Alzheimer and meals: how to transform mealtime into moments of pleasure

Table of contents

1. Understanding eating disorders in Alzheimer’s

2. Adapting the environment and dishes

3. Nutrition: adapted foods and textures

4. Strategies for managing food refusal

5. Technical assistance: when and how to help

6. Ritualizing meals: creating moments of pleasure

Understanding eating disorders in Alzheimer’s {#comprendre}

Why do they refuse to eat?

1. Loss of appetite (anorexia)

Causes:

• Dysfunction of the hypothalamus (hunger center)
• Medications (some suppress appetite)
• Depression

2. Forgetting the need to eat

No longer feels hunger or forgets that one needs to eat.

"I already ate" (when not).

3. Swallowing disorders (dysphagia)

Difficulty swallowing (choking).

Fear of choking → Refusal.

4. Apraxia (loss of gestures)

No longer knows:

• How to use knife, fork
• How to bring food to the mouth
• How to chew, swallow

5. Agnosia (non-recognition)

No longer recognizes:

• The food (sees an object, not food)
• The utensils (knife = unknown object)

6. Sensory disorders

Altered smell, taste → Tasteless food.

Altered vision → Does not see food on the plate (if low contrast).

7. Dental, oral pain

Cankers, poor dentition, ill-fitting dentures → Pain → Refusal.

8. Disturbing environment

Noise, agitation, too many people → Confusion → Inability to concentrate on meals.

Consequences of malnutrition

Vicious circle:

Malnutrition → Fatigue, weakness → Falls → Fractures, hospitalization → Sliding syndrome (total loss of appetite) → Death.

Warning signs of malnutrition:

• Weight loss >5% in 1 month
• Clothes hanging loose
• Extreme fatigue
• Poorly healing wounds
• Frequent infections

→ Consult a doctor URGENTLY.

Adapting the environment and dishes {#environnement}

1. Calm environment

Turn off TV, radio (distractions = forgetting to eat).

One person at a time speaks (no multiple conversations).

Soft lighting (no harsh neon lights).

Soothing atmosphere → Focus on meals.

2. Ritualized table

Same place every day (landmarks).

Same tablecloth, same set (familiarity).

No decorations (simplicity = clarity).

3. Adapted dishes: visual contrast

CRUCIAL: The Alzheimer’s brain has difficulty perceiving low contrasts.

Problem:

White plate + white tablecloth + light foods (rice, fish) = Cognitive invisibility ("I don’t see the food").

Solution: STRONG CONTRAST

If light tablecloth → Dark plate (blue, red, black)

If dark tablecloth → White plate

Visible foods → Eats better (study: +25% quantity ingested with contrasting plate).

4. Adapted dishes: ergonomics

Plate with edges:

Adapted cutlery:

Glass with handles:

Non-slip set:

Where to buy: Medical shops, Amazon ("Alzheimer dishes").

5. Eliminate unnecessary cutlery

Too many utensils = confusion.

Only give what is necessary:

Simplify = facilitate.

Nutrition: adapted foods and textures {#nutrition}

1. Textures adapted to swallowing disorders

Alzheimer stages:

Mild: Normal diet (monitor hydration).

Moderate: Beginning of chewing/swallowing difficulties.

Adaptations:

Severe: Significant dysphagia.

Adaptations:

Consult a speech therapist (swallowing assessment, texture advice).

2. High-calorie foods (to combat malnutrition)

If weight loss:

Enrich each dish:

Caloric snacks (between meals):

Goal: Small portions, but DENSE in calories.

3. Favor sweet tastes

The sweet taste is preserved longer in Alzheimer’s.

Strategy:

If refuses main meal: Offer dessert first (better than nothing).

4. Hydration: 1.5L/day minimum

Dehydration = worsens confusion + urinary infections.

Strategies:

5. Avoid high-risk foods

Risk of choking:

Risk of suffocation:

Strategies for managing food refusal {#refus}

Strategy 1: Eat together (social mimicry)

Eat at the same time as your loved one.

Mimicry principle: Sees you eat → Imitates → Eats.

Powerful effect: Stimulates appetite, social ritual.

