Eating and drinking well with dementia at home
A guide for
family carers and friends
Person
Introduction
Welcome to this eating and drinking well guide for people living with dementia at home. Eating well, staying nourished, and drinking well are essential for everyone. As dementia progresses, we know that the ability to eat and drink can become more and more challenging. This guide has been developed to provide some helpful advice and tips to family carers and friends on how to increase food and drink intake for people living with dementia at home. Food and mealtimes should be and can continue to be an enjoyable experience, even when navigating through dementia.
This guide has been adapted from an award-winning Nutrition and Dementia Care Toolkit originally designed for Care Homes (2019) based on research with best practice examples.
The guide has been shaped by input from various stakeholders, including people living with dementia, their family carers, home care professionals, healthcare professionals, the care sector and practice experts, as well as the multidisciplinary project team, all of whom provided valuable feedback.
We hope you pick up a few ideas for supporting your loved one with dementia at home and that these suggestions go a long way to help support you as a carer in overcoming some challenges you might face.
Also available:
• A handy guide for home care professionals
• A handy guide for family carers and friends
For more details, please visit the project TOMATO webpage: www.bournemouth.ac.uk/tomato
and also the Ageing and Dementia Rersearch Centre webpage: www.bournemouth.ac.uk/nutrition-dementia
1. Availability of food and drinks
How to accommodate for changes in appetite, food preferences and ability with practical suggestions for modifying food, planning menus and improving the presentation of food.
2. Monitoring and care planning
Spotting the signs of poor nutrition and using validated tools to dentify clients likely to be at risk of undernutrition.
3. Relationship: working together
Practical ways of working together with home care professionals to improve food and drink intake. .
4. Enhancing the mealtime experience and activities
Improving the dining environment and mealtime experience practical activities to stimulate appetite, evoke memories and create a sense of purpose.
5. Consistency of care
Improved communication between all those involved with care and the provision and prioritisation of nutrition and hydration.
6. Provision of information
Access to trusted information, training, resources and current guidelines.
We have adapted this guide based on the published model of ‘person-centred nutritional care’ which is underpinned by 6 key factors tailored for home care: Working
This guide does not cover nutritional care in people living with advanced dementia. It is important to seek specialist nutritional support at this stage.
Availability of food and drinks
It is important for people living with dementia to...
...eat well at home
Often, people living with dementia lose weight when they are not trying to. Weight loss can speed up how dementia progresses, increasing the likelihood of developing pressure sores and infections. Additionally, it may cause dizziness and confusion, making people more likely to fall, trip over, or have injuries.
Not all people will experience weight loss. Some people living with dementia at home may gain weight because of memory problems and will eat again after having had a meal. Refer to your GP if this is causing concern.
How to... spot weight loss
• Poor appetite
• Clothes, rings, jewellery, dentures may become loose
• Tiredness, loss of energy, muscle weakness
• Reduced physical performance or ability to perform normal tasks
• Increased risk of falls
• Constipation
• Altered mood and changes in behaviour
• Poor concentration
• Poor wound healing.
drink well at home
...
If an older person or someone living with dementia does not drink enough, they may be at risk of several health conditions. These can include reduced cognitive abilities, incontinence, constipation, fatigue, poor oral health, low blood pressure, and a higher risk of falls due to dizziness and confusion.
Some people may drink less because they are worried about incontinence or have difficulty getting to the toilet in time. It’s important to remind them to drink and explain how it benefits their health. Offer reassurance that you’re there to provide help and support whenever they need it.
How to... spot dehydration
• At present, there are no validated screening tools to determine dehydration in older adults
• The best approach is to assume risk of dehydration for people living with dementia.
How much drink should older adults aim for daily?
To stay well hydrated, it’s important to drink plenty of fluids. It is recommended that women aim for at least 1,600ml per day and men for 2,000ml. The variety of drinks can include water, milk, sugar-free options, diluted squashes, juices, tea, and coffee, allowing the choice of preferred drinks. Keep in mind that not everyone likes to drink water. It might not be easy for someone living with dementia at home to meet these recommendations, but any increase in the amount they drink is a positive step. All hot and cold drinks count.
11-14 full cups
8-10 full glasses
7-8 full mugs
3-4 full glasses
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (A2) The British Dietetic Association (BDA) | Hydration in older adults
Why do people living with dementia have eating and drinking difficulties?
Eating and drinking can become increasingly difficult as dementia progresses for a number of reasons including:
• Problems expressing hunger and thirst
• Limited recognition of hunger
• Lack of interest in food and drink which could be due to low mood or feeling sad
• Poor concentration - difficulty sitting down
• Confusion in recognising food and how to eat
• Reduced ability to drink, difficulties with chewing and swallowing
• Poor mouth care
• A craving for sweet food as preferences change.
Also, this can occur due to:
• Loss of ability to feed oneself and reduced coordination
• Storing food in the mouth, spitting out or refusing to eat or drink
• Reduced thirst sensation
• Paranoia surrounding food.
Check for underlying problems: Difficulty with eating or drinking may be caused by various issues, such as mouth ulcers, sore throat, or headache.
