Expert Q&A on Eating and Drinking - Thursday 23rd June, 3-4pm

[derin49]

Chewing and spitting out

Hi Gemma,
Mum has advanced vascular dementia and it is becoming more and ,more difficult to find things she will eat. Apart from anything crunchy, desserts and bacon and eggs, she just chews the food and then removes it from her mouth. The day centre she goes to also say she refuses everything except the desserts. It is the texture of certain things, I think. She won't eat soups or yoghurts that have any bits in them.

 

[GemmaJ]

I have some difficulty with my wife with eating and drinking, meals take a long time and one major problem is if we go to a restaurant to eat. She often just sits and looks at a meal, but does not eat it and we have sometimes left without her touching her meal. There is some difficulty in helping her choose what she wants but then as said she does not eat. Drinking can be a problem but is usually overcome by placing the cup in her hands. Tablet taking is a nightmare as she tends to hold the tablet in her mouth, sometimes producing it hours later. Overcome partly by grinding them down and mixing them with food or drink. Unfortunately not all of them dissolve as I would hope. Any suggestions woul be welcome

Hello Robertus,

Thank you for your question.

As dementia progresses, it is quite common for people to take a long time to eat. This can be for a range of reasons including problems with coordination, concentration, recognising food and drink.
Is your wife having problems with cutlery? Some people end up just looking at their food because they struggle with using a knife and fork. In this situation it can help to choose food you can eat with your hands (e.g. burgers, sandwiches, chips, salad etc). Sometimes gentle reminders about what to do and mirroring, so showing what to do by showing her what you do can help. Sometimes using a spoon can also help. The restaurant environment may also be quite uncomfortable, it can help to go somewhere quieter or ask for a quieter table. Also the food may go cold which can be unappealing. It can help to speak to the restaurant and see whether they could do a smaller portion.

With the tablet taking a referral to a speech and language therapist may help to identify any problems with swallow that could be causing the problems.

I hope this helps and if you have any more questions please let me know.

Gem

 

[Mum&me]

Helping to hydrate

My mum was bedridden and her hands had stopped working. I found the following through experience.

Patience- assume feeding even a small quantity of drink or soft food will take time .
Never rush it as it will cause more stress

Concentrate(even when tired!) to avoid mishaps.

Avoid distractions such as noise or other people talking .

Test food liquid temperature

Use small spoons to get food into the mouth-I used baby spoons

Use protein type shakes

Mum found sucking on straws difficult so I cut them down

I used squeezable juice cartons to gently push juice up the straw

I kept a log to monitor fluid intake .

A couple of times during late stage vascular dementia it was very difficult to get mum to drink anything at all - so I researched types of food with high water content which are easy to eat - grapes. I peeled each one and fed them too her. Sometimes they were spat out as she got tired but other times they were used as a staging post to return to eating and drinking other things.
Hope this helps

 

[GemmaJ]

My mother was diagnosed two years ago with vascular dementia. At the moment she is fairly stable but has severe memory problems and is getting more and more confused. She doesnt seem to remember whether or not she has eaten and always says she isnt hungry. She has carers to get her meals (although she swears she gets her own and they do nothing!). I take her shopping weekly and she always wants sweet things: cake, biscuits, pastries etc. I dont like for her not to have a treat but she eats them all at once. I think its partly that she doesnt remember she's already had some and partly that she would rather have that than anything else. When the carers arrive she tells them she's not hungry - its because she's been eating cake, biscuits etc all day!
She also seems to forget that she has just had a meal. She will tell me she hasnt had anything to eat when there are the remains of a meal still on the table. One day I went to see her about 6pm when I got home from work, there was a dinner plate on the table, meal eaten on this occasion, but she was eating bread and jam, saying she was a bit hungry as she'd had no dinner.
Does vascular dementia stop people knowing if they are hungry or not? I can understand she forgots what she has eaten because her memory retention is very poor, but does it mean that they dont know if they are hungry or not? And is the need for sweet things part of it? I can buy cake, fruit, etc Saturday lunchtime and by Saturday night its all gone!
I have started to keep things back in my fridge and take them round to her a bit at a time.

Hope Ive posted this in the right place.

Hello March56,

Thank you for sharing your situation. It sounds like a challenge.

Not recognising hunger is a common feature of dementia (of any type) especially as the disease progresses. Also as people become less active they are likely to be less hungry because they're not burning as many calories. So your mum is not alone in this.

A craving for sweet foods is also a feature of dementia. As we get older in general our tastebuds change, but with dementia a desire for sweet foods is also a feature. If you're worried about how much sugar your mum is eating you can try 'sweetening' up other types of food (bread and jame is a good example, as is things like adding sweet sauces and chutneys to food, honey helps). You could also trier sweeter types of foods e.g. carrots, sweet potato etc.

I hope this helps,

Gem

 

[GemmaJ]

Hi Gemma,
Mum has advanced vascular dementia and it is becoming more and ,more difficult to find things she will eat. Apart from anything crunchy, desserts and bacon and eggs, she just chews the food and then removes it from her mouth. The day centre she goes to also say she refuses everything except the desserts. It is the texture of certain things, I think. She won't eat soups or yoghurts that have any bits in them.

Hi derin49,

Thank you for your question.

It does sound like the texture is causing some problems for your mum. It would be a good idea to ask for a referral to a dietitian as they will be able to advise on whether a 'soft' diet would be appropriate. It's always best to get advise before starting a diet like that.
Also has your mum had a check-up with the dentist recently? Good oral care is really important and it may be that there is some problems in her mouth that is causing the problems. It might be helpful to see a dentist and get this checked out.

Have you tried softer foods e.g. sandwiches with soft fillings (hummus, cream cheese etc), milkshakes, soup and yoghurt without bits in.

I hope this helps, let me know if you have any questions.

Gemma

 

[Mark_W]

This is another question we've had in via email:

My mother who is 93 and has Mixed dementia Alzheimers and Vascular can eat but prefers not to unless it is sweets cake or desserts how can I get her to eat more nutritious foods….currently I make soups using meat and vegetables and blending them right down but even then she will leave it wanting (aka demanding) sweet puddings

Also she has developed sores at each side of her mouth from dribbling (not drooling but more apparent when she dozes which of course she increasingly does). I cannot get the sores to go away despite using barrier creams as suggested by GP. Any advice because now she says the sores hurt when she eats savoury stuff (or is that an excuse to stick with the sweet?) Such a damned difficult disease as you don’t know when the brain is partway functioning or just not

Many thanks have a good conference

Judith
-----

 

[GemmaJ]

This is another question we've had in via email:

My mother who is 93 and has Mixed dementia Alzheimers and Vascular can eat but prefers not to unless it is sweets cake or desserts how can I get her to eat more nutritious foods….currently I make soups using meat and vegetables and blending them right down but even then she will leave it wanting (aka demanding) sweet puddings

Also she has developed sores at each side of her mouth from dribbling (not drooling but more apparent when she dozes which of course she increasingly does). I cannot get the sores to go away despite using barrier creams as suggested by GP. Any advice because now she says the sores hurt when she eats savoury stuff (or is that an excuse to stick with the sweet?) Such a damned difficult disease as you don’t know when the brain is partway functioning or just not

Many thanks have a good conference

Judith
-----

Hello Judith,

Thank you for your email.

People with dementia tend to crave sweet food, due to changes in the brain and changes with taste as we get older. This is why so many people will eat cakes, biscuits etc but not touch anything savoury.
In order to support your mum get a more balanced diet it may help to add 'sweeteners' to other food. Things that can help include: honey, jams, sweets sauces (cranberry/apple), sugar, chutney and sweeter food in general (carrots etc). These might make things more appealing.
If your mum is asking for sweet things you could try smaller portions of these or slightly healthier options e.g. bananas and custard, stewed apples, frozen yoghurt, low fat ice cream etc

I'm not sure that there is anything about savoury food that would cause the sores to hurt more unless it's texture or certain types of savoury food?
It might be worth arranging to see a dentist and/or asking for a referral to a speech and language therapist because it sounds like the sores are having a negative impact.

I hope this is helpful.

Gemma

 

[Mark_W]

And here's a question from Ceri on email:

My mam has Alzheimer's and vascular dementia. Eating is an issue. She lives with dad (who has health issues too) and between them, they have carers 4 times a day. The carers can prepare meals and monitor eating/drinking. However, mam rarely eats a meal as she continually grazes through the day. Whilst in respite, she has eaten meals. We can put fruit out and other things in the fridges (such as cheese and cold meats) and she will eat them all! She can get through a pack of meat, 6 bananas, a punnet of grapes and a bag of pears over night! She will eat several bags of crisps and has been known to finish boxes of cereals. She is also a diabetic so keeping blood sugar stable is crucial. We've tried buying shopping on a daily basis but we can't sustain this. We now shop twice a week but are not sure what to do about regulating her food intake. What strategies can you suggest?

Thank you,

Ceri
-----

 

[GemmaJ]

And here's a question from Ceri on email:

My mam has Alzheimer's and vascular dementia. Eating is an issue. She lives with dad (who has health issues too) and between them, they have carers 4 times a day. The carers can prepare meals and monitor eating/drinking. However, mam rarely eats a meal as she continually grazes through the day. Whilst in respite, she has eaten meals. We can put fruit out and other things in the fridges (such as cheese and cold meats) and she will eat them all! She can get through a pack of meat, 6 bananas, a punnet of grapes and a bag of pears over night! She will eat several bags of crisps and has been known to finish boxes of cereals. She is also a diabetic so keeping blood sugar stable is crucial. We've tried buying shopping on a daily basis but we can't sustain this. We now shop twice a week but are not sure what to do about regulating her food intake. What strategies can you suggest?

Thank you,

Ceri
-----

Hello Ceri,

Thank you for your email. It is a difficulty situation, especially when you add diabetes to the mix.

People with dementia can end up eating everything they can find because they either don't remember eating previously or they are worried about where the next meal is going to come from.

Often this can be made worse if the person doesn't have much stimulation or social occupation. Does your mum have lots to do during the day? Finding ways to increase activity may help, are there things your dad can do with her to take her mind off the food.

It sounds like you have the right food in the house which is great. Are there places in the house that she doesn't look for food? It may be helpful to keep food somewhere she doesn't associate with food and only keep in the fridge/ kitchen cupboards what she has for the day. It might be worth speaking to the carers about facilitating this.

Distraction can sometimes work and finding ways to eat regularly and often can help. It's a really difficult situation and their are no easy answers. Sometimes it can help to try something, see if it works and review as necessary.

I hope this helps.

Gemma

 

[Mark_W]

And here's another question in from S via email:

My mother who has middle-stage dementia drinks very little, which I am sure is a contributory factor to her chronic constipation and I think may be affecting her health more generally. We have tried to persuade her to drink more but without success. She claims that a full cup is too heavy for her, and so only fills it half-full, which does not help. I wonder if she may be afraid that she will not be able to find a toilet if she goes out, but she has the same behaviour even when she is staying at home all day. How can we get her to drink more?

-----

 

[GemmaJ]

And here's another question in from S via email:

My mother who has middle-stage dementia drinks very little, which I am sure is a contributory factor to her chronic constipation and I think may be affecting her health more generally. We have tried to persuade her to drink more but without success. She claims that a full cup is too heavy for her, and so only fills it half-full, which does not help. I wonder if she may be afraid that she will not be able to find a toilet if she goes out, but she has the same behaviour even when she is staying at home all day. How can we get her to drink more?

-----

Hello S,

Thank you for your email.

You've hit the nail on the head with the lack of fluids contributing to constipation. Trying to encourage people with dementia to drink more fluids can be really difficult. Are there types of drinks she enjoys? Such as a cup of tea? If there is it can help to start with this.
Other things that may help include having a drink on hand whenever she eats, and encouraging her to take a sip often.
It can help to use a clear glass or a brightly coloured cup so you can see what's in it. Sometimes water can look like an empty glass so juice may be better.
Offering the person the cup or putting it in her line of sight might work.
You can get adapated cups which might be easier to hold, if your mum is struggling.
You can also try foods that are high in fluid such as gravy, jelly, ice cream etc as these can help someone take on fluid.

You mention that she might be worried about making it to the toilet if she drinks too much and this is quite common in people as the dementia progresses. If they're worried about not making it to the toilet they are less likely to drink. It can help to try a routine of going to the toilet, and making it as easy as possible such as easy clothing and making sure toilets are easy to find.

If the cup is too heavy, half a cup is better than no cup and maybe you could try putting cups around the house so she can take a sip when she is ready.

I hope this helps,

Gemma

 

[Mark_W]

This question from Trapped77:

Hello,
My Mum has alzheimer's and I am her sole carer now - she hated having other carers so much that she eventually pushed one in anger and the company decided they would not send in people any more. They had been very good, charming and intelligent but something displeased her (I suspect a young person decided to protest her habit of eating yoghurt without a spoon) and that was too much for her.

Anyway, at the moment I am a bit anxious because she seems to be eating less and less. She does not automatically turn down the food but it looks almost like that. She will never refuse an egg. Admitedly she has no teeth - consistently refusing to get any made and the dentist decided it was not worth upsetting her.

Anyway, I try to find soft things for her to eat, but even then, she is not usually going to have more than a couple of spoonfuls.

The other thing she has taken to doing is having a couple of spoonfuls and then protesting she doesn't need any more and trying to get me or my children to finish her food, as if we were in the war (which she spent in France) and starving. So I don't know if she is not eating because she is afraid we are not having enough or because she is genuinely not hungry or interested.

Having said that, I have not got unduly worried because this not eating was not consistent until now and she would graze outside meals. But her meals now are smaller and smaller and she is grazing less and less.

Can you make any suggestions?

Many thanks

Best regards
Trapped77
-----

 

[Mum&me]

And here's another question in from S via email:

My mother who has middle-stage dementia drinks very little, which I am sure is a contributory factor to her chronic constipation and I think may be affecting her health more generally. We have tried to persuade her to drink more but without success. She claims that a full cup is too heavy for her, and so only fills it half-full, which does not help. I wonder if she may be afraid that she will not be able to find a toilet if she goes out, but she has the same behaviour even when she is staying at home all day. How can we get her to drink more?

-----

Could I ask - is your mum physically able to use a standard toilet now? My mum had difficult climbing stairs and getting onto a toilet so the Physio bought in a commode. It can be an issue of dignity / privacy but can be necessary. --- also is any medication causing constipation as a side effect? Sometimes as well - I found mum was frightened of spilling hot drinks so only filled the cup half full. I used different sized cups too .

 

[Beate]

Hello S,

Thank you for your email.

You've hit the nail on the head with the lack of fluids contributing to constipation. Trying to encourage people with dementia to drink more fluids can be really difficult. Are there types of drinks she enjoys? Such as a cup of tea? If there is it can help to start with this.
Other things that may help include having a drink on hand whenever she eats, and encouraging her to take a sip often.
It can help to use a clear glass or a brightly coloured cup so you can see what's in it. Sometimes water can look like an empty glass so juice may be better.
Offering the person the cup or putting it in her line of sight might work.
You can get adapated cups which might be easier to hold, if your mum is struggling.
You can also try foods that are high in fluid such as gravy, jelly, ice cream etc as these can help someone take on fluid.

You mention that she might be worried about making it to the toilet if she drinks too much and this is quite common in people as the dementia progresses. If they're worried about not making it to the toilet they are less likely to drink. It can help to try a routine of going to the toilet, and making it as easy as possible such as easy clothing and making sure toilets are easy to find.

If the cup is too heavy, half a cup is better than no cup and maybe you could try putting cups around the house so she can take a sip when she is ready.

I hope this helps,

Gemma

There are also fruit and veg with high water content like water melon and cucumber so maybe try them as well.

 

[GemmaJ]

This question from Trapped77:

Hello,
My Mum has alzheimer's and I am her sole carer now - she hated having other carers so much that she eventually pushed one in anger and the company decided they would not send in people any more. They had been very good, charming and intelligent but something displeased her (I suspect a young person decided to protest her habit of eating yoghurt without a spoon) and that was too much for her.

Anyway, at the moment I am a bit anxious because she seems to be eating less and less. She does not automatically turn down the food but it looks almost like that. She will never refuse an egg. Admitedly she has no teeth - consistently refusing to get any made and the dentist decided it was not worth upsetting her.

Anyway, I try to find soft things for her to eat, but even then, she is not usually going to have more than a couple of spoonfuls.

The other thing she has taken to doing is having a couple of spoonfuls and then protesting she doesn't need any more and trying to get me or my children to finish her food, as if we were in the war (which she spent in France) and starving. So I don't know if she is not eating because she is afraid we are not having enough or because she is genuinely not hungry or interested.

Having said that, I have not got unduly worried because this not eating was not consistent until now and she would graze outside meals. But her meals now are smaller and smaller and she is grazing less and less.

Can you make any suggestions?

Many thanks

Best regards
Trapped77
-----

Hello Trapped77,

Thank you for your email, and for sharing your situation.

It is not unusual for people as their dementia progresses to eat less, the body needs less due to the disease progression, less activity etc. So your mum eating less may be part of the disease progression.

If there are foods she likes eating then I would stick to offering her these, it's important to have a balanced diet but it's more important to eat.

Taste changes as a result of dementia and you might find it helps to make food stronger tasting e.g. sweeter or use herbs etc.

Soft food options can sometimes be a bit unappealing so trying to make the food look appealing (a range of colours can help) and stimulating other senses with smells of food can help. You could also seek the input of a dietitian.

With regards to your mum insisting others take the food, this sounds understandable based on her history. You may find it helps to reassure her that you have enough food. Eating together may help with this.

I hope this helps,

Gemma

 

[Mum&me]

This question from Trapped77:

Hello,
My Mum has alzheimer's and I am her sole carer now - she hated having other carers so much that she eventually pushed one in anger and the company decided they would not send in people any more. They had been very good, charming and intelligent but something displeased her (I suspect a young person decided to protest her habit of eating yoghurt without a spoon) and that was too much for her.

Anyway, at the moment I am a bit anxious because she seems to be eating less and less. She does not automatically turn down the food but it looks almost like that. She will never refuse an egg. Admitedly she has no teeth - consistently refusing to get any made and the dentist decided it was not worth upsetting her.

Anyway, I try to find soft things for her to eat, but even then, she is not usually going to have more than a couple of spoonfuls.

The other thing she has taken to doing is having a couple of spoonfuls and then protesting she doesn't need any more and trying to get me or my children to finish her food, as if we were in the war (which she spent in France) and starving. So I don't know if she is not eating because she is afraid we are not having enough or because she is genuinely not hungry or interested.

Having said that, I have not got unduly worried because this not eating was not consistent until now and she would graze outside meals. But her meals now are smaller and smaller and she is grazing less and less.

Can you make any suggestions?

Many thanks

Best regards
Trapped77
-----

My mum also lost her false teeth and I couldn't get more fitted. I got the GP to refer mum to a dietitian because she was visibly wasting whilst bed bound. The dietitian said to feed mum the exact opposite to "weight loss " advice ! - High fat diet - so I made toast ( no crust ) and put loads of butter on it and egg yolks from boiled eggs - sometimes up to 8 yolks soaked into the bread and then cut the toast into small squares and fed them using a small spoon. I know every one is different but it helped my mum.

 

[Mark_W]

And I'm afraid that's all the questions and answers we have time for today. Thank you Gemma for all your answers today.

If you've got any further questions please do start a new thread in the forum and the community will share their thoughts with you. You can also read some of our factsheets on Eating and Drinking here

https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=149

Thanks

 

[GemmaJ]

Thank you everyone for your questions. I hope the answers were helpful!
Gemma