Strategy 2: Finger food (eating with fingers)

If refuses cutlery or can no longer use them:

Offer foods that can be picked up with fingers:

Preserved autonomy + Dignity (not fed like a baby).

Strategy 3: Small portions, several times a day

Large full plate = overwhelming.

Better:

Strategy 4: Offer favorite dishes

Strategy 5: Olfactory stimulation

Smells stimulate appetite.

Let them smell the dish before serving.

Cook in front of them (cooking smells = appetite).

Strategy 6: No pressure

If refuses: Do not force, do not scold.

Offer something else or try again 30 min later.

Never conflict around food (negative association).

Strategy 7: Game before meals (cognitive stimulation EDITH)

15 min of EDITH before meals:

Cognitively stimulates → Awakens → Sometimes improves appetite.

Creates routine: Games at 10am → Meals at 10:30am (ritual).

Technical assistance: when and how to help {#aide}

When to help?

Mild Alzheimer’s: Total autonomy (just monitor).

Moderate Alzheimer’s:

Severe Alzheimer’s:

How to help without infantilizing?

1. Gentle verbal guidance

"Take your spoon." "Bring it to your mouth." "Chew well."

Respectful tone (not a nursery tone).

2. Gestural guidance

Hand on their hand (guide spoon movement → mouth).

Then let go (let them finish alone).

3. Demonstration

You eat (they imitate).

4. Positioning

Sitting face to face (sees your gestures).

At their height (not standing above = dominating).

Feeding with a spoon (severe stage)

Position:

Technique:

Patience: Can take 45 min (do not rush).

Ritualizing meals: creating moments of pleasure {#ritualiser}

1. Fixed schedules

Same times every day:

Biological clock adjusts → Hunger at the right times.

2. Careful setup

Beautiful table (tablecloth, napkins) → Values the moment.

Flowers (if they like) → Aesthetic.

3. Soft music

Music from youth (background sound) → Calms, evokes memories.

4. Conversation

Talk (even if they don’t respond much anymore).

Evoking memories: "Do you remember meals at your mother’s?"

Emotional connection > Quantity eaten.

5. Celebrate occasions

Birthdays, holidays: Decorated table, favorite dishes.

Maintains social bond, pleasure.

6. Involvement

If possible, involve in preparation:

Feeling of usefulness → Appetite.

Nutritional supplements (if malnutrition)

When to consult?

If weight loss >5% in 1 month → Doctor.

Medical solutions

1. Oral Nutritional Supplements (ONS)

High-calorie drinks (200-300 kcal/unit):

Medical prescription (reimbursement if proven malnutrition).

2. Protein powders

To add to dishes, yogurts, soups.

Increases protein intake (maintains muscle mass).

3. Enteral nutrition (last resort)

Gastric tube (if totally refuses oral, vital risk).

Medical + ethical decision (end of life).

Testimonials

Marie, 59 years old (father with moderate Alzheimer’s)

"My father was eating less and less. I changed dishes: dark blue plate (instead of white). Miracle! He finally SAW the food. He eats 30% more. A detail that changes everything."

Jean, 68 years old (wife with severe Alzheimer’s)

"My wife refused her cutlery. I bought 'finger food': mini-sandwiches, cheese pieces, fruits. She eats with her fingers, alone, with dignity. She has gained 2 kg. I am relieved."

Dietitian EHPAD (Toulouse)

"We ritualized meals: soft music, neat table, staff eat with residents. Result: 40% decrease in malnutrition. The social aspect nourishes as much as the plate."

Conclusion: Nourishing the body and soul

Meals with Alzheimer’s are not just a matter of calories. It’s a moment of connection, dignity, pleasure. Adapting the environment, dishes, textures, ritualizing: all solutions to transform meals into precious moments.

The keys:

1. ✅ Calm environment, contrasting dishes

2. ✅ Adapted textures, caloric enrichment

3. ✅ Finger food, frequent small portions

4. ✅ Eating together (social mimicry)

5. ✅ Ritualization, music, conversation

6. ✅ Patience, kindness, no pressure

Your loved one needs to eat to live. But they also need pleasure to want to live. Offer them both.

DYNSEO resources to improve meals:

To nourish is to love. Share more than meals: share moments.