I don’t know about you, but if I found myself in a situation where I was sitting with a plate of food in front of me, feeling those all too familiar pangs of hunger, but was unable to decipher the complexities of just how to banish that hunger by manoeuvring the contents of the plate before me into my stomach… I might just grumble at whoever was nearby, I might get up and walk away, I might even lash out or bring into play any other array of practical demonstrations of my frustration!
In my experience, many people living with dementia who don’t eat, or reject food (or drink, but that’s a whole other article!) offered to them, will eat it readily with just the right assistance. Of course, there are times when our inputs may not work, or when dementia has progressed to such an extent that eating becomes physically nigh on impossible, but I believe we must never assume that ‘not eating’ necessarily means ‘not hungry’.
And what is even more worrying, is that ‘behaviour’ like calling out or becoming angry or aggressive at the table might then be dealt with in ways that make things worse – including with medication that impacts alertness or concentration, so further reduces interest in food or ability to eat safely and exacerbates the problem!
For people living with dementia, staying well-nourished and hydrated can involve all sorts of challenges. One contributor to those can be the gradual loss of the connections in the brain linking hunger to eating and thirst to drinking. There may be reduced ability to recognise food and drinks or to identify and recall how to use cutlery and the array of items in a kitchen or on a dining table. Alterations in taste and smell and impaired ability to clearly make food preferences and desires known, add to the picture.
There’s so much to understand about eating in dementia, but here I just make a plea to anyone who is caring for or cares about someone living with dementia who is not eating well: Think outside the square – it’s up to those of us who are not facing these sorts of cognition challenges to think of ways to help, not to assume that someone not eating just ‘isn’t hungry’.
Some may just need verbal encouragement or company at mealtimes – often being able to mimic the actions of eating made by others around a table is enough. It is common for those who will sit at a table to do better with company, especially when that table is set as ‘mum used to’. And remember, TV didn’t exist when these people were young – neverhave it blaring at mealtimes. The distraction of a TV, medication trolley, clattering plates, discussions between staff over people’s heads and more can easily cause residents with poor concentration skills to give up on eating, and that’s an opportunity for good nutrition wasted.
Some people may just need a suggestion to pick up a spoon, or benefit from a gentle ‘hand over hand’ guiding of a spoon from food to the mouth – the repetitive action of filling spoons/forks/chopsticks and conveying food to the mouth is so embedded in our brains, that just starting the action can empty a bowl or plate! And, if cutlery is a problem, go for food that can be picked up in the fingers – that harks back to our earliest experience with food and can often make a huge difference in what ends up being eaten.
I am passionate about ensuring every person, dementia or not, gets the very best chance to relish every mouthful offered to them, as long as they can, and we can all assist in that.
Ngaire Hobbins APD is a dietitian specialising in ageing, brain health and dementia and the author of 3 books presenting the evidence in these areas in the language of everyday people. Eat To Cheat Ageing, Eat To Cheat Dementia and Better Brain Foodare available in bookstores, online and via the website: www.ngairehobbins.com