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DementiaandNutrition

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Overview

• Dietandcognition

• Malnutritionanddementia

• Dementiaandfoodrefusal

• Strategiestoincreaseoralintake

AimandObjectives

Aim: • Toincreasegeneralknowledgeofnutritionalneedsfor

peoplewithdementiaObjectives: • Toidentifyreasonsformalnutritioninpeoplewith

dementia• Toidentifynutritionalstrategiesforfoodrefusalin

dementia• Toidentifystrategiestoimproveoralintakeforpeople

withdementia

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DietaryInfluenceonCognition

• HTN,highcholesterol,diabetes,highBMIandmetabolicsyndromeassociatedwithdevelopmentofsomedementias

• HeartDiseaseandT2DMlinkedtoAlzheimer’sDisease

• AMediterranean-styleDietmayhelpdecreaseriskofcognitiveimpairmentanddementiainhealthyolderadultsØ Protectagainstoxidativestressandinflammation

TheMediterraneanDiet

• Highintake:vegetables,fruit,nuts,legumes,cereals,fish,olive

oil

• Moderateintake:alcohol

• Lowerintake:meatanddairyproducts

• OilyFish consumed>1perweekdecreasesriskofcognitive

impairmentanddementiainhealthyolderadults

MalnutritionandDementia

• Gradualdeclineinbodymass

• Anadequatedietischallenging

• Aggravatessomebehaviouraldisordersassociatedwith

progressionofdementia

• Riskofmicronutrientdeficiencies

• Utiliseanutritionscreeningtooltoidentifythoseatrisk

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MalnutritionandDementia

• Malnutritionresultsin:• Weightloss&musclewasting• Subcutaneousfatlosses• Reducedmobility• Lossofindependenceindailyliving• Increasedriskoffalls/fractures• Increasedriskofinfections• Poorwoundhealing• Skinfragility• Frailty

ReasonsforMalnutritioninDementia

• Weightlosswithdepressioninearlystages

• Weightlosswithconstantpacing,wandering

• Poordentalhealth

• Certainmedications

• Bowelissues eg.constipation

ReasonsforMalnutritioninDementia

•Tooagitatedtofinishmeals

•Lackofconcentration

•Reducedappetite(lossofsmellandtaste,impairedbrainfunction)

•Inabilitytoeatindependently

•Difficultychewingand/orswallowing

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ReasonsforMalnutritioninDementia

•Lackofinterestinfood

•Texturemodifieddiet/fluidsnotvisuallyappealing

•Unabletousecutlery

•Difficultieswithcoordinationtogetfoodtomouth

•Unabletounwraporpeelfooditems

•Foodrefusal

DealingwithFoodRefusal

• Explorereasons• Dislikesfood?• Unfamiliarwithfood?• Doesnotrecognisefood/utensils?• Physicalproblems. e.g.soremouth,dentition?• Lackofunderstandingofeatingprocess?• Thinkingtheyhavetopaymoneyformeals?• Painand/oranxiety?• Noappetite?

StrategiesforFoodRefusal

• Offeralternativefoods

• Encourageandprompt

• Involveotherpeople;maytakefoodfromothers

• Interaction;holdhand,quietchattingoreatingwiththeperson

• Demonstrateeating,talkthroughstepbystep

• Considercurrentmedicationsaffectingappetite

• Considermealvouchers

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StrategiesforFoodRefusal

•Provide‘cues’thatappealtothe5senses

•Liquidsmaybebettertolerated,highcaloriedrinks

•Keepfoodonhandatalltimes

•Ifagitated,offerfoodatlatertime

•Tryfingerfood

•Providemainmealearlierinday

AsDementiaProgresses….

• Forgettoeat• Forgethowtochewandswallow• Forgethowtouseutensils(Dyspraxia)• Forgetwhatfoodanddrinkare(Agnosia)• Eatthewrongfoods• Forgettodrinkfluids• Forgettheyhavealreadyeaten• Developacravingforsweetfoods• Lossofinterestineating

Strategiestoincreaseoralintake

• Dietmodification

• Feedingassistance

• Environmentalalterations

• Supplementation

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DietModification

• Offerfoodsfromthe5foodgroupsdaily

• Ifcravingsweetfoods,offersweetpreferenceserved

alongside1-2othervariedfoods

• Providefamiliarfoods

• Texturemodifiedfoodandfluidsifrequired

• Aimtomakelookasappealingaspossible

• Offerfoodmoreofteninsmallquantities

DietModificationcontinued

•OfferHigh-Energy,HighProteindietandincludesnacks•Encourage:

•Meat,fish,chicken,eggs•Dairyproducts(milk,cheese,yoghurt)•Bakedbeans,fortifiedsoupswithlentils/beans•Desserts eg.mousse,icecream•Snacks eg.cake,biscuits,cheeseandcrackers•Nourishinghighcaloriedrinks eg.flavouredmilks,juice,smoothies

DietModificationcontinued

• Fortifyfoodsandmeals

• Addmilk,creamormilkpowder

• Servefruitswithicecream,yoghurtorcustard

• Enrichmilkwithextramilkpowder

• Addbutter/margarine/plantandseedoilstovegetables,

soupsandcasseroles

• Usemayonnaise/avocado/cheeseonsandwiches

• Offerfingerfood

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FingerFoods

•Offernutritionontherun

•Assisttomaintainindependenceineating

•Helpsmeetenergyrequirementsnotreceivedatsitdownmeal

time

FingerFoods

• Butteredtoastfingers&Frenchtoast• Pancakes&Pikelets• Rollswithbutter/avocado• Sandwiches• Pastaspirals• ButteredEnglishmuffins/crumpet

fingers• Biscuits• Fruitloaf• Cakes/scones/muffins– includebeans,

vegetables• Slicedmeats&Sausages• MiniHamburgers• Meatballs• Minipizzas• MiniQuiche

• Pies/sausagerolls• Chickennuggets&drumettes• Fishcakes/fishfingers&crumbedfish• Cheeseontoast• Cheesecubes• Quarteredboiledeggs• Vegetablesticks(mayneedtobecooked

untilsoft)• Quarteredtomatoes/avocados• Hotchips,potatogems&potatowedges• Vegetablefritters• Pinwheels• Fruitpieces• Jellycubes• Icecreamincones

FeedingAssistance

•Involverelatives

•Remind'itismealtime‘

•Feedwithdignity,notasachild

•Allowenoughtimetofinishmeals

•Reassureandencourage

•Demonstrateeatingprocess

•Tryusingbowlsratherthanplates

•Placespooninhandwhilebeingfed

•Seatatdiningtableasfoodarrives

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EnvironmentalAlterations

• Calmenvironment

• Reducedistractions eg.TVoff

• Quietbackgroundmusic

• Comfortabletableandchairheight

• Goodlighting

• Avoidsmellsofcleaningfluidsorodours

• Encouragecookingaromastohelporientate

EnvironmentalAlterations

• Avoidgarnishes- canconfuse

• Considerspeciallydesignedcutlery/plates

• Usecrockeryeasilydistinguishablefromtableortablecloth

• Simplifytablesetting

• Avoidpolystyrenecups,serviettestoreduceconfusion

• Offermealsatconsistenttimes

NutritionalSupplementation

• Rangeofproducts

• Helpsmaintainweight

• Helpsachievenutritionalrequirements

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NutritionalSupplements

• Powders• Canbeaddedtomilkshakes,

porridge,desserts,soups,baking,casseroles,mashetc.

• Fruitdrinks• Often 1cal/ml• Notgenerallynutritionally

complete• Addtosoftdrinks,makeinto

jelly

•Milkdrinks•1.5cal/ml or2cal/ml•Nutritionallycomplete•Utilisedasa‘medication’•Usuallygivenas60-80mlsTDSorQID

Summary

Bytheendofthissession,haveyouachievedthefollowing...

Increased generalknowledgeofnutritionalneedsforpeoplewithdementia?

Identifiedreasonsformalnutritioninpeoplewithdementia?

Identified nutritionalstrategiesforfoodrefusalindementia andstrategiestoimproveoralintake?

Pleaserefertothequizquestionstoassessyourknowledge.

References

1.JoannaBriggsInstitute.Interventionstoreduced undernutrition andpromoteeatinginolderadultswithdementia.BestPractice15(15);2011.2.Morgan-JonesP,etal.Don’tgivemeeggsthatbounce. HammondCareMedia,2014.3.DietitiansAssociationofAustralia.DAAsubmissionforActiononDementia2013-2017.May2013.4.Alzheimer’sAssociation– SouthCentralWisconsinChapter,theWisconsinAlzheimer’sInstituteandtheWisconsinBureauofAgingandLongTermCareResources,DivisionofDisabilityandElderServices,DepartmentofHealthandFamilyServices.PlanningGuideforDementiaCareatHome:AReferenceToolforCareManagers.Revised3/2004.5.Alzheimer’sAustralia.Nutrition(webpage).Accessibleathttps://fightdementia.org.au/support-and-services/families-and-friends/personal-care/nutrition6.Coppede F,etal.NutritionandDementia.CurrentGerontologyandGeriatricsResearch.V2012;2012.7.PrinceM,etal.NutritionandDementia:Areviewofavailableresearch.Alzheimer’sDiseaseInternational,London;2014.