When a Person with Dementia Won’t Eat: Three Approaches Based on Agnosia and Disorientation
Written by: 稲山 未来 (Registered Dietitian)
You serve your mother a dish you worked hard to make.
Today it’s nikujaga, the simmered meat and potatoes she used to make so well. Surely she’ll enjoy it.
But for some reason, even with the meal right in front of her, she makes no move to eat.
Instead, she picks up her chopsticks, takes a piece of nikujaga from the small plate on the left, and moves it to the right edge of her tray.
Even when you say, “It’s lunchtime, please eat,” she keeps on doing it…
What would you do if you saw this?
You might feel anger welling up, “If you don’t want to eat, then don’t!” or “I went to all that trouble and you won’t eat it,” or you might simply feel sad.
So what is going on in her mind at this moment? Let’s explore the eating problems people with dementia face.
How does mealtime look to them?
One symptom of dementia is agnosia. As the word suggests, it means losing recognition. Agnosia appears in many people with dementia, and in some cases, as with this mother, it can mean being unable to recognize the meal in front of them as a meal.
People with dementia may also experience disorientation, which means not knowing what time it is or where they are.
With these impairments in mind, the mother may not be aware that it is mealtime or that she is sitting at the dining table. And she may not perceive the food in front of her as a meal.
So why is she so intent on moving the nikujaga around?
Perhaps, in her mind, it is “cooking time.” Think of removing the roots from bean sprouts: you take a sprout from the left, check whether it has a root, remove the inedible part and place it on the right. Perhaps she believes she is doing a task like that.
This happens because of agnosia and disorientation. Because she can’t recognize what is in front of her as a meal, she thinks hard about what it might be. As a result, she mistakes it for something other than a meal. It might be an ingredient such as bean sprouts, or she might think it is something that isn’t food at all, or food for a child or a pet.
On top of that, because of disorientation, she may think it is time to make a meal rather than eat it, or that it is time to go to bed.
Of course, how a person misinterprets things depends on their life history and personality, so we can’t say exactly what they see. What we can say is that, at least, it doesn’t look to them like something they are supposed to eat.
What you can do to help them recognize the meal
The caregiver puts the meal in front of the person because “it’s mealtime,” but the person doesn’t realize that it is time to eat or that what is in front of them is food. That is the situation.
The first thing to do is to help them notice that it is mealtime and that what has been put in front of them is a meal.
Approach 1: Let them see you eating
Imagine this. You are in a country you have never visited, and a plate of something is placed in front of you. Because it is foreign food, it doesn’t look like a meal at all: some kind of thick, gooey substance. What’s more, it isn’t mealtime; it’s just before bed.
“Surely this isn’t something to eat. Maybe it’s for washing my face?” The situation is similar.
Now, what if a local person in front of you started eating it with obvious enjoyment? Once you realize, “Oh, people in this country have a custom of eating this before bed,” you would try it yourself, wouldn’t you?
Simply letting the person see someone eating with enjoyment in front of them can be the trigger that helps them recognize the meal.
Approach 2: Ask them to help with the cooking
Dementia is a curious condition: people often remember movements they have repeated for many years. People who cooked for their families for decades, in particular, have the movements of cooking ingrained in their bodies.
So even a person who doesn’t recognize a meal may, once you hand them a kitchen knife, julienne vegetables with a speed and precision that would put a professional to shame.
If you are worried about letting them use a knife, simply asking them to help arrange food on plates can switch them into cooking-and-eating mode. This approach uses actions they have done for many years as a cue to help them understand the situation they are in now.
Approach 3: Wait until they are in the mood to eat
A common case among men is mistaking mealtime for work time. Anyone would be angry at being interrupted while working hard. Some people refuse to eat, saying, “I have a meeting with the company president, so this is no time to be eating!”
In such cases, it may be better to wait until their focus on what they are doing has faded. When the feeling of being at work has settled, offer the meal again.
Meals don’t have to be eaten at a fixed time. When someone isn’t in the mood, they don’t need to eat so badly that it’s worth an argument. Try not to be too anxious about it, and adapt to the person’s view of the world.
Key point: use the five senses
People with dementia find it difficult to work out their own situation from what is going on around them. So try to engage the five senses as much as possible:
Sight: seeing someone eat
Hearing: hearing the words “This is delicious!” or the sound of vegetables being chopped on a cutting board
Smell: noticing the appetizing aroma of cooking
Taste: taking a first bite and tasting it
Touch: being reminded of a meal by foods eaten with the hands, such as rice balls (onigiri)
Most important of all, even if it’s hard for us to understand, the person has their own view of the world, so don’t deny it.
They cook because they think it’s cooking time; they concentrate on work because they think it’s work time. They aren’t doing anything wrong. Take a moment to think about what they are feeling and what kind of world they see right now, and try to stay close to them.
Meals are meant to be enjoyed. Try a few small changes so that mealtimes can be calm and pleasant.
About the author: 稲山 未来 (Registered Dietitian)
This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.
This is an English translation of a column originally published in Japanese by Next Co., Ltd.
About Next Co., Ltd. We are a Tokyo-based company working in Japan’s senior care and end-of-life planning field. Alongside these expert columns, we publish professional training textbooks and support businesses entering Japan’s eldercare market. More expert columns | Our English textbook | Contact us
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