Appetite Changes and Dementia

Gong Xi Fa Cai! Today is the final day (Day 15th) of the Chinese New Year, which may also be the final day of (non-stop) feasting for some of us. So, eating seems to be the most appropriate topic for this month.

I remember visiting my beloved late grandmother with her favourite foods, and she would eat them and often finishing them… regardless the time of the day. On some days, I would visit her around 1pm with her favourite fish ball meetaibak soup, my petite-sized grandmother would finish the whole bowl of  noodles despite having her lunch at 11.45am.  On other days, I would bring her bean-curd dessert, cheng ting or her favourite yam with ginkgo nuts dessert, she would finish them too. Back then, before being diagnosed with dementia, she had a regular appetite of a petite granny; with the progression of dementia, she never failed to amaze me with how much she could eat. One day, upon realising that her appetite had been changed by the disease, we decided that we need to prevent her from over-eating. We would time our visit mindfully, reduce the amount of food that we would bring for her, and would get her to share the food with us.

Yet, I know of many caregivers complaining about how difficult it is to get their loved ones with dementia to eat a decent amount of food for each meal in order to stop their weight loss.

According to Kai, et al (2015), eating disturbances such as “change of appetite”, “change of eating habits”, and “swallowing disturbance”, etc. do occur as dementia progresses. They are likely to be linked to many factors including cognitive dysfunction, persons with dementia becoming more sedentary with increasing decline in their daily activities, and psychiatric and neurological symptoms related to dementia. They also shared that “patients with Alzheimer’s disease (AD) sometimes suffer loss of appetite and decrease their body weight. Some patients with vascular dementia (VaD) have pseudobulbar palsy resulting in difficulty swallowing and have a high risk of aspiration pneumonia. Patients with dementia with Lewy bodies (DLB) have difficulty swallowing and loss of appetite. Patients with frontotemporal dementia (FTD) and semantic dementia (SD) increase in appetite, come to prefer sweet and strong foods, and want to eat the same foods repeatedly.” In short, the different types of dementia changes the way your loved ones experience the taste and smell of the food, the perception of the dish, their meal times experience, even the perception of hunger.

Therefore, if you notice changes in eating in your loved one with dementia, remind yourself that he/she is not doing it on purpose to frustrate or upset you, rather it is the disease that is causing him/her to behave in such a manner. And as a result of this change, your loved ones are not likely to be eating a well-balanced and healthy diet, hence, may not be getting sufficient necessary nutrition to sustain their energy need for their daily activities as well as to maintain their overall health and wellbeing. It is therefore important for us to ensure that they are eating healthily whenever they eat.

10 Simple Tips for Caregivers with Loved Ones with Eating Disturbances 

If the appetite of your loved one is similar to that of my late-grandmother:

1. Control the portion sizing each time they eat. Expect them to eat fairly regularly, therefore, serve them food in smaller amount each time or split up a meal into a few timings. For example, for breakfast, serve them coffee first, followed by bread / oatmeal, followed by some fruits and water.
2. Schedule the timing of their meals and tea time into a routine that they can be familiar with.

If your loved one is the “I’m full” despite not eating or eating very little:

3. Eat together with him/her. Make mealtime a social event as eating is a social activity for most people. Chatting with him/her during the meal on topics that they feel relaxed and comfortable about may make them eat more. My late grandmother used to eat more when she was eating with us and chatting.

4. Prepare their favourite food. Ask them what they will like to eat for that meal. But do be flexible about food preferences. Your loved ones with dementia may start to reject certain foods that they used to like previously and develop new food preferences instead.

5. Don’t force-feed them or force them to eat. Make meal time non-stressful for them. If they are not moving much, they will naturally not feel hungry, just like all of us. Hence, plan for and encourage them to 3 or more small well-balanced meal instead of forcing them to eat regular portions. They may also be suffering from other conditions that cause them to be eating poorly such as Gastroparesis. You may want to discuss your concerns with a doctor.

6. Help them eat a well-balanced meal each time that they are eating since they are already eating very little. Choose natural whole food instead of processed food / snack or canned food. For example, choose part of a chicken breast / drumstick instead of fishballs, chicken nuggets, luncheon meat or sausages. (Fishball noodles may be a favourite food for many of us here in Singapore but it does not contain much nutrients / nutritional value.) 

Ensure that the food groups on their plate resemble the food groups on “My Healthy Plate” as much as possible, especially the blue and the green food groups.

Picture source: Health Promotion Board

7. Prepare foods that are not difficult to chew or swallow. For example, they may prefer papaya over apple as apple is hard to bite and chew. Liquid or soft food like porridge, and oats can be easier to swallow as compared to bread. Smoothies and milkshakes can be nutritious and easy to swallow too.

8.  Provide plenty of time for your loved ones to eat, chew, swallow and finish his/her meal. Do not hurry and stress him/her. Be prepared for each meal to take more than an hour now.

9. If they are really eating very poorly, ask your doctor if it is ok to supplement their nutritional needs with nutritional supplement like Ensure.

10. Increase their level of physical activity in-between meals. If they are always sitting or lying in bed, they naturally may not require many calories, hence, will eat less. Involving them in the meal preparation process can be a way to increase their activity level. Doing the strength-training exercises in my Feb 2018 post is another way of increasing their activity level.