Everyone is different, but you may recognise some common challenges around eating and drinking. Make a note of the times they struggle and the times they eat and drink well to identify patterns, considering what helps and what is a hindrance. For instance, a person may not recognise the actual food, such as being served a pie if they have always eaten curry (or vice versa), lentil stew, or meat and potatoes. We have included some suggestions for managing these diferent issues.
Observation
Food left uneaten or refused
Poor drink intake
Walks around during mealtimes
Difficulties chewing or swallowing
Suggestions
• Offer smaller portions
• Check texture and consistency of food
• Discuss food preferences
• Assist with eating if necessary
• Talk to the person about the food and drinks they like. Also talk to other carers or staff to find out what they think.
• Encouraging prompts – make a drink rather than asking
• Offer a variety of different drinks.
• Ensure mealtimes are calm – no distractions
• Provide finger/ bite sized food that can be eaten ‘on the go’
• Take a walk together before a meal, if possible in the garden, and finish in the dining area or wherever you plan to eat
• Eat together to model eating behaviour and encourage intake
• Offer food at times when the person is more likely to sit down.
• Use verbal cues as a reminder
• Contact your GP for advice. An Occupational Therapist may be able to help, depending on local referral criteria
• Maintain good communication with the home care provider and care professionals regarding support for the person.
Difficulty using cutlery or drinking utensils
Distracted from eating
Hoards or hides food or plays with food
Eats non-food items
Eats too fast
Eats dessert first or mixes food together
Holds food in mouth or doesn’t open mouth
• Use verbal cues as a reminder
• Ask your GP to refer to a Speech and Language Therapist (SLT)
• Maintain good communication with the home care provider and care professionals regarding support for the person.
• Ensure mealtimes are calm – no distractions
• Make sure they have everything needed for the meal – glasses, dentures, been to the toilet
• Use verbal or manual cues – place crockery into hands
• Sit together and model eating.
• Serve small portions of individual foods.
• Remove non-food items from the table and replace with food or drink.
• Offer food in smaller portions
• Use verbal cues and demonstrate slower eating
• Reassure that there is plenty of food – it won’t run out.
• If food is eaten, this can be ignored regardless of the order in which the person chooses to eat.
• Use verbal cues to chew or open the mouth
• Offer smaller amounts of a variety of foods
• Gently massage the cheek or touch the lips with a spoon
• Contact your GP, community nurse or dietitian for advice.
Encouraging eating and drinking well
Nourishing meals provide essential nutrients and support overall health and well-being. Meals and snacks can be adapted to meet changing personal preferences whilst meeting their nutritional needs. People living with dementia can still aim to have a healthy and balanced diet, following the same recommendations as the general older population. This includes foods that are slightly higher in protein, calcium, folate (folic acid), and vitamin B12. The recommended amounts of carbohydrates, sugar, fibre, fat, and salt are generally the same as for younger adults.
In addition to boosting energy, the aim is to promote and prioritise more nutrient density.
Examples of balanced meals include:
Breakfast - try fortifying:
• Porridge with skimmed milk powder, ground almonds
• Breakfast cereal with fortified milk, ground almonds, evaporated milk, or greek yoghurt
• Bread or toast with spread of preferred nut butter or cheese.
Lighter meals - try fortifying:
• Soup with skimmed milk powder, evaporated milk, grated cheese, nut butter, ground almonds
• Sandwiches with plenty of protein rich fillings such as meat, fish, cheese, nut butter etc.
Main meals - try fortifying:
• Meat dishes with grated cheese, skimmed milk powder, preferred nut butter (e.g., almond, cashew or peanut), or milk-based sauces
• Potatoes and vegetables with milk-based sauces made with fortified milk, grated cheese or add egg to mashed potato
• Puddings with evaporated milk, custard made with fortified milk.
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (A2) The British Dietetic Association (BDA) | Hydration in older adults
Fortified Milk:
You can add 4 tablespoons (60grams) of skimmed milk powder to 568ml full fat milk. You can use this as a base for making milky drinks or add it to suitable foods.
How to... encourage eating and drinking well
• Ensure good mouth care and properly fitted dentures to avoid discomfort
• Eat little and often - offer three small meals a day with two or three snacks in between (every 2-3 hours). Keep plenty of favourite snacks to hand
• Try to have 2-3 portions of high protein foods such as meat, fish, eggs, beans, quorn, soya every day. In addition, try food and drinks based on milk, as milk is a good source of protein
• Include nutritious drinks – such as milk-based drinks and fruit juice
Tips to encourage drinking more at home
• Offer the drink instead of repeatedly asking
• Offer a good variety of drinks throughout the day –take care not to offer them too close to mealtimes, as they may make a person feel too full to eat
• Smoothies, milkshakes, ice lollies, and squashes all count
• Consider ease of handling when offering drinks, such as using two-handled mugs or one-way drinking straws
• Drinks can be served in jugs, small decanters, or dispensers, with ice in summer. Jugs should be kept half full so they can be lifted easily by the person, where possible
• Drink together, clink glasses say, ‘Here’s to you!’
