Dementia not eating: why it happens and what to try first

When someone with dementia is not eating, there's usually a reason you can look for: a sore mouth or loose dentures, constipation, depression, a medicine, a noisy table, or a plate she no longer recognizes as food. Start by checking those, then make meals smaller, simpler and more frequent. If you searched "dementia not eating" because your mom has lost weight, coughs when she eats, or stopped eating over a few days, call her doctor this week, or today if it was sudden.

Late-stage dementia is different. There, eating less is part of how the disease progresses, and the conversation moves to comfort. That section is further down.

Why someone with dementia stops eating

Run through this list before you change anything at the table. Several of these are things a doctor or dentist can fix.

• Her mouth hurts. The Alzheimer's Society lists sore gums, painful teeth and dentures that no longer fit. Look inside her mouth with a flashlight.
• Constipation. It can make her feel bloated or sick, and less likely to eat.
• Depression. The Alzheimer's Society says loss of appetite can be a sign of it, and depression is common in dementia.
• Medicines. The National Institute on Aging names medication as a cause of poor appetite. Changes to a medicine or dose can affect appetite, so tell the doctor about anything new.
• Taste and smell. The National Institute on Aging notes that both fade, so food is less appealing.
• Too little activity. A day in the recliner doesn't build an appetite.
• She doesn't recognize the food, or how to start. The Alzheimer's Association says she may not recognize what's on the plate, and patterned dishes or tablecloths can confuse her.
• She's tired. The Alzheimer's Society says tiredness can make someone give up halfway through a meal.

Dementia forgetting to eat

In the earlier stages, the problem is often memory. She lives alone, the day has no shape, and lunch never happens. Then you open the fridge and find last week's groceries untouched.

• Call at mealtimes. The National Institute on Aging suggests a phone reminder if she still lives alone. A call at noon that says "Let's both have lunch now" works better than "Did you eat?" She'll say yes either way.
• Leave food out where she'll see it. A covered plate of sandwiches at eye level in the fridge, a bowl of fruit on the counter.
• Use delivered meals. The National Institute on Aging points to Meals on Wheels, which delivers to the home. You can reach Meals on Wheels America at 888-998-6325.
• Check what's gone, not what she says. Count the yogurt cups. Weigh her once a week if you can.

If she can't tell you whether she's eaten and the food sits there untouched, she likely needs someone with her at meals. The guide on when it's time for memory care covers that decision.

When a dementia patient refuses to eat: what to try at the next meal

Try two or three of these at a time, for a few days each.

1. Clear the table. The National Institute on Aging suggests a quiet room with the TV off, at the same times and in the same place each day.
2. Use a plain white plate on a contrasting placemat. The Alzheimer's Association recommends this so the food stands out.
3. Serve one or two things at a time. A full plate can be too many decisions. The National Institute on Aging also says one food at a time.
4. Go smaller and more often. Small meals and calorie-rich snacks through the day, and honey or syrup to sweeten food if she isn't eating enough.
5. Offer finger foods. Sandwich quarters, chicken pieces, cheese cubes, banana slices. She can eat them walking around if she won't sit.
6. Let dessert come first. The Alzheimer's Society says it's fine to offer pudding if she refuses the main meal. A sweet bite between savory bites can also help.
7. Eat with her. Sit beside her, not across, and take bites yourself so she can copy you.
8. Help her hand to her mouth. If she holds the fork but stalls, the National Institute on Aging suggests resting your hand on hers and guiding it.
9. Try again later. If she refuses, take the plate away calmly and offer it in 30 minutes.

Drinks count too. If she won't drink water, the National Institute on Aging suggests juice, flavored water, broth, milk or decaf coffee or tea.

Take Marcy, whose mom pushed away every dinner for two weeks. Marcy switched to a white plate with only chicken and mashed potatoes, ate her own dinner at the same table, and stopped asking if she was hungry. Her mom still skipped some meals but started eating most lunches.

What to say at mealtimes

Questions invite "no." Short, warm statements usually go better.

Swallowing problems and weight loss: call the doctor

As dementia progresses, chewing and swallowing get harder. The National Institute on Aging explains the risk: if she chokes on food, some can go into her lungs and cause pneumonia, which can be fatal. She may also hold food in her cheeks. MedlinePlus notes that a speech-language pathologist can help with swallowing problems, and her doctor can order a swallowing test.

Until she's assessed:

• Keep her sitting upright to eat, and for at least 20 minutes after, as the National Institute on Aging advises. Don't feed her if she's drowsy or lying down.
• Cut food small and soft. Mash or blend it if she struggles.
• Skip straws. Give small sips from a cup.
• Check that she has swallowed before the next bite.

Late stage dementia not eating

In the last stage, most people eat less, and then very little. The Alzheimer's Association says that as the disease progresses, people need less food, and that weight loss near the end of life is expected. It also says weight loss can point to other illness or a medicine side effect, so tell her doctor either way. The National Institute on Aging notes that appetite declines in the late stages.

This is the part of caregiving where many daughters feel they're failing. You aren't. She isn't starving because you did something wrong. Her body is changing in the way this disease changes it.

What helps now is comfort. Small amounts of foods she enjoys, offered when she seems willing. Sips or ice chips if she's awake and her mouth is dry, which the National Institute on Aging suggests. A damp cloth to wipe the inside of her mouth. Your voice while you sit with her.

Bigger questions, like whether a feeding tube would help her or what to do about hospital trips, belong with her doctor or hospice team. Ask them on a calm afternoon, not at 2 a.m.

Questions caregivers ask

Do dementia patients refuse to eat?

Many do at some point. Earlier on it's usually a fixable problem, like a sore mouth, a busy table or forgetting. Later in the disease, appetite drops on its own. Either way, tell her doctor if it lasts more than a few days or she's losing weight.

Dementia not eating and sleeping all the time: what does it mean?

If it came on over a few days, call the doctor the same day. It can be an infection or another treatable problem. If it has crept in over weeks or months in someone already in the late stage, it can be a sign that the end of life is coming closer. Her doctor or a hospice nurse can tell you what they see.

How long can someone with late-stage dementia live without eating?

Nobody can give you an honest number from a website. It depends on her health, how much she's still drinking and what else is going on. Ask her hospice nurse or doctor directly. They see her and can tell you what they expect, and what to watch for.