Fluid and diet management in dementia

Poor appetite, problems with food preparation, depression and difficulties with swallowing or chewing can make it a challenge for people with dementia to get the nutrition they need. Weight loss and dehydration can be a problem, especially in advanced disease, which can make your loved one frail and vulnerable to illness and infections.

Food and drink can be a source of joy, but our diets also provide fuel for living, protein for cell repair, micronutrients for function and water which is essential for life. Calorie needs decrease as we grow older, but a healthy balanced diet is still important. Inadequate nutrition will cause weight loss, muscle weakness, fatigue and increase the risk of falls and infections.

Hydration and dementia

Water makes up an incredible sixty percent of the body, so maintaining adequate hydration is vital for life. People living with dementia can become dehydrated because they may forget to drink, may not recognise that they feel thirsty, or may struggle to communicate their needs.

The sensation of thirst tends to decrease as we grow older, which compounds the problem, especially in someone with Alzheimer’s, stroke or vascular dementia. So, thirst cannot be relied on to indicate dehydration and trigger drinking.

Dehydration can cause headaches, dizziness and a lack of energy. However, it can also make the symptoms of dementia worse by increasing the levels of confusion and irritability. Inadequate fluid intake can also predispose to urinary tract infections, pressure sores, and constipation, causing debility, confusion, and incontinence.

The problem is that there is an overlap between many of the symptoms of dehydration and dementia, so it can be easy to miss the signs. There are a few indicators that someone may have too little fluid on board. Look out for:

• Dry mouth, lips, and tongue
• Sunken eyes
• Lack of elasticity in the skin
• Drowsiness or disorientation
• Dizziness on standing
• Dark, strong-smelling urine

Ensuring proper hydration is an essential part of good care for the elderly and infirm. With someone who struggles to get to the loo, or who has continence issues it can be tempting to restrict fluids, especially at bed-time. However, this can paradoxically make things worse. It is much more critical for health, wellbeing, and function to maintain fluid levels:

• Make sure that a drink is readily available at all times
• Use cups, straws, and receptacles that are easy to hold and resistant to tips and spills
• Clear cups and bottles can act as a visual prompt that there’s a drink nearby
• Provide drinks that are fresh and palatable – try adding fruit slices, ice cubes to increase the appeal
• Offer regular fluids throughout the day, especially with medication and activity
• Offer both hot and cold drinks, remember that tastes change and they may not always want the same beverage
• Fluid doesn’t have to be in the form of drinks; soups, ice-cream, and ice-lollies can all increase liquid intake
• Monitor fluid input and keep an eye on urine output

Diet and dementia

A healthy, balanced diet is important throughout life. There is evidence that what we eat can affect the health of our brains and our bodies. A Mediterranean diet based on fresh foods and natural produce, with lower levels of sugar, salt, and unhealthy fat may help protect against dementia. However, in the later stages of the disease, appetite can be suppressed, and it can be more important to make sure the individual is getting enough calories to fuel their body.

Weight loss and dementia

With a western obesity epidemic, weight loss is usually thought to be a good thing. However, in the frail and often underweight elderly, it can be a real problem. People with dementia are vulnerable to weight loss because of low appetite, depression, difficulties shopping and cooking, fatigue, forgetting to eat and problems recognising hunger. The difficulties increase as dementia progresses when chewing and swallowing food can become a challenge.

If someone has lost their appetite there are a few things to consider:

• Are they depressed? Low mood can reduce hunger and increase the symptoms of dementia. Ask their doctor whether antidepressants could help.
• Is eating painful? Ill-fitting dentures, toothache, mouth sores, and ulcers can all make eating uncomfortable. Think about arranging a dental check-up.
• Are they constipated? Dehydration, decreased activity, and medication can all predispose to constipation. Anyone who is bunged-up may feel bloated, uncomfortable and unwilling to eat. The GP may prescribe stool softeners or laxatives to ease the problem.
• Is chewing or swallowing difficult? Breathing and swallowing require complex coordination, which can be lost in advanced dementia. This can increase the risk of the individual inhaling food or fluids into the lungs, causing dangerous pneumonia. If you’ve noticed coughing or choking when eating or drinking, see the GP – they may refer to a speech therapist for support and guidance.
• Are they happy with the eating environment? When someone is confused or disorientated, lots of things can put them off their food. Feeling rushed, bewildered by unfamiliar people preparing food, paranoid about food safety, or worried about not having a favoured plate or position at the table can all be problems. Offer reassurance and try to respond to their concerns and needs.
• If your loved one is losing weight, speak to their GP, they can review their medication, their health and may refer them to a dietitian. There are also a few ways of tempting their appetite:
• Focus on flavour: As we grow older, our senses become weaker. With less ability to taste and smell, food can seem bland and boring. Seasonings, herbs, and spices can help set their juices flowing and bring a meal to life.
• Little and often: When your appetite has shrunk, big plates of food can seem overwhelming. Offer frequent, small snacks and meals throughout the day.
• Make food easy: Sometimes meals can be a challenge. Hard, tough or chewy foods can be particularly tricky if their gums are sore, their throat is dry, or their dentures are loose. A medical or dental check-up is a good idea but also offer soft stews, soups and custards to keep them nourished.
• A helping hand: Buying, preparing and cooking food requires a complex combination of skills. For someone with dementia, it can be difficult to manage, so it’s easier to go without. Think about arranging a regular food delivery or using professional home carer to come into the home to provide support, prepare snacks and monitor their food and drink input.