When Someone With Alzheimer’s Won’t Eat or Drink

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

It’s common for people with Alzheimer’s disease to stop eating or drinking in the later stages. At any time, about 10% to 15% of people who have it don’t eat or drink enough and lose weight. This becomes more of a problem as the disease gets worse.

Most of the time, you can handle these issues at home, but call 911 or take your loved one to an emergency room or doctor right away if they show signs of:

  • Delirium. They’re more easily distracted and forgetful than usual, have less energy, see things that aren’t there, have sudden changes in personality and behavior, are strangely emotional, or ramble when they talk.
  • Serious dehydration. Their body doesn’t get enough fluid to meet its needs. You’ll notice at least five of these signs: peeing very rarely, dark yellow pee, a dry tongue, sunken eyes, confusion, weakness, a fast heart rate, or trouble talking.
  • High fever. In elderly people, a body temperature of 101 F or higher is high.
  • Belly pain, especially if they are vomiting.

Call their doctor if they:

  • Suddenly stop eating or drinking for 24 hours without other signs of illness
  • Have a low-grade fever for more than 24 hours
  • Stop eating and drinking after a change in medication
  • Don’t have a bowel movement for 4 days
  • Are breathing faster than usual
  • Seem to be sick with a new illness or one that is getting worse

What Causes It?

People with Alzheimer’s disease can slow down or stop eating or drinking for many reasons. If you watch your loved one and put the clues together, you can often get them to eat and drink again.

Sometimes it’s a sign of a condition that you need to understand and act on quickly. If the problem came up suddenly, it probably is caused by something other than dementia. Look for signs of these:

  • A new or worsening illness: A cold, urinary tract infection, stomach problem, chronic illness, or even constipation can make someone eat or drink less.
  • Depression or anxiety: People who feel sad and anxious may not want to eat.
  • Pain or discomfort: Pain anywhere in the body, especially in the teeth and gums, can take away appetite.
  • Medication: Side effects of many medicines cause nausea, take away the appetite, or bother the stomach.
  • Problems with where or how they’re offered food: Changes in where they live, what they’re served, who helps them, or relationships in the place where they live can affect their appetite.
  • Depression: People who feel sad and feel hopeless usually don’t want to eat.

If your loved one is to the point that they’re hard to feed, it may be part of the natural course of dementia. They may not recognize food as something to eat, they could have lost the sense of hunger and thirst, or they might get distracted at mealtimes.

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What Can You Do to Help?

If they refuse food or won’t open their mouth but don’t seem seriously sick, they may not realize the food is something to eat. Let them smell or feel it to give them a chance to recognize it. It may also help to serve food on dishes that are a different color from the food. This makes it easier for them to see it and know what it is. Keep the area clear of dangerous things like sharp knives, or things they can’t eat, like ketchup packets or paper napkins.

Serve their largest meal at the time they’re most hungry. Offer food at the same time each day. When someone is on a routine, they’ll be hungrier at mealtime. Make sure the food isn’t too hot or cold. People with Alzheimer’s often have a change in tastes, so you may have to try different foods until you find something they like. Your loved one may not remember to open their mouth. Gently remind them, but don't force the food in. It might hurt to chew or open their mouth.

Check for sores, redness, bad teeth, or other signs of irritation in their mouth. If you think there’s a problem, take them to a dentist. Help them take care of their mouth. They should brush their teeth two times a day. If possible, clean between teeth with floss or an interdental brush. Most cavities and mouth infections start between the teeth, so this is especially important.

They also may have trouble moving their muscles to open their mouth. If this is the case, you can ask a doctor or occupational therapist about ways to help them eat.

It may help to only serve foods that are easy to chew and swallow, like applesauce, yogurt, or pureed foods. Stay away from sticky foods like peanut butter or hot drinks like coffee. Cut solid food into small pieces.

If they don’t chew well, cough, or choke when they eat, have them swallow several times between bites. Get them to sit up straight when they eat. See if they can take a deep breath and hold it while they take food or drink, and breathe out afterward. It can help to cough while they breathe out. Someone in the later stages of Alzheimer’s disease may not be able to do all these things, but they should be able to sit straight, take small amounts, and swallow between bites. Watch to see if they cough, wheeze, can’t breathe, or grab for their chest or throat.

