There are many reasons why do dementia patients stop eating, ranging from changes in appetite and food preferences to pain, difficulty communicating and problems with chewing or swallowing.
A person with dementia may forget to eat, no longer recognize the food in front of them, struggle to explain what is wrong or simply lose interest in meals.
Sometimes the cause is relatively simple, such as food being too hot, an uncomfortable denture or a medication side effect. In other cases, eating difficulties can be related to the progression of dementia itself.
Reduced food and fluid intake can contribute to weight loss, weakness and dehydration, so a persistent change in eating should not simply be dismissed as part of getting older.
Below we look at seven common reasons a person with dementia may stop eating, followed by practical ways caregivers can help.
Why Do Dementia Patients Stop Eating?
Eating and drinking rely on many abilities that dementia can gradually affect.
A person needs to recognize food, understand what to do with it, coordinate the movements involved in eating, communicate their needs and safely chew and swallow.
At the same time, unrelated health problems can also reduce appetite. This is why it is important to look for the underlying reason rather than assuming the person simply does not want to eat.
1. Chewing or Swallowing Becomes Difficult
As dementia progresses, some people develop difficulty chewing or swallowing.
Difficulty swallowing is known as dysphagia. A person may cough or choke during meals, hold food in their mouth, take a long time to swallow or appear to have difficulty managing certain textures.
The National Institute on Aging explains that swallowing problems become more common in the later stages of Alzheimer’s disease and can increase the risk of choking and food or liquid entering the lungs.
If swallowing appears difficult, speak with the person’s doctor or healthcare team. A speech-language pathologist can assess swallowing and recommend safer ways to eat and drink.
Do not assume that simply switching to puréed foods or thickened liquids is appropriate for everyone. The safest food and drink consistency depends on the individual.
2. They May Have Difficulty Communicating What Is Wrong
A person with dementia may feel hungry but have difficulty communicating it.
They may also be unable to explain that the food is too hot, too cold, difficult to chew or simply something they no longer enjoy.
Pain and discomfort can be difficult to communicate as well.
Instead of saying what is wrong, the person might push the plate away, keep their mouth closed, spit food out or become distressed during the meal.
Watching facial expressions, body language and other nonverbal signals can sometimes help identify the problem.
3. Their Taste and Food Preferences May Change
Dementia can change a person’s relationship with food.
Foods they once enjoyed may no longer appeal to them, while they may suddenly develop a preference for different flavors or textures.
The Alzheimer’s Society notes that some people with dementia develop a stronger preference for sweet foods or stronger flavors.
This does not necessarily mean they have forgotten what healthy food is. Their experience of taste and smell, food recognition and personal preferences may simply have changed.
If a familiar meal is repeatedly rejected, experimenting with different foods, temperatures, textures or stronger flavors may help.
4. Pain, Constipation or Other Health Problems May Reduce Appetite
Not every eating problem is directly caused by dementia.
A person may not want to eat because they are constipated, nauseated, unwell, in pain or experiencing dental problems.
Sore gums, mouth ulcers, dry mouth and poorly fitting dentures can all make eating uncomfortable.
Depression can also cause appetite loss. People with dementia can experience depression, and a noticeable change in mood alongside reduced eating should be discussed with a healthcare professional.
If eating suddenly changes, consider whether a new physical problem could be responsible.
5. They May Forget to Eat or No Longer Recognize Food
Memory loss and changes in thinking can interfere with eating in several ways.
A person may forget that it is mealtime, become distracted partway through eating or forget how to use utensils.
As dementia progresses, they may sometimes have difficulty recognizing the food or drink placed in front of them.
They may also forget the sequence involved in eating: picking up the utensil, moving the food to their mouth, chewing and swallowing.
Simple verbal or visual prompts can sometimes help.
6. Medications May Affect Appetite
Some medicines can affect appetite, taste, digestion or how a person feels after eating.
Changes may be particularly noticeable after a new medicine has been introduced or the dose has changed.
Never stop a prescribed medicine simply because you suspect it is affecting appetite.
Instead, ask the person’s doctor or pharmacist to review their medications if there has been a significant change in eating.
7. Dementia May Reduce Appetite in the Later Stages
As Alzheimer’s disease or another dementia advances, a person’s appetite may naturally decrease.
They may become less active and require fewer calories, have more difficulty recognizing food or experience increasing problems with chewing and swallowing.
The National Institute on Aging notes that loss of interest in food can begin earlier in Alzheimer’s disease and become more pronounced as the condition progresses.
Reduced eating in advanced dementia therefore needs to be considered in the context of the person’s overall condition, comfort, wishes and stage of illness.
How to Help a Dementia Patient Eat
If someone with dementia is eating less, the first goal is to understand why.
Look for changes in their health, mouth, medications, mood, swallowing ability and food preferences.
It is also important to encourage fluids. People with dementia may forget to drink or may not recognize that they are thirsty, which increases the risk of dehydration.
The following strategies may help.
Keep a Familiar Meal Routine
Whenever possible, serve meals at familiar times and in a familiar place.
A predictable routine can make eating easier for someone who becomes confused by changes in their surroundings.
The National Institute on Aging recommends continuing familiar mealtime routines where possible.
