Meals and nutrition

Meals can become one of the hardest parts of the day when someone has dementia. The person may forget to eat, not know what is on the plate, or push food away. Some people eat less and lose weight. Others forget they just ate and ask for more.

This page gives you simple ways to make meals calmer and easier. It covers the plate and table, low appetite, weight, drinking enough fluids, choking safety and where to find help with meals. For coughing, choking or trouble swallowing, also read eating, drinking and swallowing.

Why eating gets harder

Dementia changes the brain, and that changes eating. A large European nutrition guideline says people with dementia face a higher risk of malnutrition (not getting enough calories, protein, vitamins or minerals). They also face a higher risk of dehydration from drinking too little.²

Common reasons a person eats or drinks less include:^1,7

• Not knowing what the food is. The person may not recognize food on the plate, or may not see it well.
• Too many choices. A full plate, many dishes and a busy table can be overwhelming.
• Changes in taste and smell. Food may seem bland, so it is less tempting.
• Mouth problems. Sore gums, a bad tooth or loose dentures can make chewing hurt. The person may not be able to tell you this.
• Medicines. Some medicines lower appetite. For example, memory medicines like donepezil can cause nausea and loss of appetite, and weight loss is listed as a possible side effect.⁸ See donepezil, rivastigmine and galantamine.
• Less activity. A person who sits most of the day may not feel hungry.

Mood also matters. Depression can lower appetite. Read about apathy and depression in dementia if the person seems withdrawn.

The guideline advises looking for and removing these causes first, then giving the person the support they need to eat, such as help, the right tools and good mouth care.²

Set up the plate and table

Small changes to the table can help a person see their food and focus on eating.

1. Pick a quiet spot. Turn off the TV and radio. Clear the table of mail, keys and decorations.¹
2. Use plain dishes with contrast. A plain plate on a placemat of a different color helps the food stand out. Skip patterned plates, placemats and tablecloths.¹
3. Serve one or two foods at a time. Bring the next food when the first is done.¹
4. Set out only the tools needed. A spoon with a large handle may be easier than a fork. Plates with a rim, or bowls, keep food from sliding off.¹
5. Stop spills before they start. Use cups with lids, fill glasses only halfway, and use bendable straws. A non-skid mat keeps plates in place.¹
6. Give plenty of time. Allow an hour or more if needed. Eat together when you can, so the person can copy what you do.¹

Help at each stage

What helps changes as dementia moves on. See stages of dementia for more on each stage.

Finger foods let a person keep feeding themselves longer. Try bite-size foods that are easy to pick up. Examples are small pieces of chicken, fish sticks, orange segments, steamed broccoli pieces or sandwiches cut small.¹ Do not worry about neatness. Eating with hands is fine.¹

Hand-over-hand help can get a person started. Place your hand over theirs and guide the spoon to their mouth.¹ Often they take over after a few bites.

Repeated meals. A person may not remember eating. Instead of saying "you just ate," you can offer a small snack. Some families serve a "breakfast in parts," such as juice, then toast, then cereal.¹

A steady daily rhythm also helps. Read building a good daily routine.

When appetite is low

Try these ideas, one or two at a time:¹

• Serve their favorite foods and familiar dishes.
• Offer several small meals or snacks instead of three big meals.
• Encourage light activity, such as a short walk or helping wash dishes, to build hunger.
• In later stages, a little extra sweetness on food may make it more appealing.
• Have the dentist check the mouth if the person frowns, winces or refuses food. Ask the doctor to review medicines, especially any that are new.^1,7

Watching weight

Weight loss can sneak up slowly. Clothes that hang loose, a belt on a new notch or dentures that no longer fit are clues. Experts advise regular checks of weight and of how much the person eats and drinks.²

• Weigh the person on the same scale, at the same time of day, in similar clothes.
• Write it down so you can see changes over weeks and months.
• Tell the doctor about any weight loss you notice.

