As the U.S. population ages at an incrementally faster pace, it is thought that by 2030, 20 % of all U.S. citizens over the age of 65 will have dementia, naturally including Alzheimer’s disease. The prevalent symptoms in that older population will include memory loss, confusion, disorientation, and a wide range of other cognitive challenges. On the plus side however, there are many studies that point to good nutrition as being at the top of the list for factors that can defer the onset of dementia and then slow down its progression.
Aging itself presents overlapping dietary issues such as suppressed appetite and feeding problems, both resulting in possible deficiencies in good nutrition and the right type of vitamins. but with dementia there may be other issues due to the progression of the disease.
This article therefore addresses what to look for and how to handle possible reasons for poor eating habits, malnutrition, and weight loss in older adults with dementia. Our objective is to help caregivers boost their patients’ energy by delivering proper nutrition, including the right daily amounts of proteins, carbohydrates, fats, vitamins and supplements. Other aspects to nutrition and dementia that this article will explore include how diet can help prevent dementia and alleviate dementia symptoms. We will also offer different diets that maintain brain health, and some resources to brain healthy recipes and other body nutrients.
In this article are sections that include:
- Nutritional Issues that occur in dementia patients
- Strategies to combat nutrition-type issues
- Heart healthy to stay brain healthy: Prevention and slowing the progression of symptoms
- The Mediterranean Diet, The DASH Diet, and the MIND Diet
One of the most prevalent nutritional problems faced by dementia patients is malnutrition (and its resulting deficiencies in good nutrients, including proteins, carbohydrates, and vitamins). According to Alzheimer’s Disease International (2014) 10 % of dementia patients living at home, 30% of those living in care facilities, and 70% of those in hospitals suffer from malnutrition. As the disease progresses, malnutrition becomes more prevalent, with weight loss becoming a possible concern. There are different problems that can contribute to malnutrition including:
- Loss of appetite
- Difficulty swallowing (dysphagia)
- Disinterest in food due to the loss of taste and smell
- Inability to recognize food items
- And side effects of medications
In addition, fluid intake can become greatly reduced, resulting in the body dehydrating and exacerbating cognitive issues.
By definition, caregivers can thus help prevent malnutrition by addressing the main issues causing their loved ones to not eat. Here are some problems -and solutions- that may be preventing your patient from eating regularly and getting the right kind of nutrients on a daily basis:
Loss of Appetite
Loss of appetite may occur due to the side effects of medications, lack of movement or exercise, depression, constipation, difficulty swallowing, or even pain. Some strategies to encourage appetite may be as simple as addressing these issues, such as evaluating the side effects of the patient’s medications with their doctor, or getting your loved one moving with exercise with, for example, a daily walk. Other ways to encourage appetite and the absorption of healthy nutrients include:
- Preparing your loved one’s favorite meals
- Having smaller and more frequent meals rather than one large meal
- Gently reminding the person to eat
- Making meal times engaging and good fun
- Or having your loved one involved in preparing meals
Remember, there could be a simple underlying issue that could be contributing to a decreased appetite, but if it continues and you begin to see weight loss and other issues (perhaps involving the content of the food you offer), consult with your loved one’s physician.
Eating in the Good Old Days
A 65-year-old memory care resident slowly started eating less and less at each mealtime and, as a result, she began to lose weight. Her family members and the staff began to naturally become concerned. At meal times, the resident kept neglecting her food, reflecting that perhaps she was “not very hungry”. One caregiver decided to ask the resident’s family what were her favorite meals as a child, and her family told her that their mother loved meatloaf and mashed potatoes. The caregiver told the kitchen to make meatloaf and mashed potatoes for the resident’s next meal. Later that day, when the resident saw her meal, she smiled, and the caregiver quickly noted that she indeed liked the meat and potatoes that had been prepared for her. She looked at the nurse’s aide and said, “Yes! My mom always used to prepare meat and potatoes forme in the good old days.” The resident ate her meal happily and told the caregiver about all memories of family dinners and her mom’s home cooked meals.
Problems with the senses can occur in dementia patients. These include such issues as:
- Misjudgment of temperature
- Visual and spatial changes that can lead to inability to distinguish the food from the plate
- And loss of taste and smell
When a patient cannot properly judge temperature, this can result in burns. Losing your sense of smell alone impacts taste, and loss of taste and smell makes eating an unrewarding experience. When tackling temperature issues, always check the food to make sure it is at a safe temperature for the patient before they attempt to indulge in it.
To help distinguish between plate and food, it is best to serve the food items on white plates backed by a contrasted color from a place mat or table cloth.
