In the late stage of Alzheimer's disease and related dementias (ADRD), a person may no longer be able to eat on their own. They might live at home or in a long-term care setting. No matter the setting, the goal of mealtime is comfort, safety and connection, not just nutrition.
Some people may need help with recognizing food. They may also need help with chewing or swallowing. Meals tend to move at a slower, gentler pace. Changes in movement and other bodily functions can happen, too, so careful, hands-on help is important.
Remember, in the later stage, eating is less about how much someone eats and more about how they feel. Small amounts of familiar, tasty foods can bring comfort. When you offer food with patience, it can lower stress and make each day feel better.
What to Expect for Nutrition, Mealtimes and Shopping
- Noticeable weight loss
- Greater risk of choking or aspiration (accidentally inhaling food or liquid into the lungs) due to weaker swallowing ability
- May not show signs of hunger or may refuse food or drink
- Sleepiness during meals; eating becomes slow and may take a lot of effort
- Difficulty with movement and posture such as sitting up straight, holding utensils or opening the mouth
- Changes in smell, taste and sight; meals may look unfamiliar or unappealing
- Feeling upset when grocery shopping, including questioning why items are chosen and wandering from shopping companions
What to Try
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Take part in regular screenings
Late Stage Take part
- Go to regular doctor visits to watch for problems like poor nutrition and dehydration, trouble swallowing (called dysphagia) and weight loss.
- – Follow your doctor’s advice about safe swallowing and nutrition changes.
- – If you have questions about your condition or treatment, talk with a doctor or ask for help from registered dietitians, speech-language pathologists, occupational therapists, community health organizations, local Area Agencies on Aging or dementia navigators.
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Adjust foods for safe, comfortable eating
Adjust foods
- Cut, mince or purée foods. You may need to thicken liquids. The International Dysphagia Diet Standardisation Initiative’s (IDDSI) framework explains how food and drink textures change as trouble swallowing increases.
- Cut easy-to-hold, moist foods into bite-size pieces before serving.
- Help the person sit upright during and after eating.
WATCH
Helping a Person with Alzheimer’s Disease to Eat
Source: Melissa Batchelor, PhD
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Focus on nourishment and enjoyment
Focus nourishment
- Help the person eat enough, even if it means eating less healthy foods.
- Add vitamins and minerals when needed. This includes adding milk powder, grated cheese, cream, butter or protein powders. Ask your health care team about protein powders or high-calorie shakes.
- Serve foods that bring back positive memories, such as childhood meals or family favorites.
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Support eating with care and patience
Support eating
- Offer help during meals. This includes close watch, gentle reminders, hand-over-hand help, proper seating and simple tools.
- Never force food. Watch for signs that the person is ready and feels comfortable.
- Give plenty of time to eat. A meal may take up to an hour.
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Create calm, supportive mealtimes
supportive mealtimes
- Eat together when you can. Shared meals can support appetite.
- Turn off the TV, use soft lighting and reduce noise.
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Simplify choices, routines and tools
Simplify choices
- Offer different foods, snacks and drinks, but limit choices to 2–3 at a time.
- Choose utensils and tableware that are easier to use.
- Serve easy-to-eat, soft foods and thickened drinks, as directed by a care team, to support safe eating.
- Give simple visual or verbal cues like pointing or gentle reminders to guide eating without causing stress.
What to Watch For
Contact your health care team if you notice:
- Signs of choking, such as coughing or gurgling sounds before, during or after eating or drinking
- Eating less than usual
- Clenching the mouth shut or refusing to open mouth
- Frequent congestion or wet-sounding breathing after meals
- Signs of dehydration, such as cracked lips or reduced urination
- Weight loss, weaker muscles or feeling tired
Visit these resources for more helpful information
Caring for the Care Partner
As ADRD advances, the ways you can care for your loved one may keep changing. You may need to give more hands-on help, mealtimes can take longer and daily routines may not look the same as before.
Don’t forget, your health matters. Try these tips:
Take care of your own nutrition
- Even when you have less time and energy, regular meals and enough hydration matter.
Accept help from others
- Support with meals or daily tasks can give you a break and time to rest.
Stick to shared mealtimes when you can
- Even if your loved one needs help eating, sitting together can bring comfort and connection.
Watch for signs of burnout
- If you feel very tired, lose weight or feel strong sadness, think about reaching out to a doctor or counselor.
Why this matters
As your loved one needs more care, it is important to care for yourself, too. Taking care of your own health helps you stay close and involved. Sharing meals or quiet time can still bring comfort for both of you.
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