Nutrition and suggestions for more successful mealtimes
Some Changes that may occur
Loss of appetite and signs of weight loss may be unsettling to caregivers and families. They may feel distressed from seeing the physical changes from dementia such as loose fitting clothes, and dentures, a gaunt appearance and generalized frailty and weakness. This perceived change in the nutritional status can be confirmed by assessing the amount of the weight loss and determining blood levels of protein and cholesterol.
Caregivers of persons with dementia are usually challenged by a wide range of difficulties in providing adequate nutrition and maintaining the individual’s weight. Issues related to eating, feeding, and swallowing can lead to weight loss, poor overall nutrition, and dehydration. Causes of weight loss include increased activity, changes in appetite, changes in taste and sensation, metabolic issues and physiological changes in the ability to chew and swallow. Causes may vary depending upon the stage of the disease, the type of dementia and changes in the physical and mental state requiring adjustments in treatment methodology.
Difficulty in swallowing often leads to poor oral intake and also puts individuals at risk for aspiration of food particles into the lungs leading to pneumonia. Individuals with advanced dementia are generally at a higher risk for swallowing problems. Both cognitive and non-cognitive conditions can impact eating including short-term memory loss causing an individual to forget either a meal or meal time or, if having eaten, what was eaten. Other cognitive difficulties include recognizing food and the ability to use cutlery. Apraxia is a condition in which an individual loses the involuntary ability to utilize a knife or fork, open the mouth to receive a spoon, or facilitate moving food from the front of the mouth to the back of the mouth in order to swallow. Other cognitive issues can occur if there are language difficulties or poor understanding. Communication about meal-time may be confusing, resulting in depression and a refusal to eat, or demonstrating aggressive behaviors such as refusing to take direction or throwing food.
Non-cognitive status can also result in pacing and agitation that impacts the ability to sit at the table and focus on eating.
Each one of these factors may contribute to a decline in the nutritional status of the individual with dementia.
In order to make suggestions for improving overall nutritional status of an individual with dementia, an in-depth review is required including:
- Teeth. People without their own teeth may have an increased potential for poor nutrition. If there has been weight loss, dentures may be ill fitting, loose and add to an inability to chew. Even with presence of a few or all of their teeth, as the dementia progresses, oral hygiene may not be done as effectively or at all. This may cause discomfort, alter the taste of foods and impact behaviors.
- Sleepiness and altered states of consciousness. Individuals who have an altered consciousness from being drowsy or agitated may have an impact on nutrition. Drowsiness may create less attention to chewing and swallowing or pocketing food and potentially aspirating food.
- Changes in food preferences. Alterations in food choices may occur as a result in altered tastes. There may be preference to sweet or savory foods that might not have been liked in the past.
- Changes in eating pattern. People with dementia may require a long period of time to eat small portions. As a result, the food may become cold or unappetizing.
- Food spills. Individuals with dementia who continue to be able to feed themselves may be losing functional mobility to eat comfortably without dropping food on themselves or around their plate. There is embarrassment about spilling and having soiled clothing that diminishes the interest in eating.
- Changes in posture. Frequently there is an inability to sit in an upright position with control of head and neck and the trunk in alignment. When the individual is out of alignment, the potential for swallowing problems is increased.
- A noisy environment. An environment that may not be well lit, or dark, and be may noisy with a number of auditory or visual stimuli occurring may create a distraction to the ability to focus on eating.
Some recommendations are offered that may be implemented quite easily to improve the nutritional intake and reduce the caregiver’s anxiety:
- Environment. Create an environment that promotes an atmosphere conducive to eating. Eliminate extra auditory and visual stimulation from TVs and loud playing music. Offer soothing music in a low volume. Establish a seating arrangement at a table that is comfortable with adequate support to maintain good eating posture. Minimize the number of items on the table that may cause confusion between food choices, and condiments.
- Dinnerware and cutlery. Utilize adaptive equipment to allow as much self-feeding as possible. Use distinctive colored cutlery and dinnerware, such as a non-breakable place setting and matching cutlery to help the individual distinguish food on the plate. This will reduce the difficulty that arises from discerning foods on a light colored plate or patterned plate. A good option would be the set of Astrum Red Dinner Ware with plates, bowl, and cutlery.
- Beverages. A cup with a lid or cups without handles make it easier to place a cup down without being overturned. See the option for Astrum Cups
- Table surface. Utilize non-slip placemats under the plate or plate guards to stop food from falling off the edge of the plate.
- Personal support during eating. Promote direct conversation gentle in tone and a kind touch. Provide verbal cues and physical assistance to use fork and or spoon. Cut portions of food into small enough portions to avoid choking. Introduce finger foods that are soft and easily chewed. Soft and pureed foods may need to be added and a product that thickens the food without changing the flavor may be an additional option if coughing becomes a frequent occurrence and fear of aspiration.