Dementia is an incurable neurological disease that is progressive and results in cognitive and functional decline. Dementia affect’s a person’s abilities to perform everyday activities. There are many different forms of dementia but the most common is Alzheimer’s disease. Alzheimer’s accounts for 60-80% of all dementia cases. According to the Alzheimer’s Association, dementia is caused by damage to brain cells. This damage interferes with the ability of the brain cells to communicate with each other and when brain cells cannot communicate normally, thinking, behavior and feelings are affected.
Long term care facilities are inundated with residents suffering from this syndrome. Dementia is a major cause of dependence and disability. Each year there are 10 million new cases. According to the World Health Organization it is estimated that 5-8% of the population over the age of 60 have dementia.
There are many different symptoms with dementia and the disease is very progressive. Symptoms vary along the early stage, middle stage, and late stage of dementia. Early-stage symptoms may be easily overlooked and can include forgetfulness and loss of time. Middle stage symptoms can include forgetting events, names, difficulty concentrating, and experiencing behavior changes. In late-stage dementia typically total dependence is needed.
Many elderly that suffer from dementia also suffer with eating issues. Common nutrition complications that go along with dementia include dehydration, poor appetite, difficulty feeding self, and forgetting how, when and what to eat.
Below are some strategies to help improve oral intake and maintain nutritional status for patients with dementia. Due to the high risk of malnutrition care staff should be trained with skills to help optimize nutrition in this population.
- Maintain a good dining environment.
- Limit distractions- Distractions in the dining room can prevent patients with dementia from eating.
- Adequate lighting- Appropriate lighting aids older adults with dementia in seeing and recognizing the foods served to them, making it much easier to eat.
- Make food the focus.
- Eat meals with others- mealtimes that are social and pleasant help make food more enjoyable.
- Serve meals and snacks at the same times each day- consistency helps establish a routine and this may help improve intake.
- Provide foods the patient likes to eat.
- Foods that are easily recognized and comforting to the patient.
- Some residents prefer sweets so adding sweeteners to foods or serving naturally sweeter fruits and vegetables may be better accepted.
- Some residents prefer savory flavors so adding seasonings and serving those varieties may improve intake.
- Increase calories provided from meals if needed.
- If weight loss is present nutritional supplements may be utilized to increase total calorie intake
- Fats, such as oils, nuts, or nut butters, may be added to meals and snacks to increase the amount of calories provided. Try adding avocado or cheese to entrees.
- Provide appropriately textured foods.
- Some patients with dementia may require texture modifications due to chewing and swallowing difficulties.
- A speech pathologist can evaluate a resident for the most appropriate diet.
- Following the appropriate texture modifications is critical for safety – risks include choking, aspiration, pneumonia, or even death.
- Appropriate textures help allow adequate intake even when swallowing is challenging to perform.
- Adaptive equipment may help maintain independence and encourage intake.
- An occupational therapist can evaluate a resident to help with adaptive eating.
- There is a variety of adaptive equipment that can be utilized. Ex. Scoop plates and bowls, plate guards, weighted or non-slip bowls and plates, cups with lids and straws, cutout cups, and large rubber handle utensils.
- Finger foods may be an alternative if utilizing utensils becomes too difficult.
- Provide contrast in colors.
- A patient with dementia may struggle with differentiating between a plate, table setting, food, and beverage.
- Serve food on a plain plate or bowl with a colored place mat.
- Color helps stimulate interest in dementia patients.
- Some studies have suggested a red or yellow plate to help increase intake.
- Enteral nutrition support may be utilized if necessary although typically a last resort.
- The American Geriatric Society states, “when feeding difficulties arise, feeding tubes are not recommended for older adults with dementia” and that “health care providers should promote choice, endorse shared and informed decision making, and honor preferences regarding tube feeding.”
Problems with eating and drinking are common for people with dementia. Caring for these residents can be quite challenging and equipping staff with knowledge and resources is pertinent. If there is a concern about a resident’s diet a dietitian can help give advice on what is best in a particular situation.
Alzheimer’s Association: https://www.alz.org/alzheimers-dementia/what-is-dementia
Allison Cammer1, Debra Morgan2 and Susan J Whiting1. (2019). Nutrition Care for Residents with Dementia in Long-Term Care Homes: Umbrella Review of Care Aide and Registered Dietitian Services. International Journal of Aging Research, 2(2), 32. https://doi.org/10.28933/ijoar-2019-03-1005