Good nutrition is essential for health and well-being.
For people living with dementia, getting the correct nutrition through food can sometimes be challenging.
It is important to remember that dementia can affect each person differently. As dementia progresses, changes may develop that can impact eating and drinking. This can lead to under-eating resulting in weight loss, or over-eating, causing weight gain.
It can be upsetting to see someone we care about struggle with eating and drinking and to see weight loss or weight gain. Good practical nutritional advice can help people with dementia manage these challenges and remain strong, healthy and independent for as long as possible.
It is essential to:
- Eat a balanced diet
- Eat regularly
- Include healthy snacks during the day
- Keep hydrated by drinking water and fruit juice as part of your daily routine
- Talk to your doctor about particular food and drinks you should take or avoid, especially if you are taking medication.
Some suggestions for a balanced diet include:
- Eat Fish, especially oily fish such as salmon, trout, mackerel, and sardines, twice a week. It can be fresh, tinned or frozen.
- Eat Fruit and Vegetables– Aim for five servings daily, including tinned or frozen and fresh fruit and vegetables. Enjoy a variety of colours and limit fruit juice to unsweetened, just once a day.
- Eat Wholemeal, grain cereals – at least three servings per day. One serving is a slice of whole grain bread, half a cup of brown rice or a cup of wholegrain cereal. Where possible, choose wholegrain versions, as they are also a good source of fibre.
- Try to include high-protein foods in two main meals each day, as well as with snacks. Good protein sources include meat, chicken, fish, dairy products, eggs, beans and lentils. Try a wholegrain cracker with cheese mid-morning in place of a sweet biscuit.
- Consume milk and dairy products such as cheese, yoghurt and custard. Try to choose lower-fat options unless advised to follow a high-energy diet
Good nutrition is essential for the health and well-being of a person with dementia. Members of the Dementia Carers Campaign Network made these short videos to share insights about their experiences of promoting this with their loved ones. Those featured in the videos have all had a real-life experience of caring for a loved one with dementia, and the videos also include evidence-based tips and information.
Those featured in the videos wanted to share their experiences of caring for a loved one to offer real-life insight into some key topics in this area. The videos focus on aspects of nutrition, from shopping for ingredients to preparing meals to dysphagia and the social impact of eating together.
The booklet ‘Eating Well with Dementia, practical tips for Family Carers’ and short videos were funded through an educational grant by Nutricia.
For further information:
- Visit your doctor
- Call the National Helpline on 1800 341 341
- Read and download our resources
- Irish Nutrition + Dietetic Institute have information on the following:
- Feeding for people with dementia
- The dining environment and surroundings for people with dementia
- Guide on Nutritional Consideration when supporting someone with dementia
- Irish Nutrition and Dietetic Institute have created many resources on supporting older people with food during COVID-19.
Sleep is one of the most essential components of our well-being. If you and the person with dementia are to lead a healthy life, it is of vital importance that you both receive adequate sleep and rest.
Problems with sleeping and changes in the sleep-wake cycle are common occurrences with dementia. Some people sleep during the day and are awake and restless at night. Some can no longer distinguish between night and day, while others are simply not as active as they used to be and thus need less sleep. Trying to recognise the cause of the sleeping problems will help you decide how best to deal with them. Below are some possible causes of changes in sleeping patterns:
Physiological or Medical Causes
- Pain, e.g. arthritis
- Urinary tract infections cause frequent need to urinate
- ‘Restless legs’ or leg cramps can indicate a metabolic problem
- Depression can cause early morning wakening and inability to get back to sleep
- Side effects of medication such as diuretics
- Sleep apnoea and snoring
- Too hot or too cold
- Poor lighting with the effect that darkness causes the person to become disorientated
- Changes in the environment, such as moving to a new home or having to be hospitalised, may cause disorientation and confusion.
Other Possible Causes
- Going to bed too early
- Sleeping too much during the day
- Over-tiredness causes tenseness and difficulty in falling asleep
- An insufficient exercise so that the person does not feel tired
- Too much caffeine or alcohol
The following are some helpful hints that you, as a carer, may find helpful to enable you both to have a restful night.