Prioritising food based approach
Food based approach is a way of adapting meals and snacks by adding extra amounts of nutrient dense foods.
Common nutrient dense food items that can enrich foods without increasing portion sizes include:
• Full fat milk
• Fortified milk
• Skimmed milk powder
• Evaporated milk
• Grated cheese
• Ground almonds
• Egg
• Soy protein powder
• Greek yogurt
• Peanut butter.
Practical examples for adapting food and drink
Prioritise food based approach - If someone is losing weight unintentionally, here are some practical examples of how to increase energy (calorie) and nutrient content.
You can add 4 tablespoons (60grams) of skimmed milk powder to 568ml full fat milk. You can use this as a base for making milky drinks or add it to suitable foods.
needs of the person living with dementia, soft nut bars could be an alternative
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (A21) Creating a fortified diet recipe book: How to Optimise Nutrition Using Food
• (A22) Spotting and treating malnutrition - British Dietetic Association (BDA)
Falafel
mini balls; 22grams)
Suggestions for snacks and drinks
Some sugary snacks and drinks may not be suitable for someone with diabetes and those with swallowing problems.
Oral food supplements
If the appetite is poor, food based approach can be used to meet nutritional needs. Over the counter or prescribed oral nutritional supplements may be used following advice from a Registered Dietitian. These are available as powdered milkshakes, soups, or ready-to-drink products. It can be helpful to know that oral supplements do not contain anything which cannot be found in a balanced diet.
Savoury
Toasted crumpets and cheese
Hummus and bread sticks
Cheese and biscuits
Samosas, pakoras, bhajis
Spanish omelette or frittata
Mini pancakes with cream cheese topping and smoked salmon
Sweet
Malt loaf
Flapjack
Tub of custard
Drinks
Hot chocolate with fortified milk
Milky coffee
Hot malted milk
Greek yoghurt
Fruit smoothies
Milk shake
Finger food and grazing menus
Finger foods can help people engage more actively with eating, using their hands. They offer a great alternative to meals presented on a plate and can prolong independent eating while maintaining dignity For someone who has a tendency to walk around and is unable to sit still to eat, or has difficulty concentrating, consider leaving snacks and drinks out in places where they may walk past.
Finger foods are perfect for those who find it difficult to use cutlery (with arthritic hands or tremors) or no longer recognise the purpose of cutlery.
It is possible for a finger food or grazing menu to meet the nutritional requirements of clients. Fibre and folate may be in shorter supply, so take care to include foods containing these nutrients - cereal bars, broccoli, green beans, asparagus, wholegrain bread, fruit and vegetables.
Finger food suggestions
Breakfast
Hard boiled egg cut into quarters
Lunch / main meal
Fish goujons, fish fingers or fish cakes
Kebabs
Sliced or cubed roast meat
Chicken drumsticks
Salad - lettuce, cherry tomatoes, cucumber, avocado, beetroot, celery - cut into slices or sticks
Tea / light meal
Sandwiches with variety of fillings
Bread rolls, chapatis, roti, naan bread, bagels
Tortilla wraps
Dessert
Tips for serving finger foods
• Use foods that are easy to hold
• Serve in bite-size chunks
• Choose foods that are moist and not too dry
• Serve at room temperature
• Provide a variety of different foods to ensure good nutritional balance
• Pack foods into a lunch box or paper bag
• Make sure food looks colourful and appealing
• Provide drinks that are easy to hold – two handled mugs, use straws, small cartons, frozen drinks
• Provide wipes or flannels to clean hands.
French toast (eggy bread)
Mini new potatoes or small roast potatoes
Potato waffles or chunky chips
Steamed or raw vegetable batons
Broccoli spears, green beans, asparagus
cubes
Cheese cubes
Salad - as above
Grilled cheese on toast
Fresh fruit - individually or chunky fruit salad
Snacks
Vegetable batons
Buttered malt loaf or tea loaf
Fresh fruit portions – try with a yogurt dip
Cheese and crackers
Spanish omelette or frittata
Paninis
Remember to consider food safety advice and don’t leave food out which can become contaminated.
Finger food may not be suitable for someone with swallowing difficulties as the texture might not be appropriate. Speak with your GP to be referred to a Speech and Language Therapist.
Tofu
Good mouth care
Good mouth care is important for health and wellbeing. It helps maintain the ability to eat, improves ability to taste, and helps avoid mouth or gum infections. It is especially important for those on a pureed or thickened food diet (because of swallowing difficulties), those with a preference for sweet foods, and anyone eating frequent snacks.
How to... ensure good mouth care
• Brush teeth and gums with fluoride toothpaste twice daily
• Clean dentures twice daily
• Have regular dental checks
• Encourage drinking milk as it is nutritionally rich and ‘tooth friendly’
• Some medication can cause a dry mouth and it may be necessary to ask a dentist to prescribe high fluoride toothpaste
• If tooth brushing is refused, try again another time –refer to the resource below for further advice.
Special diets and person-centred care
It is important to consider the individual needs of the person living with dementia. Verify any existing advice in place for managing their diet, as there may be other conditions that can be managed through dietary changes. Some people may follow a special diet or have specific dietary requirements recommended by a dietitian or doctor for conditions such as high blood pressure, high cholesterol, or coeliac disease.
