Alzheimer's: Making mealtimes easier

Problems with eating often occur in people who have Alzheimer's. Some forget to eat, while others forget that they've already eaten. Although nutrition may have little effect on how Alzheimer's disease progresses, it's important for your loved one to eat a variety of foods, particularly fruits and vegetables.

Poor nutrition can result in physical weakness, increasing the likelihood of falls and fractures. It can also reduce the efficiency of the immune system, making it less able to fight off disease and heal wounds. Malnutrition and dehydration may increase confusion and stress, and reduce your loved one's ability to cope.

Determine the cause

Some eating problems are caused by factors that can be changed. So the first step is to figure out what is causing the problem. It may be:

• Ill-fitting dentures. As a denture wearer ages, the fit of his or her false teeth tends to loosen. This can cause pinching or rubbing that can make eating painful. Make sure dentures fit properly, and regularly check your loved one's mouth for sores.
• Disease. Diabetes, heart disease or digestive problems can decrease appetite, as can depression or constipation. Treating these conditions may improve appetite.
• Medications. Many medications decrease appetite, including certain antibiotics, heart medications, arthritis drugs and antidepressants. Your doctor may be able to substitute other medicines that have less impact on appetite.

Fading skills and senses

The senses of taste and smell tend to diminish with normal aging. So even healthy seniors often eat less because food doesn't smell or taste as good as it once did. Alzheimer's disease seems to inhibit eating even further.

In the early stages of Alzheimer's, your loved one may simply forget to eat or lose the skills needed to prepare proper meals. Some families call to remind loved ones to eat. Others prepare food in advance and then, over the phone, talk their loved ones through the steps of unwrapping, reheating and serving.

As the disease progresses, your loved one may forget table manners and eat from others' plates or out of serving bowls. He or she may lose impulse control and eat anything in sight, including items not intended as food. During the later stages of the disease, swallowing difficulties may develop.

Agitation and distraction

Agitation, one of the most common symptoms of Alzheimer's, can make it difficult for the person to sit still long enough to eat a meal. Distractions at mealtime make this even worse. To reduce distractions, you might turn off the telephone ringer, television and radio. Some caregivers clear the table of items that may distract the person with Alzheimer's from focusing on his or her meal. If patterns on dinnerware are distracting, choose solid colors.

Plates and utensils

In fact, studies have shown that people with Alzheimer's eat as much as 25 percent more when their food is served on brightly colored plates. Bright red and bright blue plates work much better than those in pastel colors. Researchers believe it's easier to distinguish between the plate and the food when there's more visual contrast.

It may be easier for your loved one to use a bowl rather than a plate. Make sure plates or bowls don't slip around by setting them on a place mat that has traction on both sides. You can make your own place mat from a roll of the rubbery mesh typically used to line shelves. Even a wet washcloth will work. Large-handled spoons often are easier to use than are forks. Try bendable straws or lidded cups for liquids.

Easy, safe foods

If an entire plateful of food is overwhelming, try placing just one type of food at a time on the plate. You could also offer several small meals throughout the day, rather than three larger ones. Cut food into bite-sized portions. Finger foods are even easier. If necessary, thicken fluids to prevent choking.

Give your loved one plenty of time to eat. Remind him or her to chew and swallow carefully. Avoid nuts, popcorn and raw carrots, which can become lodged in the throat or airway. Learn how to perform the Heimlich maneuver in case it is needed.

Extra nutrition

If you're having a hard time getting your loved one to eat enough, you might take advantage of the fact that many people with Alzheimer's disease are most alert and hungry in the morning.

You may want to offer more food at breakfast time or even serve your loved one several breakfasts, each featuring just one food item. The first breakfast could be a glass of juice, the next one could be eggs, and the next one could be toast or cereal.

If your loved one is losing weight, you may want to try adding high-calorie snacks, such as protein milkshakes. Consult your doctor if your loved one suddenly loses a substantial amount of weight, such as 10 pounds in a month.

Quality of life

Alzheimer's itself reduces a person's quality of life, and its common side effect of malnutrition can make this situation even worse. Providing your loved one with good nutrition can help him or her better cope — both physically and emotionally — with this difficult disease.