How to feed someone in the advanced stage of dementia?

My father is in a very advanced stage and hardly opens his mouth to eat anymore. I feel like every meal is a struggle and I no longer know if I'm helping him or just stressing him out even more.

In the advanced stage of dementia, eating stops being a simple task and becomes a moment that requires extra patience, careful observation, and often, accepting that the goal changes: from "ensuring all calories" to "ensuring comfort and dignity".

Why eating becomes more difficult

At this stage, it's common to have greater difficulty recognising food, coordinating chewing and swallowing movements, and even staying awake or attentive during meals. Dysphagia is frequent, and the risk of choking increases. It's also normal for appetite and caloric needs to decrease naturally — the body itself is going through a different phase.

Practical strategies

• Prioritise safe texture: well-seasoned pureed or mashed foods are usually easier and safer to swallow than solids.
• Very small, frequent meals: small amounts several times a day are more realistic than trying to "finish" a large plate all at once.
• Always position at 90 degrees: sitting upright, never lying down, with extra time after swallowing before the next spoonful.
• Use a small spoon: and gently touch the lower lip to stimulate the reflex to open the mouth, without forcing.
• Observe signs of discomfort or refusal: turning the face away, pursing the lips, or spitting are forms of communication at this stage — respect them instead of insisting.
• Maintain hydration: thickened liquids (if indicated) or jelly can help when drinking water becomes difficult.

"At a certain point, I realised that insisting my father eat a little more was no longer care, it was stress for both of us. I learned to read his signs and stop when he clearly didn't want any more."

What NOT to do

• Do not force the mouth open or continue to insist after clear signs of refusal.
• Do not give thin liquids without clinical guidance if there is a history of choking.
• Do not blame yourself if the amount ingested is small — at this stage, comfort takes priority over quantity.

When to seek professional help

This is also the stage where it's worth having an open and early conversation with the medical team about care goals — including sensitive decisions such as the use (or not) of feeding tubes, which do not always bring added benefit or comfort at this stage of the disease. A speech therapist can regularly reassess swallowing safety, and palliative care teams or the National Network for Integrated Continuous Care (RNCCI) can provide valuable support to both the person and the family in these decisions.