Diabetes
Most people with diabetes can eat the same healthy diet as recommended for the rest of the population. However, dementia can make the management of diabetes difficult and poorly controlled diabetes can impact on the safety and wellbeing of people living with dementia. It is important to have a regular review with your GP or diabetes team as dementia progresses.
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (E5) Guide to Diabetes
• (E6) Diabetes Recipe Finder
• (A9) African, Caribbean and South Asian Food Guide | Healthier You NHS Diabetes Prevention Programme
• (E7) Healthy Eating for the South Asian Community (Diabetes UK) – Recipe Search
Swallowing difficulties (Dysphagia) explained
Dysphagia is the medical term for swallowing difficulties and there is a high prevalence in older people living with dementia at home. As a result, they are at increased risk of undernutrition, dehydration and breathing in food particles (aspiration) which can lead to aspiration pneumonia or severe chest infections.
How to... spot the signs of dysphagia
• Coughing or choking at mealtimes
• Sensation of food getting stuck in the throat
• Bringing food back up
• Frequent heartburn
• Pouching /holding food in the mouth
• Difficulty controlling food or drink in the mouth
• Drooling saliva
• A hoarse voice or ‘gurgly’ wet sounding voice
• Unexplained weight loss
• Frequent chest infections.
What you can do
If you have any concerns that the person you care for is showing signs of dysphagia, see your GP to be referred to a Speech and Language Therapist who may may make various recommendations which could include a texture modified diet and changes to the texture of food and drink.
Monitoring and care planning
Practical ways to monitor and spot the signs of poor nutrition
Having a simple conversation about appetite, weight, and any noticeable changes is a good way to spot and monitor signs of poor nutrition. A useful tool like the Patients Association Nutrition checklist can encourage these conversations by asking 4 simple questions. In this guide, we have adapted section A of the checklist to offer a starting point and to determine where further assistance is needed.
Adapted from: The Patients Association and Health Innovation Wessex.
It is helpful to monitor and keep an eye on the person’s progress over time. Raise any concerns with your care provider, and work with your home care professional to ensure that any additional nutritional support is consistent.
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (M1) The Patients Association Nutrition Checklist (plus section B-D and online version)
• (M5) National Institute for Health and Care Excellence (NICE) | Nutrition Support in Adults
Relationship: work ing together
Working together with home care professionals
Maintaining a positive working relationship with home care professionals is vital. They play a critical role in the life of the person living with dementia and rely on the support of family carers and friends to deliver person-centered nutritional care and improve outcomes.
When planning and shopping for meals, it is important to work together, keeping the preferences and needs of the person living with dementia as a top priority. Depending on the person’s needs, home care professionals can assist with meal preparation. Ensuring easy access to food is crucial for providing meals and drinks to your loved one.
Maintaining good and effective communication with the home care professional and the care provider is crucial to ensuring nutritional care remains consistent.
About my cultural, and religious preferences
Enhancing the mealtime experience and activities
Identifying food preferences
Understanding life histories can encourage meaningful participation in the eating and drinking process for people living with dementia at home. It is crucial for people to have control and involvement in their food and drink choices. Keeping a record of their preferences becomes increasingly important as dementia progresses and it becomes even harder to communicate.
About me and my Eating & Drinking
About me and my Eating & Drinking is a simple tool that can be used to record details about the person living with dementia and their specific preferences. It can be completed as early as possible and updated as necessary. It is not a medical document, but the information provided can assist home care professionals and those involved in their care in building a better understanding of the person’s likes and dislikes. Please only include any details you are comfortable sharing. See below for the link to download a one-page copy and update as needs change.
About me and my Eating & Drinking
Consider
• What type of foods do you like?
• What type of drinks do you like?
• What foods do you dislike?
• What types of finger foods do you like?
• Do you have a time-of-day preference for certain foods and drinks?
• Would you need assistance choosing foods from your home menu?
• How would you prefer to be assisted to eat and drink?
• Do you have a special crockery for eating and drinking?
• Do you require your dentures to eat?
• Do you need to have your food cut into smaller bit sizes?
• Do you have difficulties swallowing your food?
• Does the food texture need to be modified?
• What special dietary needs do you have?
• What are your religious and cultural preferences regarding foods and drinks?
Name I liked to be called
About my cultural, and religious preferences
About my eating
About my cultural, and religion
About my drinking
Information completed by
Date completed
Your role/relationship
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (M3) About Me and My Eating & Drinking (Adapted TOMATO – download the one-page version for use)
• (E1) This is me® Leaflet: Alzheimer’s Society
Meal planning and person-centred needs
Meal planning in advance is important to ensure food is available and accessible while considering the preferences of the person living with dementia. Where needed, consider pre-prepared meals and microwave meal options which can be planned and ordered online for ease of access. When planning meals and aiming to introduce variety to mealtimes, consider the following tips.
