By Betty Weiss

You sweet talk him, offer a spoonful of yummy food, cajole him to please open his mouth, and instead he turns away, clamps his teeth tighter and might swing a fist at you.  Or maybe food is stored in his cheeks because he has forgotten how to chew and swallow.  It's hard to believe that he is not being deliberately difficult just to annoy you - but he's not.

Try to keep calm, unhurried, allowing yourself plenty of time. Eliminate distractions; turn off the television and radio, have others take their conversations outside.  If a loved one is too agitated, stop and try again later. 

As Alzheimer's progresses, eating habits and tastes change so accept that things cannot be what you want them to be.  To maintain his dignity, try not to fuss about it and allow your loved one to participate as much as possible in eating by himself, even when it gets messy.

Finger foods allow people to choose what they want and maybe walk around - they won't always sit still for meals.  Give them time to look at the food and eat at their own pace.  But don't offer too many things at once; making a decision can cause anxiety for someone with Alzheimer's.  Try a variety of buttered breads, rolls or muffins, crackers with soft cheese, and waffles.  Meats should be moist--chicken, hamburgers, hotdogs, meatloaf, fish fingers or crab cakes, slices of pork, veggie sausages, pizza, hard-boiled eggs quartered, cheese cubes or melted cheese on toast - all sliced in easy to eat pieces.  Lots of fruit--sliced apples, pears, apricots, peaches, nectarines, and of course, bananas, melon, pineapple chunks, orange segments, berries, seedless grapes, dried fruits.

Veggies can be raw, steamed, boiled - broccoli and cauliflower florets, carrots, cucumbers, celery, green peppers or parsnip sticks, Brussels sprouts, tomatoes and mushrooms.  Bake, roast or boil potatoes, with or without skin, and sweet potatoes.  Don't forget favorite sandwiches cut into wedges.  Everything can also be left out for snacks.

It is not uncommon for Alzheimer's patients to lose weight, even when eating well.  Mostly it is the disease, but there could also be things like depression, sore gums, denture problems, lack of exercise, constipation.  Check with the doctor and dentist for help with these problems.  Because of damage to the brain, they may no longer understand food is to be eaten - even when they are hungry - so you need to remind them to eat and guide food to the mouth.  If they don't want to eat, ask the doctor for an appetite stimulant, but some stop eating altogether and that's that. 

Don't have elaborate meals; don't 'set' the table.  Remove everything except an unpatterned dish, a soup bowl is best, and a spoon.  Keep portions small.  Serve fluids in a child's 'sippy' cup; soup in a mug.  Sometimes they lose the ability to judge temperature, so you'll have to check that.  Small, frequent meals instead of three-squares often works.  They may eat new things and often go for sweets--offer pudding, ice cream, pie fillings, nutritional supplements.  Give lots of liquids, hopefully several cups each day.  If they can use a straw, let them.  As time goes on, liquids may need to be thickened.  Thickening products are in the market.  As well as water, try fruit juice, gelatin, sherbet - whatever liquids they'll take.  You may have to begin to puree foods or try baby foods. 

If someone doesn't start to eat, offer the first bite to 'prime the pump' or a small taste on the lips often works.  Putting food in front of them without comment and walking away can trigger an automatic response to begin eating.  Put one food at a time on a plate with contrasting color: chicken or mashed potatoes on a blue plate - not white. 

Never offer food to someone who is drowsy or lying down or leave your loved one alone while eating because of the chance of choking.  If your loved one tends to choke while eating, see a speech and swallow therapist to learn about eating safely.  It's dangerous to squirt liquids into someone's mouth - don't do it!

Some patients have ravenous appetites and seem to eat constantly.  They don't realize that they just ate or what they are eating, and obviously this presents a much different challenge. 
Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia.
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