Nutrition drinks. The doctor or a dietitian may suggest a nutrition shake between meals to add calories and protein.¹ The 2024 ESPEN guideline supports these oral nutritional supplements to improve nutrition. It does not support them as a way to improve memory or slow dementia.²

The same guideline does not recommend routine use of special "dementia" nutrition drinks, ketogenic (very low-carb) diets, omega-3 fish oil pills or appetite-boosting drugs.² Be careful with products that promise memory gains. See supplements and memory claims. Always talk with the doctor or pharmacist before adding any supplement, because some interact with medicines.

Some people eat too much instead. They may forget a meal and eat again. If weight is going up, offer smaller portions and healthy snacks, and keep tempting foods out of sight.

Drinking enough

Older adults are at higher risk of dehydration.⁵ A person with dementia may not notice thirst, may forget to drink, or may not be able to ask.

Ways to help:¹

• Offer small cups of water or other drinks often through the day. Do not wait for them to ask.
• Serve foods with lots of water, such as fruit, soup, smoothies and milkshakes.
• Keep a filled cup where they can see it and reach it.

If the person has heart or kidney problems, ask the doctor how much fluid is right. Some people are told to limit fluids.

Safe eating and choking

Swallowing problems can start in the middle and late stages.¹ To lower the risk of choking:^1,6

• Avoid hard, chewy foods such as raw carrots. Cut food into small pieces, or serve soft foods like applesauce, cottage cheese or scrambled eggs.
• Help the person sit up straight, with the head tipped slightly forward, not back.
• Make sure dentures fit well.
• Check the mouth after the meal to make sure all the food was swallowed.
• Learn the Heimlich maneuver (abdominal thrusts). A first aid class can teach you.

Frequent coughing or a wet, gurgly voice during meals can mean the food or drink is going down the wrong way. Ask the doctor about a swallowing check by a speech therapist. Learn more on eating, drinking and swallowing.

In late dementia, families often face hard choices about feeding. Read eating problems and feeding tubes at the end and late-stage dementia.

When to call the doctor

Call the doctor if you notice:

• Weight loss, or clothes and dentures that suddenly fit loosely
• A big drop in eating or drinking for more than a day or two
• Coughing, choking or a wet voice during meals
• Pain when chewing, or refusing food after a medicine change^1,7
• Signs of dehydration (see above)

Call 911 for choking that does not clear, fainting or sudden severe confusion.^5,6

Common questions

Is it okay to let them eat dessert first?

Often, yes. If the person will eat sweets but not the main dish, getting some calories in is what matters most. Keep the overall day balanced, and ask the doctor if the person has diabetes.

They keep saying they are not hungry. Should I insist?

Pushing often leads to a fight. Try again in 15 to 30 minutes, offer a favorite food, or eat something yourself next to them. Track what they eat over the whole day, not just one meal.

Should we try a special brain diet?

Eating well matters, but no special diet has been shown to reverse dementia. The 2024 ESPEN guideline advises against routine ketogenic diets for people with dementia.² Talk with the doctor before making big changes to what the person eats.

What about a feeding tube?

In severe dementia, experts do not recommend feeding tubes.² Careful hand feeding and comfort are the focus. Read eating problems and feeding tubes at the end to learn more and to prepare for that talk with the care team.

More caregiving guides are on caring for someone with dementia.

Getting help with meals

You do not have to cook every meal alone.

• Home-delivered meals. Programs funded by the Older Americans Act bring meals to older adults who cannot get to a group meal site. Many also include a friendly visit at the door.⁹ Find a local program through the Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov.¹⁰
• In Virginia, home-delivered meals serve people 60 or older who are homebound, cannot make their own meals and have no one to cook for them. A spouse may also get a meal if the local Area Agency on Aging decides it helps the older person.¹¹
• Adult day programs usually serve a meal and snacks, with staff who help at the table. See adult day care.
• Your care team. Ask the doctor for a referral to a dietitian (food expert), a speech therapist (for swallowing) or an occupational therapist (for special plates, cups and spoons).

If meals are wearing you down, that is common. Read about caregiver stress and respite care.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.