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (E12) Ready-made and Pre-prepared meals
Tips for meal planning and preparation
• The smell of fresh food being prepared may induce appetite. Some strong-smelling foods may evoke positive memories or associations e.g. curries
• Pre-prepared and microwave meals are options to consider, especially if cooking at home is difficult. These can be planned in advance for ease of access and delivered via home delivery services
• Work together with the care professionals and home care provider to ensure that everyone involved in the care of the person living with dementia stays up to date about their changing preferences and that meals are planned in advance accordingly
• Taste changes – as dementia develops, people may prefer stronger tastes e.g., sweet and sour. Use herbs and mild spices
• Mini meals – small manageable meals (and second helpings) can be less daunting than large quantities of food or consider offering more frequent smaller meals in place of 3 main meals a day
• Grazing food and snacks can help boost food intake for those who struggle to concentrate or walk around – finger food is ideal e.g., bowls of chopped up fruit, and sausage rolls
• Breakfast cereals (fortified with vitamins and minerals) with fortified full fat milk (see page 7 for recipe) is a useful source of nutrition – great for grazing or night-time meals.
Consider menu planning for the week ahead with the person. You can use the template below and include photos of the food to reflect their preferences.
Monday
Name of food/drink
Tuesday
Name of food/drink
Wednesday
Name of food/drink
Thursday
Name of food/drink
Friday
Name of food/drink
Consider the below cupboard items shopping list. Carers living in separate households can arrange an online grocery delivery while staff are present, followed by a call or video call to check stock levels and plan for the upcoming week.
Tinned vegetables and fruits
Porridge Oats
Dried fruits (raisins, dates, figs)
Tea bags or instant coffee (based on preference)
Peanut butter, honey, marmalade and jam
Mayonnaise
Tinned meats, fish and lentils (based on preference) Skimmed milk powder
Tinned custard and rice pudding
Tinned baked beans and sweet corn
Tinned tomato sauce, hot sauces, and spices
Powdered cream sauces, gravy granules
Wheat meal powder, semolina powder
Suggestions for shopping list | freezer inventory
Frozen vegetables (e.g. broccoli)
Frozen fruits (e.g. mixed berries)
Ready meals/pre-prepared meals
Tinned condensed milk
Bag of rice, spaghetti, macaroni
Hot chocolate drink powder, Horlicks, Milk shake powder
Fruit Juice and squash
Tinned in fruit juice
Frozen desserts (fruit crumbles, puddings)
Garlic bread
Frozen finger foods (sausages, fish fingers, samosa etc.)
Lunch Dinner Snack Drinks
Encourage independence at mealtimes
Eating and drinking are actions our brains remember well. Even for people living with dementia, these activities might be among the last things they can do independently. Therefore, it’s essential to support their independence in eating and drinking for as long as possible.
How to... encourage independence at mealtimes
• Put food on the table nicely presented and easy to reach so the person can serve themselves
• Consider using bowls with deep sides, or specialist crockery and cutlery
• Consider lightweight plates, such as high-quality melamine with a broad rim for a better grip
- Specialised lightweight glasses and cups - Lipped plates
• Bright coloured plates to help differentiate food (plain blue, yellow, red and green have all been shown to help increase appetite). Colour requirements may vary with different people living with dementia
• Consider weighted handle cutlery or specially adapted ones
• Support your loved one to eat and drink where required, open packets, cut up food or pour drinks. As dementia advances put hand over hand and help the person to eat
• Give positive encouraging prompts
• Allow sufficient time for food and drink to be enjoyed.
Specialist crockery for enhanced mealtime independence:
• Specialist crockery are made from specific materials and tailored to meet special needs, enhancing mealtime experiences and promoting independence during meals
• There are specialised lightweight glasses, cups, and high-quality melamine plates and bowls created to support people living with dementia. This is especially beneficial for those facing mobility issues, visual impairments, or a tendency to accidentally knock over their plates of food
• The melamine plates also contribute to keeping food warmer for an extended period and are often available in bright colours. This enhances contrast with the food, making it easier for people to see their meals on the plates
• They are designed to facilitate easier manipulation of food, thereby contributing to an improved overall mealtime experience
• Contact your GP for advice. An Occupational Therapist may be able to help, depending on local referral criteria.
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (E10) Alzheimer’s Society Online Shop | Eating and Drinking
Food presentation
Even at home, food presentation is matters. It is often said 'we eat with our eyes'. Presentation is essential, especially for someone living with dementia at home, so remember to take time to make food look appealing.
Colour
Two or three colours on a plate are more interesting and appealing than just one. Make sure each food is clearly visible on the plate.
Balance
Consider choosing foods that offer variety and contrast and think about different textures (for those not on a texture modified diet). You could serve soup alongside crunchy croutons, pair crisp vegetables with noodles, or present roast potatoes with cauliflower cheese.
Foods with modified texture
Adding a variety of different shapes can enhance the food presentation. For example, meatballs, mini whole potatoes and round-cut carrots are all similar shapes. How about substituting the whole potatoes for mashed ones and grating the carrots instead?
Portion size
Use an appropriately sized plate to prevent food from falling off the edges or appearing lost. A plate that matches the portion size helps make the meal look more appealing and easier to manage, supporting independence.