When dealing with loss of taste and smell, the caregiver should attempt to identify the flavors and nutrients a person can still taste, and then serve those items as frequently as practical. Those items can help, particularly if they include the right concentration of proteins, carbohydrates, fats, vitamins and supplements. In addition, the caregiver should always find ways to create an engaging and fun environment at mealtimes to mix enjoyment with good health habits.
Difficulty swallowing (also referred to as dysphagia), together with difficulty chewing, can present a major challenge to eating and receiving the good nutrients for Alzheimer’s and other dementia patients.
Difficulty chewing can be the result of pain in the mouth, forgetting to chew, or improperly fitting dentures. As dementia progresses, difficulty swallowing can occur due to the decline in motor function. In addition to leading to deficiencies in healthy nutrients and dehydration, both difficulty of swallowing and chewing issues can also present the danger of choking and aspiration in dementia patients. Some strategies to help with difficulty chewing and swallowing include:
- Cutting the food into smaller bites
- Offering soft-cooked foods
- Avoiding raw and hard foods
- Maintaining good oral hygiene to prevent pain in the mouth
- Having the patient properly seated at meal times to ensure proper swallowing
- And checking dentures for a proper fit
It is important to note that when difficulty swallowing occurs in dementia patients, it is an indicator of the progression of the Alzheimer’s or other dementia disease. Occupational therapists may be able to help with dysphagia, although oftentimes, adjustments to how food is prepared and offered can help the caregiver the most.
Astrid’s Dad’s Pneumonia
When Asrid visited her 70-year-old father at his long-term care facility, she began noticing that he had begun to eat less at meal times. He also seemed to have lingering issues from his recent bout of pneumonia. When her father’s physician came to visit, he noticed her father had lost quite a bit of weight, and Astrid also mentioned her father’s decreased appetite. The physician said because of his continued issues with pneumonia and his decline in appetite, he decided to order a swallow assessment for her father. He explained that aspirational pneumonia was common when patients were having difficulty swallowing, and he said that it would explain her father’s decreased appetite. The swallow assessment confirmed that her father had dysphagia, and when adjustments were made to his food’s texture to help him better swallow and eat his food, overall improvements started showing up in both his appetite and body weight.
Coordination issues can include:
- Difficulty using utensils
- Forgetting to open their mouth as they bring food to their mouth
- And drinking from a glass or cup
It is important for the care attendant to be encouraging and understanding, for coordination issues in a person with dementia can cause them embarrassment or frustration at the loss of independence when someone else must constantly help to feed them. Finger foods are a good option for those having difficulty holding utensils, and they can also help the person with dementia continue to feel independent. Having items cut up into manageable pieces can also avoid frustration with the handling of knives. Utilizing a straw or special no-spill cups may help with issues with drinking from glasses.
It is important to make sure a person is eating adequately and not losing out on food and healthy nutrients because of inability to feed themselves. Supervision of their mealtimes and how they feed themselves may thus be necessary when such concern arises.
Helping Jacob’s Mom
Jacob’s mom was diagnosed with early onset Alzheimer’s at the relatively young age of 50 and, since then, he didn’t see much change in his mom’s demeanor until about a month ago. The most evident change recently that caught Jacob’s attention was his mom’s disinterest in sitting down to partake in certain meals. Jacob tried to offer only her favorite foods, and yet she still continued to say, “I am not really hungry.” In addition to this, he noticed her snacking more frequently on easily prepared finger foods. One night at dinner, Jacob gently asked his mother why she would not eat at her normal meal times and why she kept on insisting that “she wasn’t hungry” when she was snacking so much. Jacob’s mom quietly explained that she had begun having difficulty using utensils such as her fork and knife, and that she was embarrassed to ask him for help. Jacob reassured her that he was there to help her whenever she needed his assistance, and that although she may be embarrassed at that, she should always be honest and forthcoming with what she needed. Jacob readjusted the types of foods his mom would eat at regular mealtimes by offering finger foods that she could easily pick up and indulge in herself so that he would rarely have to intervene with help. In addition, he also improved on this difficulty by adding foods that could be eaten with a spoon since she could still use that utensil with relative ease. In Jacob’s mind, it was essential, above all, that received the right proteins, carbohydrates and vitamins as part of her regular health-oriented daily diet.
