Regular, nutritious meals may become a challenge for people living in the middle and late stages of Alzheimer’s. They may become overwhelmed with too many food choices, forget to eat or think they have already eaten. 


Nutrition tips

Black family eating together, with a woman putting salad on a plate that a man is holding for an older woman,Proper nutrition is important to keep the body strong and healthy. For a person with Alzheimer's or dementia, poor nutrition may increase behavioral symptoms and cause weight loss.

The basic nutrition tips below can help boost the person with dementia's health and your health as a caregiver, too.

  • Provide a balanced diet with a variety of foods. Offer vegetables, fruits, whole grains, low-fat dairy products and lean protein foods.
  • Limit foods with high saturated fat and cholesterol. Some fat is essential for health — but not all fats are equal. Go light on fats that are bad for heart health, such as butter, solid shortening, lard and fatty cuts of meats.
  • Cut down on refined sugars. Often found in processed foods, refined sugars contain calories but lack vitamins, minerals and fiber. You can tame a sweet tooth with healthier options like fruit or juice-sweetened baked goods. But note that in the later-stages of Alzheimer's, if appetite loss is a problem, adding sugar to foods may encourage eating.
  • Limit foods with high sodium and use less salt. Most people in the United States consume too much sodium, which affects blood pressure. As an alternative, use spices or herbs to season food.

As the disease progresses, loss of appetite and weight loss may become concerns. In such cases, the doctor may suggest supplements between meals to add calories.

Staying hydrated may also be a problem. Encourage fluid intake by offering small cups of water or other liquids throughout the day or foods with high water content, such as fruit, soups, milkshakes and smoothies.

Possible causes of poor appetite

  • Not recognizing food. The person may no longer recognize the foods you put on his or her plate.
  • Poor fitting dentures. Eating may be painful, but the person may not be able to tell you this. Make sure dentures fit and visit the dentist regularly.
  • Medications. New medications or a dosage change may affect appetite. If you notice a change, call the doctor.
  • Not enough exercise. Lack of physical activity will decrease appetite. Encourage simple exercise, such as going for a walk, gardening or washing dishes.  
  • Decreased sense of smell and taste. The person with dementia may not eat because food may not smell or taste as good as it once did.

Make mealtimes calm and comfortable

During the middle stages of Alzheimer's, distractions, too many choices, and changes in perception, taste and smell can make eating more difficult. The following tips can help:

  • Limit distractions. Serve meals in quiet surroundings, away from the television and other distractions. 
  • Keep the table setting simple. Avoid patterned plates, tablecloths and
    placemats that might confuse the person. Using color to contrast plates against
    a tablecloth or placemat can make it easier for the person to distinguish the
    food from the plate or table. Consider using a plastic tablecloth, napkins or
    aprons to make cleanup easier. Provide only the utensils needed for the meal to avoid confusion.
  • Distinguish food from the plate. Changes in visual and spatial abilities may make it tough for someone with dementia to distinguish food from the plate or the plate from the table. It can help to use white plates or bowls with a contrasting color place mat. Avoid patterned dishes, tablecloths and place mats.
  • Check the food temperature. A person living with dementia might not be able to tell if something is too hot to eat or drink. Always test the temperature of foods and beverages before serving.
  • Offer one food item at a time. The person may be unable to decide among the foods on his or her plate. Serve only one or two items at a time. For example, serve mashed potatoes followed by the main entree.
  • Be flexible with food preferences. It is possible the person may suddenly develop certain food preferences or reject foods he or she may have liked in the past.
  • Allow plenty of time to eat. Keep in mind that it can take an hour or more for
    the person to finish.
  • Eat together. Give the person the opportunity to eat with others. Keeping mealtimes social can encourage the person to eat.
  • Keep in mind the person may not remember when or if he or she ate. If the person continues to ask about eating breakfast, consider serving several breakfasts — juice, followed by toast, followed by cereal.

Encourage independence

Home Safety Checklist

Download, print and keep the checklist handy to prevent dangerous situations and help maximize the person’s independence for as long as possible.

During the middle stage of Alzheimer's, allow the person with dementia to be as independent as possible during meals. Be ready to help, when needed.

  • Make the most of the person's abilities. Adapt serving dishes and utensils to make eating easier. You might serve food in a bowl instead of on a plate, or try using a plate with rims or protective edges. A spoon with a large handle may be less difficult to handle than a fork, or even let the person use his or her hands if it's easier.
  • Serve finger foods. Try bite-sized foods that are easy to pick up, such as chicken nuggets, fish sticks, tuna sandwiches, orange segments, steamed broccoli or cauliflower pieces. Or make a meal in the form of a sandwich in order to make it easier for the person to serve him or herself.
  • Try hand-over-hand feeding. Demonstrate eating behavior by putting a utensil in the person’s hand, placing your hand around theirs and lifting both of your hands to the person’s mouth for a bite.
  • Don't worry about neatness. Let the person feed himself of herself as much as possible. Set bowls and plates on a non-skid surface such as a cloth or towel. Use cups and mugs with lids to prevent spilling. Fill glasses half full and use bendable straws.

Minimize eating and nutrition problems

In the middle and late stages of Alzheimer's, swallowing problems can lead to choking and weight loss. Be aware of safety concerns and try these tips:
  • Prepare foods so they aren't hard to chew or swallow. Grind foods, cut them into bite-size pieces or serve soft foods (applesauce, cottage cheese and scrambled eggs).
  • Be alert for signs of choking. Avoid foods that are difficult to chew thoroughly, like raw carrots. Encourage the person to sit up straight with his or her head slightly forward. If the person's head tilts backward, move it to a forward position. At the end of the meal, check the person's mouth to make sure food has been swallowed. Learn the Heimlich maneuver in case of an emergency.
  • Address a decreased appetite. If the person has a decreased appetite, try preparing some of his or her favorite foods. You may also consider increasing the person’s physical activity or plan for several small meals rather than three large meals.

Help is available