How to encourage someone with dementia to eat?

My father has refused three meals in a row and I don't know if it's lack of hunger, some pain he can't explain, or simply stubbornness. How should I act without forcing him?

Refusing food is one of the most distressing situations for a carer, as it mixes concern for health with the fear of "not doing enough". But it's rarely stubbornness: it's almost always a symptom with an underlying cause, and identifying that cause is the first step.

Why it happens

Dementia can affect appetite in several ways: changes in taste and smell, difficulty recognising food as food, mouth pain or ill-fitting dentures, constipation, medication side effects, associated depression, or simply confusion about meal times. In more advanced stages, the person may no longer feel or communicate hunger in the usual way.

Practical strategies

• Check for physical causes first: toothache, ill-fitting dentures, constipation, or a urinary tract infection can suppress appetite without the person being able to explain it.
• Small, frequent meals: instead of three large meals, offer 5 to 6 small ones throughout the day — it's easier to manage and less intimidating.
• Focus on favourite foods: use dishes the person has always enjoyed, even if they're not the "most balanced" at that moment — eating something is better than eating nothing.
• Pay attention to presentation: varied colours on the plate, good lighting, and a calm environment help stimulate interest in food.
• Reduce distractions: turn off the television and avoid conversations with many people at the table during the meal.
• Allow time: don't rush or show anxiety — the person senses tension, which can further reduce appetite.

"I realised my mum ate better if I ate next to her, at the same pace. Seeing me eat seemed to remind her what to do."

What NOT to do

• Do not force, threaten, or argue — this increases anxiety and worsens refusal.
• Do not remove the meal immediately after a refusal; offer it again after a while.
• Do not compare with "they used to eat everything" — this only creates mutual frustration.

When to seek professional help

If food refusal persists for more than two or three days, if there is visible weight loss, signs of dehydration (dry mouth, dark urine, increased confusion), or refusal of liquids as well, contact your GP. A nutritionist can help adapt the diet, and in some cases, it's worth ruling out medical causes such as infections or dental problems before assuming it's "just the dementia".