The Older Persons and Dementia Interest Group have produced an excellent resource for the carers of those with dementia. Covering a huge range of relevant topics, this A4 guide will be the go-to resource for anyone working with or advising those caring for anyone with dementia. Example of topics covered include:

• Food preference changes
• Losing weight and not finishing meals
• Not drinking enough
• The dining environment
• Swallowing difficulties

A huge amount of work and dietetic experience and expertise has gone into producing this resource.

Congratulations to all those involved in OPDIG and thank you to the National Dementia Strategy Programme for funding the design and print of this booklet for carers.

Click on the link here to access the pdf of this excellent new resource: Nutrition_and_Dementia_Booklet_March_2021_Update.pdf

CONSIDER THE DINING ENVIRONMENT

The dining environment and surroundings can affect how well a person with  dementia eats.Helping a person with dementia to eat may take 45 minutes to an hour.  

Relaxed and social surroundings can add a sense of security, familiarityand structure to the day for a person with dementia.The following practical ideas may serve as a guide for planning mealtimes for a person with dementia:

HAVE A DEDICATED DINING ROOM

• A room dedicated for eating may help develop familiarity. Going into the dining room may signal that it is mealtime.
• A dining room close to the kitchen allows the smell of food to pass though, encouraging appetite and reminding the person that a mealtime is about to take place.
• If a person feels more comfortable eating in a different room other than a dining room, for example, the living room, go with it. Every person is different.

MEAL PREPARATION IS THE KEY TO SUCCESS

• Allow enough time to prepare the person for the meal.
• A short walk or time outdoors before a meal may encourage appetite.
• Encourage the person to get involved at mealtimes. Helping prepare food or laying the table can remind a person that it is time to eat.
• The smell of food, the sound of cooking of the noise of pots and cutlery can help to stimulate appetite and act as a reminder that it is mealtime.
• Think about the direction the person is facing. Do they eat better when they can see other people eating? Will they be distracted by looking outside the window or the door?
• Encourage the person to sit in the same place at each mealtime to provide familiarity.
• Ensure the person is comfortable, does not need the toilet and is sitting in a good position before a mealtime.
• Make sure the person is ready to eat: glasses on, hearing aids on, dentures are clean, fit well and in place.
• Create a calm, quiet and soothing environment
• The person with dementia may find it difficult to concentrate on meals. The environment should be free from distraction and excessive noise to allow them to concentrate on meals.
• Provide good lighting to help them identify food and cutlery.
• Mirrors in the dining room can create is orientation and it may be useful to cover them or remove them completely from dining rooms.
• Pots and cutlery can help to remind the person that a meal is about to take place, but during the meal it can be distracting.
• Vaccum cleaners and washing machines should not be turned on during meals.
• Turn off the television and radio
• Soothing background music maybe comforting, especially for people individually.
• Meals should be relaxed and unhurried. Try not to become stressed at mealtimes if difficulties arise. Stress can be sensed. If you seem to be in a hurry a person with dementia will be aware of this and may not eat as much. Try to keep food visible or it may be forgotten and left uneaten.
• When eating together at home or in a day-centre, avoid removing plates until everyone is finished. Removing plates early can be seen as a signal to stop eating.
• Avoid interruptions and people entering the room.
• Avoid talking to other people as the person maybe distracted by this.

TABLE SETTING - KEEP IT SIMPLE AND USE CONTRASTING COLOURS

The person with dementia may not always identify their own space at the table and take food belonging to someone else. Use a placement or tray to help the person to recognise their place.

• Keep table settings simple. Minimise the number of items on the table. Remove salt, pepper, condiments, napkin holders and only include essential items as it is not unusual for a person to put salt or pepper into their coffee.
• Flowers and candles may look nice, and can help create a calm environment for some, but for others can be distracting.
• Dementia can make it difficult to see the difference between plates and bowls from the surface they are placed on. Use plain, non-patterned, plates and bowles with a contrasting colour to the table cloth or plate setting, for example white plate on green table cloth can help make it easier to see.
• Pastel colours are difficult to recognise. Use primary colours (red, yellow and blue). Use coloured glasses instead of clear ones.
• Choose a plain tablecloth as the person may try to pick items off a patterned tablecloth
• Avoid the full table setting of a knife, fork and spoon. Only put out what is needed.
• If the person prefers to use a spoon, just put out a spoon. Cutting out choices at mealtimes can help to reduce distress or frustration.

