Coping with loss of appetite in elderly with dementia

Coping with loss of appetite in elderly with dementia
Mikki Firor, M.S, 2/5/2017
Hanger(n): a strong feeling of annoyance, displeasure, or hostility due to hunger.
Hangry(v): having a strong feeling of or showing annoyance, displeasure, or hostility due to hunger.

Ok, maybe those words are made up but I know that it is something I personally experience when I am hungry. When I haven’t been able to eat, I get irritable but if someone asked me “Why are you so angry?” I have the cognitive ability to express that it is because I am hungry. When I’m asked why I haven’t eaten or why I’m not eating, I am cognitively healthy enough to verbalize that as well. But for someone with dementia, they may lack the cognitive ability to express their needs or even identify the cause of the problem. Ensuring a person with dementia eats a healthy amount may help reduce some “problem” behaviors. Just like me, if I am well fed then I’m in a great mood. More often than not, the refusal to eat is due to age-related changes or the cognitive decline caused by Dementia.

When working in a Dementia Community, I had a resident that refused to sit still and eat. She would sit, take a bite, and then she would walk away sometimes before swallowing. She was a woman on the go but due to the amount of walking and the lack of food intake, she was losing weight at an unsafe rate. We had to increase her food intake.

Ever wonder why your grandmother always had candy stashed in her pocket? As we age, our taste preferences change. In fact, our “sweet tooth” becomes even more prominent. You probably thought the candy was for you! There are solutions available such as milkshakes that contain extra protein and nutrients that are essentially meal replacements.

Pro Tip: I always mix the meal replacement shakes with Chocolate ice cream and put it in a “to-go” cup so that they can drink and walk at the same time!

In addition to taste changes, we experience changes in vision. We have to hold the menu at arms length (presbyopia), we have a harder time reading in dimly lit restaurants, and for someone with dementia, they struggle to determine color and contrast. One of the biggest challenges that occur is when we coordinate the plates to the place mats or tablecloths. For instance, white and gray placemat with a white plate filled with turkey, gravy, and mashed potatoes. These colors are all in the same color family and lack contrast and because of the inability to determine contrast; the other food would be nearly invisible on the plate.

Some research has even suggested that red plates help improve one’s appetite while almost always providing the contrast necessary. A suggestion I make for my clients is to try out the red plastic plates first. If they work, we order a set of red dinner plates for them to use. This is a minor change you can make to improve mealtime for someone with dementia. However, many of us consider other factors when creating a comfortable dining environment.

I visit with clients and spend the day in the same geographic area, which means I make my own office in the middle of a local coffee shop. I have to select the perfect seat on the following criteria:
  • I can’t have a glare in my eye,
  • The sun can’t shine directly on my computer screen
  • I can’t be too close to a bathroom or a door
  • I have to sit away from a drafty vent
  • I have to be wearing layers of clothes

When one of these things is off, it is hard for me to concentrate, though I will manage. For someone with dementia, similar things may prevent him or her from wanting to eat. There is nothing worse than shielding your eyes from the sun while trying to cut a piece of meat, or having to wipe your nose while trying to eat because you’re so cold it is running! This becomes especially problematic at dinnertime, when sundowning (increased confusion usually occurring later in the day) typically occurs. With that said, sometimes the cause may be medically related.

Another resident was refusing all food except mashed potatoes. Now, I love mashed potatoes as much as the next person but watching this resident put a bite of chicken on her fork, chew it, and spit it out made me think: What is going on? As we age a lot of changes can happen in our mouth. Has the dentist ever told you to only floss the teeth you want to keep? Well, not only do most of us do not prioritize oral health care for a majority of our early lives, older adults, especially those with dementia, begin to neglect oral health care all together. If a person with dementia is wincing when eating, choosing soft foods, or refusing to eat all together it could be due to dental changes, including: cavities, abscess teeth, losing teeth, poorly fitting dentures, to name a few. There are dentists that will come to the patient so they don’t have to visit a dental office, which is ideal for someone with dementia.

Another consideration would be a check-up from the doctor. Often illnesses such as a common infection, flu, head cold, or even indigestion or heartburn can prevent someone with dementia from wanting to eat. Additionally, psychological factors such as anxiety, depression, paranoia, hallucinations, and delusions may have the same effect. When we can’t figure out the cause environmentally, it is best to consult with a physician to rule out more serious causes of loss of appetite or desire to eat.


It is hard to say which problem each person is experiencing when they are refusing to eat. Trying things such as: 1) Introducing sweeter foods into their diet, 2) Changing the temperature and lighting and minimizing distractions when dining or 3) Introducing red plates and/or contrast in the meal presentation, can help improve the appetite of someone with dementia. However, when none of these interventions work, a doctor and/or dentist should be consulted to rule out further physical causes. Food is an important part of cognitive health and physical health so a lack of eating should be taken seriously.

Someone with dementia may display undesirable behaviors before they are able to say “I’m hungry” so watch for the non-verbal cues and changes. It is our job, as those who care for and about them, to be detectives so we can solve the problems they’re unable to express. No one wants to be hangry.
Mikki Firor, M.S

Mikki Firor, M.S

Mikki Firor, M.S., is a Gerontologist with a focus in Dementia. She holds a Master’s Degree in Gerontology from McDaniel College. As a dementia consultant and president of Trovato, LLC, Mikki provides education to professionals and care partners of those with dementia regarding neurological impact, safety, communication, management of behaviors, and best practices.
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