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If they get agitated or distracted at mealtime, serve them in a quiet space without distractions. If they tend to walk around, give them food they can carry, like a sandwich or finger foods, unless they might choke or can’t swallow. Offer them just one or two foods at a time, and use only one or two utensils. Too many choices can confuse them. Allow them to take as much time as they need to finish. If you try these things and they’re still agitated, talk to the doctor.

You can also try is to eat with them. They may copy you and eat, too. If they still won’t eat, take the food away and try again in 15-30 minutes.

Also, keep them as active as possible. Any form of exercise will build their appetite, and ease agitation.

What Health Problems Can It Cause?

Not getting enough to eat or drink can lead to:

  • Dehydration: To make sure they get enough fluids, give them drinks that are easy to drink and they like. Try flavored water, juices, sport drinks, lemonade, or Popsicles. It’s common for people with advanced Alzheimer’s disease to stop drinking to the point of dehydration. This is often part of the process at the end of life. If your loved one gets dehydrated often or they’re in the advanced stages of Alzheimer’s, you should have a plan about whether to use feeding tubes or an IV.
  • Weight loss: This can be a sign of other problems, but if someone doesn’t eat, this is the most likely cause. If your loved one has lost more than 5 pounds in a week or 10 pounds in a month, they should see a doctor. To help them keep weight on, skip low-fat or low-calorie foods. Serve high-calorie foods, like milkshakes, protein drinks, ice cream, and smoothies. If the weight loss continues, talk to their doctor.

Feeding Tubes

If the problem goes on or gets worse, you’ll have to decide if you should try artificial nutrition, like a feeding tube. This isn’t an easy decision.

It’s a good idea to ask your loved one about how they feel about artificial feeding before they need one. If you can, get their wishes in writing. This is called an advance directive. Try to have a doctor, nurse, or social worker there when you talk to them to provide guidance. When the time comes, it’ll be easier for you to decide on a tube if you know their wishes.

Generally, feeding tubes don’t provide better nutrition, lower the chances of pneumonia, or help people who use them live longer. Also, tubes can be uncomfortable. But they do help some people. If the doctor thinks your loved one may eat again on their own, a tube may help them stay nourished until they get better. The doctor can help you decide how likely this is.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Minesh Khatri, MD on August 24, 2018

Sources

SOURCES:

Alzheimer’s Society: “Eating and Drinking.”

National Citizens’ Coalition for Nursing Home Reform: “Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment.”

The Caroline Walker Trust: “Eating Well: Supporting Older People and Older People with Dementia, Practical Guide.”

Journal of the American Dietetic Association: “Nutritional Needs of the Person with Alzheimer’s Disease: Practical Approaches to Quality Care.”

Lancet: “Use of Tube Feeding to Prevent Aspiration Pneumonia.”

Alzheimer’s Disease International: “Nutrition and Dementia: A Review of Available Research.”

Journal of Neurology, Neurosurgery, & Psychiatry, “Changes in Appetite, Food Preference, and Eating Habits in Frontotemporal Dementia and Alzheimer’s Disease.”

American Journal of Surgery: “Percutaneous Endoscopic Gastrostomy or Jejunostomy and the Incidence of Aspiration in 79 Patients.”

Digestive Diseases and Sciences: “Long-Term Follow-Up of Consequences of Percutaneous Endoscopic Gastrostomy (PEG) Tubes in Nursing Home Patients.”

Geriatric Nursing: “Dysphagia Among Nursing Home Residents.”

Nutrition Reviews: “Refusal to Eat in the Elderly.” 

American Family Physician: “Geriatric Failure to Thrive.”

Journal of Nutrition Health and Aging, “Preventing and Treating Dehydration in the Elderly During Periods of Illness and Warm Weather.”

Social Care Institute for Excellence: “Chewing and Swallowing Problems in Dementia.”

American Family Physician: “Evaluating Dysphagia.”

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