People with dysphagia, after being evaluated by a Speech and Language Therapist, might be recommended to alter the texture of their food and drinks for safer and more comfortable swallowing. The way modified foods are presented makes a difference. Any meal that is blended together will end up looking the same – brown, sloppy and unappetising. Remember to puree foods seperately.
Sense organs
As dementia progresses, the decline in the ability to taste, smell, and see foods can significantly affect the capacity to recognise and derive pleasure from meals.
• Vision impairment is common and often accompanied by reduced peripheral vision, making it increasingly difficult to see things to the side
• Someone living with dementia in their own home may have difficulty in judging distance, as well as the depth and size of objects
• The loss of ability to see detail and the presence of a thicker lens make objects, including food, appear cloudy. Consider their sensory needs (e.g. clean eyeglasses) to enjoy the meal experience and make sure they are comfortable
• As the brain starts to change, a liking for sweet foods can become a dominant factor for food choice in people living with dementia
• Sensitivity to sour, bitter and salty tastes become reduced whereas sensitivity and enjoyment of sweet tastes can remain the same or increase
• The number of taste buds will also reduce, which happens as part of ageing, and less saliva is produced whilst eating
• Since the preference for salty, spicy and sour food can change, take the opportunity to make good use of natural flavour enhancers such as herbs, tomato puree, cheese, Marmite and spices.
Tips to stimulate the senses
• Use of aromas and spices, herbs and other foods to evoke memories
• Sounds such as waves crashing or bacon sizzling to prompt reminiscence
• Food tasting – fruit, cheese, vegetables, smoothie and milkshake samples
• Use of natural flavour enhancers to stimulate the senses at mealtimes – spices, herbs, tomato puree, parmesan cheese, mushrooms, low salt soy sauce. Use especially with pureed meals
• Make food look appealing – presentation is important
• Encourage good oral hygiene
• Switch between different foods – taste buds and odour sensors can become saturated quickly making it difficult to continue tasting the same foods
• Use brightly coloured crockery to clearly identify food.
Avoid adding too much salt to food because of the risk of increasing blood pressure.
Social interaction during mealtimes at home
For people living with dementia, mealtimes at home can serve as the highlight of the day and provide an opportunity for social interaction. Regardless of your living arrangement—whether it is in the same house, within the same community but different homes, or even separated by distance with occasional visits—ensuring that meals are enjoyable remains vital for your loved one living with dementia.
• Eating and drinking together can have such a positive impact with great benefits for the person living with dementia. Sitting down for a meal with a family member can evoke familiar memories of past eating experiences and can be an encouragement to prompt eating and drinking by ‘copycat’ behaviour
• Eating is one of the key actions people living with dementia at home can continue with, so it is important to maintain independence for as long as possible. A relaxed environment is needed for eating. It’s important to avoid distractions and ensure there are sufficient clues to identify the area as the eating area
• People living with dementia may prefer foods that they were familiar with in their past, which could be linked to specific moments in their lives
• Assistance with eating should be provided in a way that is most comfortable and culturally familiar. For example, using hands to eat food instead of knives, spoons, and forks.
Tips for mealtimes
• Where possible, set a table to provide visual cues that it is a mealtime. You can set the table together as a social activity with the person living with dementia
• Consider using contrasting plain colours (no patterns) to provide a visual contrast between food and the plate e.g., if you have a white plate, you can use it on a green tablecloth. Consider using non-slip plain colour placemats
• Lighting is important and can enhance vision as well as creating the right mood and atmosphere
• Soothing background music – no distractions such as TV, vacuuming or other distracting sounds
• Ensure food is visual
• If clothing protection is needed avoid using a bib, instead provide an apron or napkin.
Eating out
Eating out is a sociable and enjoyable experience and there is no reason why this should not continue. Visiting a favourite restaurant or café can bring back positive memories and connections. When in a different environment, some people find it helpful to mention that they are living with dementia and may behave differently. One suggestion is to carry a card which can be discreetly handed to waiting staff to say the person has dementia and may say or do things which are unexpected, with a 'thank you' for understanding.
Consider social gathering where food and drink will be provided, such as activities with your local dementia group or memory café.
Practical suggestions on food-related activities
Activity can promote a sense of shared purpose and a strong sense of belonging. All types of meaningful activities can promote a sense of independence and wellbeing which positively impact on appetite. Activity around food and the mealtime process can help people living with dementia get ready for eating and stimulate the senses. As much as possible, the person living with dementia at home should be encouraged to engage with the entire mealtime process such as: helping to prepare food, set the table, pull out the chairs or put dishes away.
Also, remember to stay flexible and adapt to any changes. Having undertaken an activity one day, be prepared for sudden changes where they may become unable to do a task or simply do not wish to do it. It is best to accept their decision.
Activities involving movement can help stimulate appetite as well as improve other aspects of health.
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (E11) Chair-Based Exercise
Tips for activity to enhance appetite
Daily tasks:
• Helping to set the table by laying cutlery or napkins
• Clearing away dirty plates
• Washing or drying up
• Placing condiments on tables
• Sandwich making.