Offer Foods They Enjoy
A person’s preferences may change as dementia progresses.
Instead of insisting on foods they previously enjoyed, observe what appeals to them now.
If maintaining weight has become difficult, their healthcare professional or dietitian may suggest higher-calorie foods, snacks or nutritional supplements.
Offer Smaller Portions More Often
A large plate of food can be overwhelming.
Smaller meals and snacks offered throughout the day may be easier to manage than three large meals.
Allow plenty of time to eat and avoid rushing the person.
Give Simple Choices
Too many options can be confusing.
Instead of asking, “What would you like for lunch?” try offering two simple choices.
Showing the person the foods or using pictures may also make choosing easier.
Make Food Appealing and Easy to See
Food that smells appetizing and looks attractive may encourage interest.
Reduce distractions such as television or excessive noise during meals.
Contrast can also help some people see their food more easily. For example, food may be easier to recognize on a plate that clearly contrasts with its color.
Make Mealtimes Social and Relaxed
Eating with other people can make meals more enjoyable.
The Alzheimer’s Society recommends using eating and drinking as opportunities for social interaction rather than turning meals into a struggle.
If the person becomes distressed, avoid pressuring or forcing them to eat. Allow them time to settle before trying again.
Involve Them in Preparing Food
If the person is able and interested, simple meal preparation activities can stimulate appetite and provide a sense of involvement.
They might help wash vegetables, stir ingredients, set the table or choose between two foods.
Even the smell of familiar food cooking may encourage interest in eating.
Check Their Mouth and Teeth
Mouth pain can easily be overlooked when someone has difficulty communicating.
Look for sore gums, ulcers, broken teeth, dry mouth or dentures that do not fit properly.
Your dentist can assess problems that may be making eating painful.
You can read more about common issues in our guide to dementia and eating.
When Should You Seek Medical Advice?
Contact the person’s doctor or healthcare professional if they continue to refuse food, lose a noticeable amount of weight or have a sudden change in appetite.
Medical advice is particularly important if the person:
- coughs or chokes while eating or drinking
- has difficulty swallowing
- regularly holds food in their mouth
- appears to be in pain when eating
- is becoming dehydrated
- has rapid or unexplained weight loss
- has recently started or changed medication
- has a sudden change in eating compared with their usual pattern
A doctor may identify a treatable cause or refer the person to a dietitian, dentist, speech-language pathologist or another appropriate professional.
Eating and Drinking in the Later Stages of Dementia
Eating and swallowing often become more difficult as dementia reaches its advanced stages.
A person may spend more time sleeping, communicate less, lose weight and become increasingly dependent on others for everyday care.
They may also develop dysphagia, increasing the risk of choking or food and liquid entering the lungs.
The Alzheimer’s Association recommends allowing plenty of time for meals, keeping the person comfortably upright and adapting food when swallowing becomes difficult.
A doctor, dietitian or speech-language pathologist can help determine which approach is appropriate.
For someone approaching the end of life, the emphasis may gradually shift from maximizing calorie intake to maintaining comfort and respecting the person’s wishes.
How Long Can a Dementia Patient Live Without Eating?
There is no single reliable number of days that applies to everyone.
How long a person can live after eating or drinking very little depends on many factors, including their underlying health, fluid intake, stage of illness and whether they are approaching the natural end of life.
Near the end of life, loss of appetite and reduced thirst are common. The National Institute on Aging advises that appetite loss can be a normal part of dying and that a person who is dying should not be forced to eat.
This is different from someone in an earlier stage of dementia suddenly refusing food because of an infection, dental pain, medication, depression or another potentially treatable problem.
If a person with dementia has stopped eating or drinking almost entirely, contact their healthcare or hospice team for individualized advice.
Do Some People With Dementia Eat Too Much?
Yes. Although some people lose interest in food, others may eat too much or too often.
A person may forget that they have recently eaten or worry about when their next meal will be.
Certain dementias can also cause significant changes in food preferences and eating behavior.
For example, people with behavioral variant frontotemporal dementia may develop overeating, strong food preferences or repetitive eating behaviors.
Changes in a person’s dietary preferences therefore need to be considered alongside their type and stage of dementia.
Conclusion
Understanding why do dementia patients stop eating starts with recognizing that there is rarely one explanation that applies to everyone.
Memory and thinking changes, difficulty communicating, altered taste, pain, depression, medication effects and swallowing difficulties can all play a role.
Many practical changes can make eating easier, including familiar routines, smaller meals, favorite foods, fewer distractions and giving the person enough time.
However, persistent food refusal, weight loss or swallowing problems deserve medical attention rather than being assumed to be an unavoidable part of dementia.
As dementia reaches its final stages, reduced appetite can also become part of the natural progression of the illness. At this point, healthcare professionals can help families balance nutrition, safety, comfort and the person’s wishes.
References and Further Reading
National Institute on Aging. Helping People With Alzheimer’s Disease Eat Well.
National Institute on Aging. Care in the Last Stages of Alzheimer’s Disease.
Alzheimer’s Association. Food and Eating.
Alzheimer’s Society. Appetite and Dementia.
Cambridge University Hospitals. Eating and Drinking Difficulties in Dementia.