Behavior issues, such as spitting out food, also include refusing to eat, and overeating. Usually there is an underlying cause for these behavior challenges. For example:
- It could be a noisy eating environment that robbed the meal of its enjoyment factor
- Too many items on the table
- Wanting certain company or more engaging company
- Disliking the food they are being served
- And even feeling rushed or overwhelmed
By identifying these underlying causes and making adjustments, these types of behavior issues can be resolved with relative ease. Some ways to help resolve behavior issues include:
- Offering only two food items at a time to keep someone from being overwhelmed or distracted
- Creating a socially engaging but calm and quiet environment
- Knowing what the loved one’s food preferences are for each type of meal
- And encouraging independence by serving food that the person with dementia can easily feed themselves, such as finger foods.
As the Alzheimer’s disease or other type of dementia progresses, and these strategies begin to work increasingly less at encouraging eating, supplementation with healthy increments of the right kinds of proteins, carbohydrates, fats and vitamins may be recommended in order to meet your loved one’s overall nutritional and hydration needs.
Maintaining a health-oriented type of diet is beneficial to older adults, and research has shown that a heart healthy diet may help prevent Alzheimer’s disease and slow the progression of symptoms in dementia patients. Studies have also shown that nutritionally healthy eating habits lowers risk for cognitive decline and perhaps the onset of Alzheimer’s disease or other types of dementia. By preventing and controlling cardiovascular disease, hypertension, type 2 Diabetes, and other vascular risks, the patient’s brain is able to remain healthy and their risk toward dementia and rapid cognitive decline can be proportionately reduced.
Foods and ingredients that should be avoided include:
- Highly processed food
- Foods that contain dyes, flavoring chemicals, and large amounts of preservatives
- Added sugar
- High salt foods
- And foods containing high amounts of saturated fat
In recent research studies, it was found that Aluminum has been controversial for its role in the progression of Alzheimer’s disease and other types of dementia in general. Aluminum can be consumed in the diet from food additives, water used in the preparation of food, and from cooking utensils made of aluminum.
Aluminum is a neuro-toxic metal, and while it takes only a small amount of aluminum to produce neuro-toxic effects, more research needs to be done on the relationship between aluminum and Alzheimer’s disease and other types of dementia.
Research and studies on brain autopsies have revealed evidence of elevated levels of aluminum in Alzheimer’s patients’ brains. However, there has yet to be a causal relationship established between aluminum accumulation and Alzheimer’s disease because scientists have yet to establish whether this accumulation of aluminum occurs -and causes Alzheimer’s disease- or whether it occurs as a result of the dementia disease. The human body does not need aluminum, and since it has known neuro-toxic properties, it is best to avoid over exposure to the metal.
The Mediterranean Diet:
Making the Mediterranean part of the dementia patient’s everyday type of healthy food-intake has been demonstrated to slow down age-related diseases as well as the progression of Alzheimer’s disease and other types of dementia. Studies have even associated the Mediterranean diet as producing a lower risk of developing both heart-related problems as well as Parkinson’s and Alzheimer’s disease.
Mediterranean diets, include plant-based foods such as fruits, vegetables, whole grains, nuts and seeds,and fish or seafood (at least twice a week). They also have less meat than other diets, and replace butter with olive oil, and herbs and spices instead of salt or flavoring chemicals. The Mediterranean diet also includes red wine in moderation, a known healthy antioxidant.
The DASH Diet:
Studies have shown that the Dash diet has benefits that enhance the health of both your heart and brain, mostly by checking hypertension. Its main ingredients consist of foods that are:
- Low content of saturated fats, and cholesterol
- Rich in vegetables, fruits and low-fat dairy products
- High content of poultry, fish, nuts, grains
- Low content of sugars (sweets), red meats, and sodium
The MIND Diet:
Rush University has produced recent evidence linking the Mind diet to reduced risk of developing Alzheimer’s disease. This diet includes:
- A rich regimen of green leafy and other vegetables (at least once a day)
- Nuts and berries at least once a day, and whole grains three times a day
- Fish (once a week) and poultry (twice a week)
- Olive oil (like the Mediterranean diet) and one glass of wine a day
The Mind diet also includes very limited amounts of red meat, butter, sweets, other items rich in sugars, and definitely no intake of fried foods or fast and processed food.
It is hoped that this article gave you some useful insight into the importance of healthy eating and good hydration in creating buffers against the rapid decline in the progression of dementia in our older population. It is not only a question of providing the healthy nutrients but, often more so, in making mealtime a happy occasion during which your patient can have fun while ingesting the healthy foods you provide. Just make sure that the normal physical issues they may have, such as vison or smell impairments, improper swallowing, or difficulties handling of utensils, are not the main impediments to eating with appetite.