Nutritional Challenges of Dementia

Presented by: Pam Polk, RD, LD

Healthcare Account Mgr.

Objective

Discuss nutrition interventions to help maintain optimal nutritional status &

hydration status at different stages of Dementia

Est. 24 MM people living with some type of dementia

By 2015 could be epidemic numbers Many types of Dementia –

Alzheimer's main type we hear about

Most Important Goal:

Prevent weight decline Maintain hydration

General Symptoms

Loss of interest agitation Withdrawal Changes in eating habits in hygiene / self-care habits Repetition

VERY IMPORTANT!!

Rule out other things that might be causing changes in weight, behavior, etc.

Poor dentition Mouth sores Limited use of extremities Diabetes Heart Disease CVA Depression Constipation Agitation

May be difficult for them to express pain….

Only indication of PAIN may be that they stop eating

EARLY STAGES

Goal: hydration, nutrition, independence

Few interventions Confuse foods with non-foods May have to alter environment Low tolerance for new ideas (menu

changes, etc.)

EARLY CONTINUED

SYMPTOMS: food intake cereal consumption sweets Excessive sodas ( in caffeine may have

incontinence, agitation) Forget to eat or drink (or forget they already

have) May have weight loss or weight gain

EARLY CONTINUED

RESULTS: Vitamin deficiency

What looks like dementia??

UTILow PotassiumLow B12Low Iron

EARLY STAGES

INTERVENTIONS: nutritious foods fluids Simple menus

Entree:

Roast Beef

Turkey Cacciatore

Chef Salad“

Catch of the Day”

Sides:

Mashed Potatoes with Gravy

Seasoned Rice

Zucchini

Seasoned Sugar Snap Peas

Vegetable Beef Soup w/ Crackers

Dinner Roll

Garlic Bread

Bread (white / wheat)

Dessert:Yellow Cake with Chocolate IcingFresh FruitPuddingIce Cream (Vanilla, Strawberry, Choc)Sherbet (Lime, Orange, Rainbow)

Beverages:Milk (1%,2%, Whole, Skim, Choc)Juice (Orange, Grape, Cranberry, Apple, Prune)Iced Tea (Sweet, Unsweet)Hot TeaCoffee

LUNCH

MIDDLE STAGES

GOAL: Nutrition Hydration Weight maintenance

General Symptoms

Forget to eat Not find way to dining room Forget table manners Forget they have already eaten caloric needs due to walking Unable to recognize utensils sugar intake smell effective communication LATER MAY HAVE CHEW / SWALLOW ISSUES

MIDDLE STAGES

INTERVENTIONS: Finger foods Season and color on foods Small plates to prevent being

overwhelmed Serve one item at a time Don’t over stimulate

Finger Food Examples

Meats cut into Bite – Sized Pieces

Gravy and Sauces on the Side for Dipping

French Fries Green Beans Roll / Bread Cake Bites Pineapple Chunks Breaded Squash Bites Rotini Pasta Cookies

•Cheese Sandwich Bites•Vegetable Sticks•Baby Carrots•Dressing Balls•Brussels Sprouts•Sliced Apples•Sliced Peaches•Broccoli•Baked Potato Bites w/ Sour Cream for Dipping•Sliced Peaches•Chicken Salad Sandwich Bites•Meatball Bites and Rotini•Banana Bites

Finger Food Examples

Cabbage Wedge Fresh Fruit Cheese Sandwich Bites Vegetable Sticks Baby Carrots Dressing Balls Brussels Sprouts Sliced Apples Hot Cereal in Mug Soup in Mug Buttered Biscuit Corn Fritters Fruited Gelatin Cubes Brownie Sweet Potato Bites

•Chicken Salad Sandwich Bites•Meatball Bites and Rotini•Banana Bites•Hot Cereal in Mug•Soup in Mug•Buttered Biscuit•Corn Fritters•Fruited Gelatin Cubes•Brownie•Sweet Potato Bites

LATE STAGES

GOAL: Maintain weight Dignity Quality of life

LATE STAGES

Chew / Swallowing Difficulty May pocket food Forget to chew or swallow Refuse food Not recognize food Weight loss

Know / Understand the Resident

Resident may not be the best source L/D/A

Environment: May have decreased attention span Problems focusing

Communicate clear, calm, neutral tone

Consistency Well-lit area Avoid patterns on table cloths/ china Extra time to eat Have only needed utensils at the

table

STAFF

Well-trained staff can calm agitated residents and make meals pleasurable

Monitor resident self-feeding Verbal & tactile cueing Name, eye contact, compliment Calorie dense finger foods Coach to use utensils Remind to chew / swallow Encourage independence BE POSITIVE ABOUT THE MEAL (even

Puree)!!

Hydration

Water plays a CRITICAL role in these body functions:

•Transfer nutrients and oxygen to cells•Acts as a solvent for most nutrients•Remove waste from cells•Lubricant in joints•Regulate body temperature•Prevent constipation•Assist digestion & absorption•Maintain blood volume

Sources

Liquids are most obvious sourceSolids do provide some water

Reasons elderly have decreased fluid intake:

Fear of incontinence Not like taste of water Thirst mechanism decreases with age Chronic illness interfere with normal eat &

drink Alcohol increases fluid requirement Decreased renal concentrating ability Do not conserve water well Handling cups is difficult

Risk Factors: Confusion Fever Diarrhea Bed bound Previous episodes of dehydration / vomiting Diuretics Aspiration High protein diets

Symptoms: Fatigue Thirst Headache Dry nasal passages Dry cracked lips Overall discomfort Swollen tongue Mental confusion Decreased skin turgor Constipation

- UTI- Fever- Decreased appetite- Nausea- Changes in lab values- Decreased BP- Urine concentration