TRY TO EAT WITH THE PERSON

• A person with dementia may eat better in company, as they may copy others and this can help to prompt memory.
• Talk about the smell and taste of the different foods you are offering, so that the person can identify what they are eating.
• Encourage the person to eat independently where possible, even if it is only one bite per meal. Do not comment on the way the person is eating as this could be upsetting.
• Prompt the person to eat by placing cutlery or a cup in their hand if they have forgotten what to do at mealtimes.
• Keep a good level of eye contact if the person with dementia is holding eye contact and it doesn’t appear to be causing distress.
• As the dementia progresses it may be necessary to help the person at mealtimes. Always treat the person with dignity. Never treat them like a child.
• Use an apron if necessary to protect clothes
• Ask if the food is too hot or cold, and tell the person which food or drink you are serving with each bite or sip of fluid.

DOES THE PERSON WITH DEMENTIA HAVE A BEST TIME OF DAY FOR EATING?

• Appetite can vary at certain times in the day. Some people eat more as the day goes on or some people may eat more in the morning. If you notice that there are times in the day when person with dementia eats better, change your meal time to suit the person rather than trying to make them fit in with your routine.
• Serve one course at a time to keep food warm and to help avoid confusion with foods.
• Serve half portions and keep the rest of the food warm until the first portion is finished. Insulated plates may be useful.
• Offer drinks after the meal instead of at the same time, or offer small amounts during the meal. Drinks can be filling and they may put someone with dementia off their meal.
• Allow the person plenty of time for eating. A person may not be finished, even if they have stopped eating.
• Have a large, easy seen clock on the wall with a sign showing the times of breakfast, lunch and dinner.

WOULD YOU EAT THE SAME MEAL?

• Colourful foods are more appealing.
• Watch food temperatures. The person may not be able to tell if a food or drink is too hot.
• Serve foods that the person previously liked. Don’t worry if the person wants to eat the same meal twice in a row. Tastes may change so try to be flexible. Do not feel the need to prepare fancy meals but rather concentrate on the person eating and enjoying the meal.
• Expect the unexpected. People may enjoy unusual combinations of food. Some people with dementia, who previously preferred savoury foods, may develop a taste for sweet foods and other people may develop a taste for hot and spicy foods.
• Avoid serving meals of the same colour, for example chicken, cauliflower and potato on a white plate. Dark – coloured plates highlight light-coloured food well. Does the colour of the food stand out against the background of the plate? It is hard to see a poached egg or mashed potato on a white plate.
• Avoid food garnishes which can be distracting
• Do not overload the plate with too much food.
• Adapted cutlery and crockery can help promote independence and can help with poor coordination.
• Try plate warmers or insulated cups to keep food and drinks warm for longer.
• Use non-slip placements or dinnerware with suction pads to prevent dishes from sliding.
• Use a large lipped bowl rather than a plate.
• Use cups with 2 handles and a spout or cups which tip without spilling
• Try lightweight, coloured, adapted cutlery (the occupational therapist can advise).
• Use a familiar mug/china cup/plate as this may help to orientate the person.
• Using matching cups and plates may help the person to recognise which cup or plate is theirs.
• When it is obvious that the person can no longer use a spoon or fork, continue to encourage them to feed themselves but introduce finger foods. See section on finder foods for more information.
• Avoid plastic eating utensils and Styrofoam cups because the person may try to eat them which can increase the likelihood of choking.

