Improving Food Intake in Dementia
It has been shown that more than a third of people with advanced dementia are malnourished. However, unintentional weight loss can occur in all stages of the disease, as even in early dementia nutritional problems can develop. While difficulties with eating and drinking are part of the natural progression of dementia, a number of strategies can be implemented to help minimize the impact of these, improving dietary intake and reducing the likelihood of problems associated with poor nutrition.
Difficulties with eating and drinking
The various symptoms of memory loss and cognitive decline affect dietary intake in a number of ways. Although not an exhaustive list, the following problems commonly occur when people have dementia:
- Forgetting to eat or drink may start in the early stages of the condition, though tends to worsen over time. While this is less of a problem for seniors living in residential care homes, where meals are provided and prompting can be offered at mealtimes, for people living independently this can be a significant contributor to weight loss if meals are missed on a frequent basis. For dementia sufferers who live alone, placing non-perishable food and drink items – such as wrapped snacks and cartons of juice – in easy sight can act as a prompt.
- Communication difficulties can cause problems in dementia, making it difficult for people to fully express their preferences for food and drink, to say when they are hungry or thirsty and to ask for help when they need it at mealtimes. When discussing food, whether it’s what they would like you to buy when it comes to the grocery shop or what they would like for their next meal, pictures of food items can provide a useful aid. Indeed some care facilities use pictorial menus to help residents to make food choices.
- As people with dementia tend to be less tolerant of changes to routine, this may influence what they eat if mealtimes are altered or different foods are served for special occasions. This is why keeping to a routine when it comes to meals is important.
- The senses also change markedly alongside cognitive impairment, so the smell, texture and taste of foods can seem different, and someone with dementia may not recognize familiar foods. Providing a variety of different foods won’t just help to ensure nutritional adequacy, but it helps those affected to select the items that they find most enjoyable. However, food preferences can be ever-changing during the course of dementia.
- Problems with chewing and swallowing tend to develop as dementia progresses. These pose a risk as food or drink entering the lungs can lead to chest infections such as pneumonia. An appropriate texture for someone’s swallowing ability can be determined by a speech-language pathologist and they can offer practical advice for how this can be provided at mealtimes.
- Using cutlery can become difficult, so finger foods may be easier to manage at mealtimes. Finger foods can also be advantageous, as someone with dementia will often not have sufficient focus to remain at the table for the duration of the meal, particularly if they display wandersome behaviors. Items such as buttered toast cut into strips, sandwiches, cubes of cheese, chicken pieces, slices of fruit, vegetable sticks, biscuits and slices of cake are ideal for meal or snack times, as they can be eaten on the go. However, swallowing difficulties that develop will determine which items can be offered over time.
Maximizing nutritional intake
Besides providing help with the grocery shopping, food preparation and assistance at mealtimes, when dietary intake is poor or someone has high energy requirements owing to wandersome behavior, steps can be taken to ensure that the food and drinks consumed provide as much energy, protein and other nutrients as possible.
Instead of thinking about providing three meals daily, snacks in between meals and before bed should also be provided, as it is important to encourage someone with dementia to eat little and often to give them the best chance of meeting their needs for calories and nutrients. All foods offered should be energy dense and while snacks such as biscuits, cake and chocolate can be offered some of the time, try to offer more nourishing options such as small sandwiches, peanut butter or cheese on toast, yogurt, a banana or dried fruit as well. Try to serve a dessert after their lunchtime and evening meal too; milk-based puddings make a good option.
The energy density of foods can be increased further through the addition of extra fat or sugar. For instance, extra butter or margarine can be added to bread, potatoes, vegetables pasta and rice dishes, while cream can be used in porridge, soups, sauces and desserts. As long as someone doesn’t have diabetes, sugar, syrup and preserves can also be added to toast, cereal, drinks and desserts.
When it comes to drinks, try to serve milky drinks each day; milkshakes, hot chocolate and weak milky coffees are all good options. Unless they have been advised to avoid full-fat milk, use this milk, as it is higher in calories than low-fat versions. However, whichever milk is used, the calorie and protein content can be boosted by the addition of milk powder. As a guide, add 3 heaped tablespoons of milk powder per pint of milk used, but mix this with a little milk first to ensure that it blends well.
If despite using these measures dietary intake remains poor and weight loss continues, high energy and protein supplements may be advised by their doctor or dietitian. However, to receive most benefit from these supplements they need to be taken alongside the steps outlined above.
By Evelyn Farage.