- Encouraging the person with dementia to be as active as possible during the day is vital. It does not matter what the activity entails so long as they do not spend long spells sitting down. The activity provides stimulation for the senses, mobility for the joints, exercise for the lungs and assistance for blood circulation through the body.
- It is also advisable for the person with dementia to keep to a routine of getting up at a regular time. This also applies to retiring at night time. Routine is highly recommended for those confused or with memory defects.
- Coffee and tea should not be given before going to bed. These are stimulants and should be avoided as they contain caffeine which can cause restlessness. A glass of hot milk may help to get the person to sleep. Lavender oil is also beneficial. A few drops on the pillow may aid in sleep.
- If possible, a night light should be left on, especially in the bathroom, landing, or hallway. In the interest of safety, it may be necessary for the person to sleep alone in a ground-floor room. This arrangement may be essential in the advanced stages of the condition.
- Before retiring to bed, it is crucial for you as a carer to create an environment conducive to a restful night. This might include a certain degree of quietness and relaxation by, for example, playing gentle music. Avoid violent TV shows which can provoke nightmares.
- Most important of all, try to get some sleep and rest yourself. Perhaps you have had a difficult day and, in the interest of your health, you need your sleep. You, as a carer, have the person’s best interest and welfare at heart. You need your health.
For further information:
Bathing and Washing
For most adults, washing is a personal and private activity. As the illness progresses, the person with dementia may need reminders or help to wash. Sometimes they may be very reluctant, and you will need to find ways to encourage them which do not cause distress. It is essential to respect the person’s dignity at all times.
If you are finding it difficult to persuade the person to wash or if they need more assistance than you can give, contact the public health nurse, who may be able to advise or arrange help. You can contact the public health nurse through your local health centre.
Here are some suggestions:
- Encourage the person to wash for as long as possible.
- Continue with familiar washing routines established before they developed dementia, e.g. a morning shower or a weekly bath with a stand-up wash on days in between
- Try reminding them of the next step, tactfully indicating the part to be washed, or they might like to have some assistance from you, like handing them the soap or towel.
- Check that the bathroom floor is not slippery.
- Make sure that the room is warm before they undress. Older people are more sensitive to heat and cold.
- Check the water temperature of the bath or shower, as it should not be too hot or cold.
- Remove locks from the bathroom door or replace them with those that can be opened outside. The person may lock themselves in, become panicky, or even go into the bathroom to wash and forget why they are there.
Aids and equipment
Some aids and equipment may help to make washing more accessible and enable the person with dementia to feel safer and more in control. An occupational therapist or public health nurse can advise what aids and equipment may be required. You can contact an occupational therapist or public health nurse through your local health centre.
Depending on individual circumstances, aids and equipment might include:
- grab rails for getting in and out of the bath
- handrails by the shower, washbasin or toilet
- non-slip bath or shower mats
- raised toilet seats
- a bath seat or shower stool
General tips for carers:
- Make sure everything is in place before you start.
- Use the opportunity to communicate and, if necessary, explain what you are doing.
- When they are undressed, check for any red or sore areas of skin or skin rashes. These should be discussed with the GP or public health nurse.
- Use a mild soap and make sure all traces are rinsed off.
- Ensure the person is thoroughly dried, especially in the skin folds. Otherwise, the skin may become chaffed and sore.
- Take the opportunity to apply moisturiser all over the skin because as we get older, our skin becomes drier.
Dressing is a private activity for most of us and one where we are used to making decisions about what to wear. Suppose people with dementia need assistance with dressing. In that case, it should be offered tactfully and sensitively to enable them to maintain their dignity and make their own choices for as long as possible.
It is vital to allow plenty of time if you are helping someone to dress so that neither of you feels rushed. Try to use the opportunity to communicate what you are doing. If you can make it an enjoyable activity the person with dementia is more likely to feel relaxed and confident.
It is essential always to give personal independence and choice when getting dressed. Ways you can do this include:
- Laying out clothes in the order the person will put them on.
- Give clear instructions, remind them which garment goes on next, or hand them the appropriate clothes.
