Food refusal is expected at the advanced stage of dementia and can be a sign that the person is reaching the final phase of this terminal disease. When a person is nearing death, the metabolism slows and there is reduced need for food.
However, it is important to assess the cause of food refusal in case it is for reasons other than dementia, including ill-fitting dentures, difficulties self-feeding, or changes in diet preferences due to alterations in sensations of smell and taste.
Families often value eating for social and health reasons, and may lack understanding that refusing food is expected and is a natural part of the dying process. A case conference can be a means of providing support and education. Careful hand feeding can provide the family with an opportunity to interact with their loved one and feel they are contributing to care.
Families and health professionals alike may need help to understand that force feeding or tube feeding does not improve nutritional status or prolong life in people with advanced dementia (1). They may also need reassuring that the person with dementia will not feel hungry or thirsty during the final phase of illness.
1. Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007209. DOI: 10.1002/14651858.CD007209.pub2Last updated 13 October 2015