USEFUL LINKS FOR PEOPLE WITH DEMENTIA AND THEIR CARERS (IRELAND)

• The Alzheimer society of Ireland (www.alzheimers.ie)
• The dementia services information and development centres (www.dementia.ie)
• Alzheimer café (www.alzheimercafe.ie)
• Living well with dementia (www.livingwellwithdementia.ie)
• Irish National Dementia Strategy (www.health.gov.ie/blog/publications/the-irish-national-dementia-strategy/)
• Sonas (sonasaps.ie)
• Dementia Friendly Communities (www.alzheimer.ie/get-involved/dementia-friendly-communities.aspx)
• The crystal project (www.crystalproject.ie)
• Irish Nutrition and Dietetic Institute (www.indi.ie)

Updated by members of the Older Person and Dementia Interest Group May 2016.

Review date: May 2019

© 2016 Irish Nutrition and Dietetics Institute, INDI. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a dietitian. It is intended for educational and informational purposes only.

Printer Friendly PDF: Consider the dining envirnoment

Dementia is a progressive illness of the brain and can often be associated with confusion, agitation and forgetfulness. If you are supporting or caring for someone with dementia you may have noticed that mealtimes can be particularly challenging.

This information is designed to help you understand how dementia affects someone with respect to eating and drinking and to help you manage some of these difficulties.

EXAMPLES OF FEEDING DIFFICULTIES

• Confusion and lack of coordination

You may notice that a person is becoming confused and uncoordinated. For example, the person may attempt to load food onto their knife or attempt to drink a food item.

• Behavioural changes

These include refusal to open the mouth or spitting out food. This may be because the person no longer recognises the food in front of them or dislikes certain textures and tastes. This can even happen with foods that they previously liked. It may be because the person is having difficulty chewing or swallowing their food. If this is the case, check for loose-fitting dentures or painful gums or loose teeth. Remember, a person with dementia may not be able to communicate these problems to you.

• Coughing after food or delayed swallowing

Be aware of subtle signs or symptoms such as coughing after food or drinks or taking a very long time to chew and swallow foods. This may need further investigation by a speech and language therapist. Ask your GP to make a referral.

SUGGESTIONS FOR MANAGING FEEDING DIFFICULTIES

• Ensure mealtimes are relaxed and as unhurried as possible.

• Choose a calming setting with minimal noise or distractions.

• Try not to become stressed at the mealtime if difficulties are encountered. A person with dementia can sense stress, making the situation worse.

• If the person is confused at mealtime and not able to initiate feeding, use gentle reminders or prompts of how to use certain items. If this fails then load the fork / spoon for the person and gently guide the person’s hand to mouth.

• Talk about the different foods you are offering so they can identify what they are eating.

• Avoid mixing foods together as the person may dislike one particular ingredient and end up refusing all of the meal.

• Finger foods are foods that can be easily picked up and eaten with the hands and are sometimes preferred to meals that require a knife and fork. They allow a person eat independently and at their own pace.

Examples of Finger Foods:

• Finger sandwiches
• Pancakes rolled into fingers
• Crackers with butter or soft cheese
• Baby boiled potato
• Potato wedges
• Meat balls
• Cocktail sausages
• Chicken / fish goujons
• Cheese sticks or cubes
• Sliced apple
• Melon wedges

• Taste changes are common in dementia. Bland foods which were previously liked may not seem appealing now. Extreme flavours such as very sweet, salty or spicy foods may be more appealing to the person. Experiment with different flavoured dishes and desserts.

• Check the temperature of food and drinks before offering it to the person. A person with dementia may not sense extreme temperatures which can make them prone to burning their mouth and tongue.

• If food refusal or difficulties at mealtimes persist or if wandering becomes a problem, then weight loss is likely to occur. Offering small meals or high calorie snacks and drinks at regular intervals throughout the day will help keep energy levels sustained and minimise weight loss.

If you are concerned about weight loss or any of the issues raised here, ask your GP to make a referral to a dietitian. You can also find a dietitian in the 'Find A Dietitian' section of our website. A dietitian can give expert, individualised advice on how to manage feeding difficulties.

OTHER USEFUL WEBSITES TO VISIT

• The Alzheimer Society of Ireland: www.alzheimer.ie

• Dementia Services Information and Development Centre: www.dementia.ie

Created by Ciara Murphy, MINDI, October 2013

 Review date: October 2015

© 2013 Irish Nutrition and Dietetics Institute, INDI. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a dietitian. It is intended for educational and informational purposes only.