- If the person with dementia lives independently, steps such as labelling drawers with their content or putting whole outfits together for a particular day may be helpful.
- Ask the person what they would like to put on wherever possible. People with dementia need the dignity of having some choice in what they wear.
- Try not to give too many options, as it can be confusing. It may be better to make suggestions one at a time.
- If you are buying clothes for a person with dementia, take them with you, wherever possible, so they can choose the style and colours they prefer.
- Check their size. They may have lost or put on weight without you realising it.
General Tips for a Carer:
- Make sure the room is warm.
- Try to encourage the person to use the toilet before getting dressed.
- Try to follow the routine they are used to. They may prefer to put on all their underwear first or completely dress their top and then their bottom half.
- If they resist your efforts to help, it may be better to leave them for a little while rather than cause distress. They may be more amenable if you try again a little later.
- The person may be unable to tell you whether they are hot or cold. Several layers of thin clothing may be better than one thick layer. You can then suggest removing one layer if it gets too warm.
Incontinence occurs when someone loses control of their bladder (urinary incontinence) or their bowels (faecal incontinence).
Among the conditions which may cause urinary incontinence are:
- a urinary tract infection which usually responds well to medication
- enlarged prostate gland in men can cause an urgency to urinate suddenly.
- the side effects of drugs; however, the GP may change the drugs or alter the dose
- severe constipation, which causes incontinence due to pressure on the bladder. To prevent this, it is essential to eat foods rich in fibre and drink plenty of liquid to help to deal with constipation. Exercise may also help.
You can discuss this with your Public Health Nurse, GP or Practice Nurse. Some areas in Ireland may have a Continence Advisor who is a specialist resource in promoting continence and managing incontinence for people in the community. Referrals can be made to the Continence Advisor by your GP, Practice Nurse, Public Health Nurse or other Health Care Professionals.
Strategies for carers:
- Remind the person to go to the toilet or take them regularly. Faecal incontinence can sometimes be managed by taking the person at a set time if their habits are regular.
- Being aware of signs such as fidgeting, getting up and down or pulling at clothes may indicate that the person needs to go to the toilet.
- Making sure that the toilet is easy to use. An occupational therapist can advise on aids such as handrails.
- Making sure that the person has clothes that can be quickly removed or unfastened. Velcro fastenings rather than zips or buttons may be simpler if the person has difficulty managing clothes.
- Avoiding drinking for several hours before the person goes to bed if the person is incontinent at night. However, you should make sure that they drink plenty during the day.
- Making sure that they remember where the toilet is. A sign on the door may help, or they may need reminding.
- If it is too difficult for the person to get to the toilet, a toilet aid such as a commode may be helpful. A public health nurse or occupational therapist can advise.
A pressure ulcer is commonly known as a pressure sore or a bed sore. It is a damaged area of skin which occurs when the pressure reduces or cuts off the blood supply to a part of the body over some time. If you notice any red patches on the person’s skin which do not disappear after a few hours, these may well be pressure ulcers.
Whenever you help the person to wash or dress or if they seem to be in discomfort, be alert to the possibility of pressure ulcers. Older people who are not very mobile are particularly vulnerable. Pressure ulcers are usually easy to treat at an early stage. However, they will get worse if left untreated and can be dangerous. You should contact your local public health nurse for further support and information.
Tips for the carer:
- Try to make sure the person has a good, balanced diet. Good nutrition means the skin will be healthier and more resistant to sores developing.
- Help the person exercise regularly. Exercise improves circulation and helps relieve any pressure which has built up.
- Ensure the person does not remain in wet clothes or a wet bed if incontinent. If urine remains in contact with the skin at any time, it will make it spongy and less resistant to sores.
- Avoid tight clothing or tight bedding, especially over the feet.
- Excessive heat and moisture can also contribute to pressure sores, so try to prevent the person from becoming hot and sweaty.
- Ensure the person is thoroughly dry after a bath or wash, particularly in the skin folds. Pat rather than rub dry.
- Never rub or massage anywhere the skin has reddened, as this could cause further damage. Encourage the person or help them to move their position when they are lying or sitting for any length of time.