestions.

Environmental issues: can be noise, visual stimulation, poor lighting, and temperature.  These  all have an effect on your loved one’s ability to eat.

• Solution: Try serving meals in quiet surroundings, away from the television and other distractions. Keep the table settings simple. Avoid any table arrangements that may distract or confuse the person.  Use only the utensils needed for the meal.  Vision changes for all older adults, but especially for those living with dementia.  Remember that you will need to approach from the right angles in order for them to see you.

New medications or a dosage change may affect appetite.

• If you notice a change, call the doctor.

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It is common for individuals in later stages of dementia to lose a considerable amount of weight. Physiological changes associated with aging, such as decreased thirst and hunger perception, can further complicate nutrition and hydration status in dementia patients.

It is important to address a decreased appetite while still making the most of your loved one’s abilities. Adapt recipes to enable self-feeding abilities at mealtimes, These are important opportunities for them to make choices.