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    Dementia Symptoms & Caregiver Strategies: Guide For Increasing Food Intake: Making Mealtime Easier for Cognitively Impaired Adults

    Possible Causes of Poor Appetite

    • 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. Lack of physical activity will decrease appetite. Encourage simple exercise, such as going for a walk, gardening or washing dishes.
    • Not recognizing food. The person may no longer recognize the foods you put on his or her plate.
    • Decreased sense of smell and taste. The person with dementia may not eat because food may not smell or taste as good as it once did.
    Ways to increase the amount of Calories in each bite or swallow:
    • Add fats to foods (check with your care receiver's doctor first to see if this is appropriate):
      • Try a pat of butter or cream on servings of hot food.
      • Add extra mayonnaise on a sandwich.
      • Use more oil (any kind) in preparing foods.
    • Add a high Calorie bed time snack or nutritional drink
      • Can be a sweet drink or even a cup of warm cream soup.
      • Carnation Instant Breakfast can be made with half and half; try it warm.
      • The "plus" versions of "nutritional drinks" (such as Ensure) have 1 ½ times the calories of the regular ones.
      • Avoid high fat, chocolate and spices at bedtime if the individual you care for tends toward reflux or heartburn.
    NOTE: Please check with the primary doctor if your loved one has dietary restrictions or medical conditions (i.e. high cholesterol, diabetes) to see if the above tips are okay to implement.

    Guidelines for meal times:
    1. Establish routines for meals & snacks:
      • Same time, place and utensils. Same plate, same drinking glass/cup (one that is easy to grasp & lightweight). Give reminders to chew and swallow.
        Example: Every evening when the TV is turned off your care receiver sits at the kitchen table and drinks warm milk and eats 2 graham crackers.
    2. Sit and eat with your loved one. Slow down your pace to match theirs.
    3. Serve foods in bite sizes:
      • Try to serve either finger foods (sandwich & apple wedges) or fork or spoon foods. This way the individual doesn't have to change utensils with each bite.
    4. Serve the amount that he/she can finish.
      • Being part of the "clean plate club" is important to many. Try using a smaller plate if the food looks "lost" on a large one. When in a restaurant, ask for an extra plate and create a smaller portion for the person you care for.
    5. Limit choices to only two and ask one question at a time.
      • Example: "Would you prefer a tuna or a grilled cheese sandwich?" Wait for the answer. then, "Would you like milk or orange juice?"
      • You can use this approach in a restaurant too.: "I'm having an egg sandwich. Would you like that?"
    6. Limit distractions during meals.
      • Keep away from the television and other activities. Use simple plates so that food can be more easily seen. Try to keep other items off the table.
    7. Provide opportunities to help.
      • Keep the task simple and demonstrate. Example: ask, "Can you can help by holding this spoon and stirring the soup."
    Other notes:
    1. Factors affecting appetite:
      • Sense of smell-- not everyone has a good sense of smell and is able to enjoy the aromas of warm foods that heighten appetite. Try cold foods more often.
      • Praise. Reassurance. Smiles. "Thank you for helping with the soup." "Good job finishing your orange juice."
    2. Ensure hydration:
      • Hand the person a small cup or glass of water or favorite beverage regularly throughout the day. (Does he/she prefer "no ice"?) Try to use the same kind of cup or glass every time and refill it as needed. Some may prefer to use a straw. Consider fruit smoothies for calories and hydration.
    3. Oral hygiene
      • Observe the individual while brushing his or her teeth. You may need to put the paste on the brush, hand them the brush and demonstrate the motion. Smile at yourselves in the mirror.
    4. Treating constipation
      • Try prune juice (works faster if it's warm) or prunes every day at the same time each day. It takes up to 2 weeks of daily intake to notice results.
    5. Keeping track
      • If more than one person is helping your loved one, consider using a calendar with lots of space so you can record meals, snacks, liquids, bowel movements, etc. Using different colored ink for different topics may be helpful!
    6. Be okay with differences
      • A decrease in appetite is normal, and can vary from day to day. Persons with cognitive impairment may suddenly develop 'new' food preferences. Be flexible and encouraging by giving these new ideas a try.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: