Promoting independence at mealtimes for people with dementia

For people with dementia, eating and drinking can become challenging as the dementia progresses. Dementia can cause difficulties with co-ordination and remembering the processes or sequences involved with eating and drinking. These difficulties can make mealtimes slow and drawn out.

It is up to us to identify what the difficulties are and not make the assumption that they do not wish to eat.

Problems using cutlery

A person with dementia may start to experience difficulty eating food with cutlery as their dementia progresses, for example they may struggle to use a knife and fork. Food may fall off cutlery and the person may become so frustrated they give up (see the Kitchen and dining areas feature in the Dementia-friendly environments section).

‘Finger foods’ may be a solution in these situations: this means food that can be eaten easily with hands, such as small sandwiches, orange segments or chunky chips. Finger foods enable a person to eat independently, helping to maintain their dignity and control at mealtimes.

As this family carer says: ‘At home we found that when dad didn’t want to sit down to eat we would place food where he would walk so that he could see it and he would help himself to eat. He was far happier doing this than sitting at the table.’
If a person needs adapted eating equipment, an occupational therapist can provide assessment and advice. To contact an occupational therapist, ask for a referral from a person’s GP.

Problems seeing and recognising food

We also need to be aware that some people with dementia may experience difficulties with their sight and visual perception. They may be unable to see or recognise the cutlery, crockery or the food in front of them and simply sit and stare. This may give us the impression that they are not hungry or uninterested in eating. However, this is an incorrect assumption to make.

It is up to us to identify what the difficulties are and not make the assumption that they do not wish to eat. We need to talk to the person about the food and provide regular prompts as to where their cutlery is and offer guidance to them on how to use it (see the Kitchen and dining areas feature in the ‘Dementia-friendly environments’ section).

Decision-making difficulties

As dementia progresses a person may have difficulty choosing and deciding on the food they want to eat. Simply calling out a list of options can be confusing and difficult for the person to understand as they may no longer recognise what the food is from hearing the words alone and may struggle to remember all the options given to them.

If the person can see the food this will help them recognise it and make a choice. Showing packets or boxes of the food can help the person connect the words with their memory. For example, showing the person a box of breakfast cereal can help that person make sense of what they have been offered. Always describe and talk about the food or meal that is being served.

At mealtimes show the food or plated meals to the person and allow them to choose what they would like to eat at the time they are about to eat. They may be able to choose from the options using words or by indicating with a gesture what they would like to eat.

Help with choices

Some people may find it confusing or difficult to make a choice if they are given too many options. If this is the case, try offering just two choices based on a person’s preferences. People with dementia have a right to make a choice about the food they want to eat and should be assisted in the most appropriate and sensitive way to make this choice. If decision-making is difficult then try offering food a person is known to enjoy. If you have limited information about a person’s likes and dislikes, try offering small amounts of a variety of food and observe the person’s response at mealtimes. This can help to build up information about the food and drinks people enjoy.

Timing menu selections

Avoid asking a person with dementia to choose a meal in advance, for example, asking them to choose their lunch at breakfast time. People with dementia experience difficulty with their short-term memory and will often struggle to remember what they requested. Allow the person to choose the food they want to eat at the time they will be eating it. Showing a person with dementia food or using pictures or photographs of food can help them make a choice.

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