Conversations around:
• Childhood food
• Growing their own food
• Helping parents prepare food
• Cooking for their family
• Past meals that were special e.g., holidays, key events - birthdays, eating out, favourite locations.
Suggestions of other activities:
• Walking in the garden, if possible
• Throwing a ball or bean bag
• Swaying, dancing, or moving to music
• Stretching exercises
• Chair based exercises
• Growing fruit and vegetables
• Trips to local pub, coffee shop, tea rooms, garden centre.
Consistency of care
How to... communicate well, verbally
• Use simple language as appropriate
• Say who you are or reintroduce yourself. Sometimes you might have to say so more than once; if so, be patient, do it calmly, and with reassurance
• Say what you are doing so your actions are not a surprise
• Ask if you can help or if they can help you (but you take the lead)
• Keep sentences short and to the point. Draw on their preferences. Instead of asking “Do you want tea or coffee?” consider asking, “Would you like a cup of tea now?” (See About Me and my Eating & Drinking)
• Try not to offer many choices or have just two options at mealtimes. Too much choice can be confusing. Give a first option, and if not received well, offer the second option
• Don’t raise tone of voice or be patronising
• Speak clearly and at a relaxed pace as information may take longer to understand and process –speaking quickly may cause distress
• Allow plenty of time to respond – 10 seconds is not unusual.
Communication
Good communication is the foundation of a strong relationship. It involves expressing oneself, being listened to, and being understood. As dementia progresses, communication skills become increasingly difficult for both the people living with dementia and their family carers and friends. Likes and dislikes may change over time, so it is important to communicate about food preferences.
How to... communicate well, non-verbally
Gaining attention:
• Approach the person so that they can see you
• Acknowledge their presence
• Before assisting with eating and drinking, try to have the person’s attention
• Make eye contact and ensure the person is able to see what is about to happen
• Distractions can get in the way – TV, other conversations.
Body language:
• Try to be calm and unhurried to show that you are focusing attention – moving quickly or showing agitation may cause confusion
• Use ‘objects of reference,’ like showing a cup or glass to enable them to choose a hot or cold drink. Also, consider using pictures to indicate mealtime and provide options for them to choose from.
• Provide reassurance – if appropriate, hold the person’s hand to help focus on what is being said.
Listening:
• Listen even when they are not speaking by observing their body language.
• Allow the person to express their feelings about food
• Be patient and allow the person to eat and drink how they wish
• Listen and show care and understanding
• Be patient and offer encouragement if someone has difficulty finding correct words.
Taking care of your own wellbeing as a family carer and friend
Taking care of a family member or close friend living with dementia at home can be a fulfilling experience with positive moments, but it can also bring its own set of challenges. It is common to prioritise the needs of the person you are caring for over your own, but it is very important to recognise that your own needs are equally significant. It is important to take care of yourself to ensure you can provide the best possible support to the person you are caring for.
Talk to other carers
Talking and sharing your experiences with fellow carers can offer valuable support. Get in touch with your GP or local social services department for information about nearby support groups.
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• Carers Connect
• Alzheimer’s Dementia Talking Point
Aim for at least 5 portions of a variety of fruit and vegetables
• Base your meals on carbohydrates (potato, yam, rice, grains), choosing wholegrain where possible
• Have some dairy or dairy alternatives (such as soya drinks), choosing lower fat/sugar options
• Eat some beans, pulses, fish, eggs, meat and other proteins (2 portions of fish every week, one should be oily)
• Choose unsaturated oils and spreads; eat in small amounts
Don’t be afraid to ask for help
Family members and friends can be a great source of help. They might be able to cover for you even for a few hours or assist with other household tasks, giving you a short break. There are local charities with group membership, local memory cafés, and voluntary organisations that offer support and advice on their websites and helplines.
To learn more visit www.bournemouth.ac.uk/TomatoPOI or call the advice lines:
• Age UK’s Advice Line 0800 678 1602 (free)
• Carers UK on 0800 808 7777 (free)
• Aim for at least 1,600ml (women) and 2,000ml (men) of fluids daily, (7–8 mugs of 250ml)
• Salt or sugar should be eaten less and in small amounts
• For older adults 65 years and over, it is best to focus on eating, drinking, and ageing well. As we age, the body requires more protein, calcium, folate (folic acid), and vitamin B12 for overall health.
Healthy eating resources
The Eatwell Guide: A simple visual representation which show the proportion of different foods and drinks needed for a healthy balanced diet.
Please note: The reference to the Eatwell Guide here is primarily a guidance for you but may not be appropriate for people living with dementia due to their specific needs and underlying problems.
Source: Public Health England in association with the Welsh Governement Food Standards Scotland and the Food Standards Agency in Northern Ireland. © Crown copyright.
The Eating, Drinking and Ageing Well Resource: A public health resource for older adults, providing a practical guide to healthy eating, offering age-appropriate messages, and highlighting the latest evidence on food and nutrition.