Nutrition has an important role to play in the management of Parkinson’s Disease (PD). On diagnosis of PD there is no need to make special dietary changes, once your current diet is well balanced.

This leaflet will provide information and advice about following a healthy, well balanced diet. Those with PD can experience nutritional issues such as changes in weight and appetite, constipation and brittle bones. This information provides useful information on ways to overcome these problems. It also includes information on diet in relation to PD medications.

SO WHAT IS A BALANCED DIET?

Good nutrition in PD involves eating regularly, including a wide variety of foods each day. Choose foods from the each of the food groups daily to make sure you are achieving a well balanced diet

Starchy Foods: Each of your meals and snacks should have starchy food, such as bread, potatoes, rice, chapattis, yams, pasta, noodles, oats, cornmeal, crackers, toast and breakfast cereals.

Fruit and Vegetables: Aim for five servings of fruit and vegetables each day. Choose from fresh, frozen, canned or dried fruit and vegetables.

Dairy Products: Aim for three to five servings of milk and dairy foods each day. A serving is a third of a pint of milk, one small pot of yoghurt, or a small matchbox portion of cheese (both reduced-fat or full-fat varieties of milk and yoghurt are good sources of calcium).

Meat, Fish and Alternatives: Aim for two to three servings each day from this group. Choose from red or white meat, white or oily fish, eggs, beans, pulses and nuts. If you have difficulty in swallowing, smooth peanut butter and scrambled or poached eggs are useful options. Lamb, beef, eggs, beans and pulses will also provide essential dietary iron.

Fatty and Sugary Foods: These foods can be eaten in moderation. (See ‘A healthy weight’, below, if weight control is a problem.)

Fluids: It is very important to drink plenty of fluids. Aim for eight to ten cups (six to eight mugs/glasses) each day of water, fruit juice, squash or milk. Keep tea or coffee to a maximum of 4-5 cups per day as caffeine in these can lead to dehydration. Try eating juicier fruits, such as melon, will also help increase your fluid intake.

A Word on Alcohol: Unless you have been advised by your doctor not to drink alcohol, a small amount (e.g. sherry, wine or beer) does no harm and may be beneficial, especially if it encourages a normal social life. The Department of Health and Children recommend that men limit their alcohol intake to 21 units per week, and women limit their intake to 14 units per week. One unit is equivalent to 1 glass of stout/lager/cider (284mls), one small glass of wine (100mls) or one pub measure of spirits (35.5mls). Alcohol intake should be limited to 2-3 units per night for women, or 3-4 units per night for men, with some alcohol free days during the week.

A HEALTHY WEIGHT

It is important for everybody to maintain a healthy body weight. Being over or underweight can have effects on your well-being. Weight loss can occur due to the extra movements associated with PD. These extra movements can be due to tremor or dyskinesia, both of which can burn up extra energy. If you are prone to extra movement, it may be necessary to increase your calorie intake to avoid weight loss. On the other hand, It is easy to gain weight if you become less active, and continue eating the same amount as before.

Sensible Ways to Keep Your Weight Under Control:

• Put away the frying pan! Use healthier cooking methods like grilling, baking steaming, microwaving, poaching.
• Cakes, biscuits, pastries and confectionery are high in sugar and fat. Reduce the number of times you eat these in the week.
• Unwanted calories from sugary drinks such as regular fizzy drinks and cordials can add up quickly. Use ‘sugar free’ or ‘low calorie’ options instead. Water is the best drink of all.

What if I am Underweight?

Sometimes, weight loss can be due to practical problems to do with food preparation and keeping your food hot while you are eating. Loss of the sense of smell is common in PD, which can reduce the enjoyment of food.

See our advice Gaining Weight the Healthy Way on our website for lots of useful tips on putting weight on while staying healthy.

