Since people with dementia can be confused and overwhelmed, it’s best to keep mealtime simple and to minimize distractions. Centerpieces, extra silverware, and multiple foods can cause confusion. Offering one or two foods at a time may increase focus and food consumed.

 Some people benefit from a quiet environment free of televisions, loud music, distracting conversations, areas with increased foot traffic, or windows. Also remember that verbal cues and food setup such as opening containers, taking off lids, and removing silverware from packaging may be necessary.

 Finger foods like quartered sandwiches, cheese and crackers, and sliced fruits and vegetables encourage independence during mealtime since ability to use silverware is not a limiting factor.

Caregivers like speech language pathologists, occupational therapists, dietitians, nurses, and aides can obtain valuable insight into food preferences and eating concerns though meal rounds.

 Since people with dementia may have trouble expressing their preferences, observing the foods eaten allows for customization of future meals. You may notice that someone always refuses peas or takes beverages from a straw better than a cup. This is a good time to watch for signs and symptoms of dysphagia (trouble swallowing) like pocketing food, coughing, choking, or food or beverages spilling out of the mouth, which warrant further swallow evaluation. 

Anticipate that mealtimes may take longer or be extra messy. This is normal. People with dementia are constantly changing. Someone who loved pasta previously may not desire it again. People may forget that a meal already happened and insist on having another one. If this happens, make the most of it. Offer “multiple” meals like salmon followed by mashed potatoes, and then green beans during this time to boost overall food intake.

Weight loss can be a serious issue with dementia. To build or maintain weight:

• Encourage small frequent meals; i.e., three meals and three snacks a day to help reach calorie goals.
• Add more fat. Of all the macronutrients, fat has the most calories per volume. Each of these equal about 100 calories:
  • One tablespoon of butter, mayonnaise, nut butter, or olive oil
  • Two tablespoons of avocado, salad dressing, or unsalted nuts
• Offer high-calorie beverages like whole milk, juice, regular soda, and lemonade instead of water or unsweetened coffee and tea.
• Fruits and vegetables are loaded with vitamins and minerals, but relatively low in calories and protein. Add extra fat (see above for ideas) or cheese to vegetables and sugar or honey to fruits to promote weight gain or maintenance.
• Promote protein at every meal and snack. Protein is important to maintain muscle mass, functioning, and strength through aging. Think meat: poultry, seafood, eggs; dairy: milk, yogurt, cheese; or even protein drinks and powders.
• Liberalize meals. When a person with dementia has multiple dietary restrictions such as consistent carbohydrate and heart health on top of a modified consistency like pureed or mechanical soft, foods can be overly restricted and decrease the amount of food consumed. General food plans with only restrictions in consistency determined by speech language pathology will allow for the most food choices.