Dementia Caregiver Web Support

Eating and Oral Care

Over time, persons with dementia may begin to experience difficulties completing basic activities of daily living by themselves.  These activities can include eating, bathing, dressing, and grooming.  Keep in mind the following information related to eating and oral care.

Changes in Eating Habits

Your loved one may have changes in eating habits or decreased appetite.  These problems can be caused by:

• Side effects from medication, such as change in bowel patterns or difficulty swallowing. Dry mouth is a common side effect of many antipsychotic drugs, which could make it difficult to swallow and even chew. The caregiver may need to make sure food items are cut small enough to swallow, OR you may need to change your loved one’s diet to incorporate softer food items, such as pureed foods.
• Mouth discomfort such as poorly fitted dentures or tooth decay
• Inability to recognize hunger
• Inability to recognize differences between food and non-food items
• Depression
• Forgetting to eat, or forgetting HOW to eat. You may need to remind your loved one to "chew the food" and to "swallow the food" so they don't store food in their cheeks.
• Hoarding food items can be a common practice in persons with dementia. You might find food being hidden in random cabinets or shelves throughout your home. Your loved one might even "pocket" food that they dislike in an effort not to eat it.
  
  

Good Eating Habits

Some tips to assist your loved one in good eating habits include:

• Encourage your loved one to sit up straight with head slightly forward
• Present food no more than 2 feet away from person
• Give only one utensil at a time
• Use a bowl instead of a plate
• Allow enough time between bites
• Avoid distractions, such as electronics or loud music, while eating. You want them to be able to focus on their meal
• Keep the table setting simple
• Make sure there is good lighting in the dining area
• Offer meals at regular times and in the same place each day
• Offer liquids frequently IF your loved one has difficulties chewing or swallowing. However, you should monitor and restrict fluid intake with meals if he/she tends to fill up on liquids prior to eating. 
• Offer finger foods or bite size pieces of food if your loved one has difficulty chewing or swallowing. Grinding or pureeing foods might be even easier for your loved one to chew/swallow.
• Monitor for signs of choking. Remember that when a person is really choking, they are unable to speak, cough or breathe, so you may not even hear that it is happening. You should avoid foods that are difficult to chew thoroughly, like raw carrots. You might be interested in learning the Heimlich maneuver in case of an emergency.
• If your loved one has a poor appetite, try making his/her favorite foods and planning for several small meals throughout the day, rather than three large meals.
  
  

Eating In Public

Eating in a public place could be difficult for your loved one with dementia.  To make your dining experience as enjoyable as possible we have included a few recommendations.

• Sit in a quiet part of the restaurant away from the main walkway
• Your loved one should sit in a chair that faces a wall to avoid distractions. Again, you want him/her to focus on the task at hand, which is eating. 
• Have your loved one wear a colorful shirt to help disguise any spilled foods or liquids from the meal
  
  

Oral Care

As Alzheimer’s disease progresses, the person with dementia may forget how to brush their teeth, or forget why it’s so important. As the caregiver, you may need to assist more with dental care, since proper oral care can prevent eating problems, digestive issues and infections.

In the early stages of dementia, dental care should focus on prevention. Ensure your loved one has regular check-ups and cleanings, and brush and floss regularly.

During the middle and late stages of dementia, when your loved one may forget how to properly brush their teeth, try the following tips:

• Provide clear and simple instructions such as “hold your toothbrush like this,” and “put the paste on the brush” and “brush your teeth.” “Brush your teeth” may be too vague and confusing to your loved one.
• Allow your loved one with dementia to watch you brush your teeth.
• Brush your loved one’s teeth by putting your hand over his/hers and showing them how to perform the act.
• Gently brush his/her teeth, gums, tongue and roof of mouth at least twice a day to keep the mouth clean. 
  
  

Denture Care

Rinse dentures in cool, plain water after meals and brush them daily to remove food. Remove dentures at night and soak them in a denture cleanser or mouthwash. Remember to use a soft toothbrush or moistened gauze to clean the gums, tongue and mouth tissue.

Additional Oral Care Tips

• Experiment with different tooth brushes. A soft bristled children’s toothbrush might work better than a hard bristled adult’s brush. A long handle or angled brush may be easier to use than a standard toothbrush. Whatever you choose, keep it simple. Electric toothbrushes may confuse a person with dementia.
• If flossing your loved one’s teeth becomes too difficult, try using a “proxabrush” to clean between the teeth instead. (For example: Proxabrush Cleaners)
• Refusing to eat or strained facial expressions while eating may indicate mouth pain or dentures that are not properly fitting. Consult with your dentist to determine the underlying cause of dental pain.
  
  

Additional Resources

VA Resources

US Department of Veterans Affairs
VA values your commitment as a partner in our pledge to care for those who have "borne the battle." We have several support and service options designed with you in mind. The programs are available both in and out of your home to help you care for yourself and the Veteran you love.

• Caregiver Support Network
• VA Caregiver Support Line: 1-855-260-3274

Geriatrics and Extended Care Services (GEC) is committed to optimizing the health and well-being of Veterans with multiple chronic conditions, life-limiting illness, frailty or disability associated with chronic disease, agining or injury. This VA site reviews information on delirium, dementia and Alzheimer's care, decision making, home and community based services, and advance care planning, among many other important topics that may be important for you as a caregiver.

Veteran's Crisis Line Phone: 1-800-273-8255 (Veterans Press 1)

The VA does not endorse the following resources or guarantee that their information is 100% accurate.  However, you may be able to find some helpful information by visiting the following pages:

Alzheimer’s Association
Personal Care: Assisting a Person with Middle-or Late-Stage Dementia with Daily Needs

References: Information adapted from Alzheimer’s Association

If you have any questions or concerns, contact Dementia Caregiver Web Support.

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