CONSTIPATION

Many people with PD find constipation is a big problem. This can be helped by:

• increasing your intake of fibre-rich foods
• increasing your fluid intake
• taking exercise

How to Increase Your Fibre Intake:

Increasing your fibre intake means boosting your intake of wholemeal and wholegrain breads and cereals, fruit and vegetables. See our information Dietary Advice for a Healthy Bowel on our website for detailed information on increasing the fibre in your diet.

Many people find that diet alone is not enough to combat constipation. If your doctor has prescribed laxatives, ensure you take them as directed, as constipation can cause your PD medications to fail.

BONE HEALTH

People with PD are more likely to get osteoporosis (brittle bone disease). An adequate intake of calcium and Vitamin D is required to keep bones strong and healthy. Calcium is found mainly in dairy foods such as milk, cheese and yoghurt, some tinned fish and fortified cereals and juices. It is important to have at least 3 portions of calcium containing foods per day. Vitamin D is needed to help absorb the calcium that is eaten. The main source of Vitamin D is from the sun via the skin. Older people, people who are housebound or may cover their skin when outside may have a particular need for extra vitamin D from their diet. Foods that are high in Vitamin D include salmon, margarine, eggs, liver, fortified milks and cereals. Try to include some high calcium and Vitamin D foods daily.

MEDICATION

When and how should I take my PD medication?

You should discuss this in full with your GP, consultant or Parkinson’s Disease Nurse Specialist (if you have one). It is important to drink plenty of fluid with your levodopa medication, such as water, squash or juice. This helps with getting the tablets where they need to be in the bowel, so they can be absorbed. However, it is advised that you do not take your PD medication with milk (see next section).

I Have Heard That Protein Affects my Medication?

In some people, protein (found mainly in meat, fish, chicken, eggs, cheese, yoghurt, milk, nuts, beans and pulses) seems to interfere with the effectiveness of their levodopa medication. Levodopa is an amino acid, and it will have to compete with the amino acid produced from dietary protein. Therefore, most people benefit from taking their levodopa 45 minutes before meals, or 1 and a half hours after meals. It is recommended that large amounts of protein should not be consumed in a single meal. Protein intake should be spread out throughout the day.

If you do wish to review the timing of your protein intake, discuss it with your GP, or ask to see a dietitian.

Can I Take Antacids?

Antacids (e.g. Rennie or Milk of Magnesia, which are used to relieve discomfort in disorders of the digestive system) should not be taken at the same time as other drugs, since they may impair absorption.

VITAMINS, MINERALS, AND ANTIOXIDANTS

Eating a well-balanced diet will provide adequate levels of vitamins and minerals for most people. Some vitamins, when taken in large doses can cause severe side effects.

Oxidation is a normal process which occurs in all cells of the body. A substance produced from this process is known to cause damage and play a part in the development of diseases such as heart disease, cancer and PD.

Antioxidants are a group of vitamins and minerals that can help lessen the damage caused by oxidation. Currently, there is no evidence that they will slow the progression of PD or provide an increased effect of drugs. If you are eating well-balanced diet, your antioxidant needs should be taken care of.

Co-enzyme Q10, found in very small amounts, particularly in protein-rich foods, has strong anti-oxidant properties. Due to a lack of scientific evidence, it has been recommended that co-enzyme Q10 should not be used as a therapy for PD.

If you want some more advice about taking vitamin, mineral or antioxidant supplements, speak to a dietitian or your GP. Taking excessive amounts of antioxidant vitamin supplements can adversely affect your health and well-being, and may interfere with your PD medication. You should not commence taking high dose supplements before discussing it with your GP.

FOR FURTHER INFORMATION VISIT

Irish Association of Speech and Language Therapists (IASLT) http://www.iaslt.ie/

 Parkinsons Association Ireland (PAI) http://www.parkinsons.ie

If you require further information about diet and PD, or a referral to a dietitian, please contact your GP, or go to the 'Find a Dietitian' section of our website.

Created by Pauline Thomas, MINDI, October 2013

Review date: October 2015

© 2013 Irish Nutrition and Dietetics Institute, INDI. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a dietitian. It is intended for educational and informational purposes only.