Source: The British Dietetic Association’s (BDA) Older People Specialist Group, with support from Friends of the Elderly and the British Geriatrics Society. ©The British Dietetic Association (BDA) 2023 - bda.uk.com
To learn more visit www.bournemouth.ac.uk/TomatoPOI to view
• (T2) Eatwell Guide
• (A3) Eating, Drinking and Ageing Well - British Dietetic Association
• (A4) Eating, Drinking and Ageing Well - Easy Read Version - British Dietetic Association
• (T3) African & Caribbean Eatwell Guide
• (T4) Healthy Eating for the South Asian Community (Diabetes UK) – Recipe Search
• (A9) African, Caribbean and South Asian Food Guide | Healthier You NHS Diabetes Prevention Programme
• (A7) Diabetes Recipe Finder
Provision of information
Sourcing trusted information
The internet can be very helpful, but there is also a great deal of conflicting advice out there. Whilst we have provided a lot of information in this guide about food and drink, we have put together a webpage with links to some helpful information to help you get started.
Always look for evidence-based information from a trusted, credible source such as government agencies, universities, charities, nutrition journals, hospital trusts.
The British Dietetic Association (BDA) and the British Nutrition Foundation (BNF) offer up-todate, evidence-based information from reputable sources regarding nutrition and hydration.
On the BDA website, you can find Food Fact Sheets specific to adults and older adults, covering various topics such as identifying and treating malnutrition and dehydration, associated health problems, diets, probiotics and gut health, as well as supplements. The BNF provides free access to webinars and information on various health conditions, life stages, and sustainable diets.
About expert nutrition professionals in the UK:
• HCPC Registered Dietitians are qualified and regulated health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public-health level. The title ‘dietitian’ is protected by UK law. Only individuals registered with the UK Health and Care Professions Council (HCPC) can describe themselves as a dietitian.
• UKVRN Registered Nutritionists provide evidencebased information and guidance concerning the impacts of food and nutrition on the health and wellbeing of humans (at an individual or population level) or animals. They serve as trusted and reliable experts in nutrition, regulated by the Association for Nutrition (AfN), which acts as the voluntary regulator for Registered Nutritionists (UKVRN).
• Healthcare professionals, including doctors and nurses, will be affiliated with their respective UK statutory bodies such as GMC or NMC. They may possess additional qualifications in nutrition, such as a postgraduate degree, to ensure they can offer nutrition advice to the public safely and competently. Additionally, these healthcare professionals may also be Registered Nutritionists.
To learn more, visit these websites:
• Project website www.bournemouth.ac.uk/TomatoPOI
• British Dietetic Association (BDA) https://www.bda.uk.com
• British Nutrition Foundation (BNF) https://www.nutrition.org.uk
or call:
• Alzheimer’s Dementia Support Line 0333 150 3456
Acknowledgements
Contributors
Profound appreciation to everyone who contributed towards producing the adapted guides and for supporting the overall TOMATO project.
Patient and Public Involvement (PPI) and Project Steering Group
Thank you to the dedicated TOMATO project PPI Group and the Project Steering Group for their invaluable contributions, which have greatly influenced the development of the study and future direction.
Dr Gladys Yinusa
Post-Doctoral Research Fellow
Bournemouth University and NIHR DEM-COMM Fellow
NIHR ARC Wessex
Dr Sarah Thomas
Senior Researcher
Centre for Wellbeing & Long-Term health
Bournemouth University
John Major
TOMATO Public and Patient Involvement lead Lay representative
Helen Knight
Clinical Head of Service for Neurology & Adult Speech and Language Therapy
Leeds Community Healthcare
NHS Trust
Professor Jane Murphy
Chief Investigator
Professor of Nutrition
Registered Nutritionist and Dietitian
Deputy Dean for Research Bournemouth University
Professor Lee-Ann Fenge
Professor of Social Care
Registered Social Worker Bournemouth University
Dr Jane Townson
CEO for the UK Homecare Association (UKHCA) Homecare Association
Caroline Hemmings
Creative Design and Administrative Support Officer Bournemouth University
Professor Claire Surr
Professor of Dementia Studies
Director of the Centre for Dementia Research
Leeds Beckett University
Professor Gordon Taylor
Professor of Medical Statistics University of Exeter
Dr Michelle Heward
Lecturer in Psychology
Dementia Champion
PPIE-lead Academic Bournemouth University
Dr Daniel Howdon
Senior Research Fellow of Health Economics School of Medicine University of Leeds
Thank you to Alexsa Brooks for her assistance with supporting Caroline Hemmings with the design of this guide.
Collaborating organisations
We recognise and appreciate all the collaborating organisations; Good Oaks Home Care; Home Instead Warrington & Lymm; Home Instead Hammersmith & Chiswick; Love in Care; Westmorland Homecare; and Home Instead Worcester, along with its Cheltenham, Warwick, and associated franchises providing care across the region.
Research participants
A special thank you to the research participants—people living with dementia, family carers, home care professionals, and healthcare professionals—for sharing their experiences and feedback, which shaped the adaptation of this home care guide.
Funding
This project (TOMATO) is funded by the National Institute for Health Research (NIHR) [Research for Patient Benefit (award identifier: NIHR203110)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
