An estimated 5.7 million Americans are living with Alzheimer’s disease, and that number is projected to rise exponentially with the aging of our population. Common symptoms in those with dementia include memory loss, confusion, disorientation, and a wide range of other cognitive challenges. Though prevalence of Alzheimer’s is increasing, there is still limited knowledge of modifiable risk factors for developing dementia. However, there is growing evidence suggesting that dietary factors and good nutrition might play a protective role in the development of dementia and may also help slow its progression.
Aging can be accompanied by dietary issues such as suppressed appetite and feeding problems, potentially resulting in possible deficiencies in good nutrition and the right type of vitamins. However, in the case of dementia, there may be additional dietary 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 loved ones’ energy by delivering proper nutrition, including the right daily amounts of proteins, carbohydrates, fats, vitamins and supplements. This article will explore other aspects of health, nutrition, and dementia, including how diet might help protect against dementia and alleviate symptoms. We will also describe different diets that evidence suggests may help to maintain brain health.
This article addresses:
- Nutritional issues that can occur in individuals with dementia
- Strategies to combat nutrition-related issues
- Strategies for 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 individuals with dementia 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 potentially serious concern. There are several 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
Malnutrition can lead to unnecessary hospital re-admissions for people with dementia and can greatly increase their risk of illness and infection. The weakness caused by malnutrition can also lead to greater risk of falls. In addition to food consumption, fluid intake can also become greatly reduced, resulting dehydrating the body and exacerbating cognitive issues.
By definition, caregivers can help prevent malnutrition by addressing the main issues causing their loved ones not to eat or drink enough. Here are some problems that may be preventing your loved one from eating regularly and getting the right nutrition on a daily basis, followed by potential solutions:
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 person’s medications with their doctor, or getting your loved one moving and engaged in physical activity like taking 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 involving your loved one in meal preparation
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, 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 naturally became 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 in the good old days.” The resident ate her meal happily and told the caregiver about her memories of family dinners and her mom’s home cooked meals.
Problems with the senses can occur in people with dementia. These include issues such 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 person cannot properly judge temperature, they risk physical harm including burns. When tackling temperature issues, always check the food to make sure it is at a safe temperature before serving it to your loved one. Losing your sense of smell also impacts taste, and loss of taste and smell can make eating an unrewarding experience. When dealing with loss of taste and/or smell, the caregiver should attempt to identify the flavors 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 strive to create an engaging and fun environment at mealtimes to mix enjoyment with good health habits.
One study found that individuals with cognitive impairment consumed 24% more food and 84% more liquid when served in brightly colored containers. If serving milk, for example, try putting it in a cup that’s some color other than white. Otherwise, they may not be able to perceive that the cup is full. There are creative products on the market to help during meal times, such as Eatwell, a tableware set with features specifically designed to meet the needs of individuals with physical, motor, and cognitive impairments.
Difficulty swallowing (also referred to as dysphagia), together with difficulty chewing, can present a major challenge when it comes to individuals with Alzheimer’s and other forms of dementia eating and getting the right nutrients.
Difficulty chewing can be the result of pain in the mouth, forgetting to chew, or improperly fitting dentures. As dementia progresses in severity, difficulty swallowing can occur due to the decline in motor function. In addition to leading to deficiencies in healthy nutrients and dehydration, difficulty swallowing and chewing can also put individuals with dementia at risk for choking and aspiration. Some strategies to help with difficulty chewing and swallowing include:
- Cutting the food into smaller bites
- Offering soft-cooked and puréed foods
- Avoiding raw and hard foods
- Maintaining good oral hygiene to prevent pain in the mouth
- Having the person 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, it may be an indicator of the progression of their dementia. Occupational therapists may be able to help with dysphagia, although oftentimes, adjustments to how food is prepared and offered can help a great deal.
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 difficulty drinking from a glass or cup
It is important for caregivers to be encouraging and understanding, for coordination issues in a person with dementia can cause them embarrassment or frustration. They may also be struggling with the loss of independence that comes from someone else having to constantly help 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 missing out on food and healthy nutrients because of the inability to feed oneself. Supervision of their mealtimes and how they eat may 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 can include spitting out food, refusing to eat, and overeating. Usually there is an underlying cause of these behavior challenges. For example:
- 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 their Alzheimer’s disease or other type of dementia progresses, and these strategies become less effective 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 healthy diet is beneficial as we age in general, and research has shown that a heart healthy diet may help prevent Alzheimer’s disease and slow the progression of symptoms in those with dementia. Studies have shown that healthy nutrition habits lower the 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, brain health is supported and the risk of developing dementia and rapid cognitive decline seems to be 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 brains of individuals with Alzheimer’s. 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 Mediterranean diet 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 with a lower risk of developing both heart-related problems as well as Parkinson’s and Alzheimer’s disease.
The Mediterranean diet includes plant-based foods such as fruits, vegetables, whole grains, nuts and seeds, as well as fish or seafood (at least twice a week). The diet also encourages eating less meat than other diets, and replacing butter with olive oil, and using herbs and spices instead of salt or flavoring chemicals. The Mediterranean diet also includes drinking red wine in moderation, a known healthy antioxidant.
Studies have shown that the DASH diet (Dietary Approaches to Stop Hypertension) has benefits that enhance the health of both your heart and brain, mostly by reducing blood pressure. It consists mainly 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, and grains
- Low content of sugars (sweets), red meats, and sodium
Rush University Medical Center has produced recent evidence linking the MIND diet to reduced risk of developing Alzheimer’s disease. MIND stands for Mediterranean-DASH for Neurodegenerative Delay, combining aspects of both the previous diets and focusing on foods that are good for the brain. 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 three servings of whole grains per 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 allows very limited amounts of red meat, butter, sweets, other items rich in sugars, and recommends avoiding fried foods or fast and processed food. There has been some initial research suggesting that individuals who stick to the MIND diet lower their risk of Alzheimer’s disease, but more conclusive research is needed.
In general, it seems to be beneficial for brain functioning to increase intake of omega-3 fatty acids and antioxidants like vitamin E. To the contrary, it is recommended to limit the intake of certain foods that are high in saturated fat and cholesterol, including red meat, butter, and ice cream. This does not mean individuals must completely avoid eating these foods, but it is recommended to consume them in moderation. Instead of highly processed foods, opt for natural and organic options instead. Basically, a balanced diet focused on heart health seems to be beneficial for both the body and the brain.
Healthy eating and good hydration might help slow decline in functioning among those with dementia. Importantly, the converse is also true in that poor nutrition and dehydration may exacerbate the disease and accelerate decline. Caregivers should make sure their loved ones are consuming the proper nutrients and one way to do so is to make mealtime an enjoyable occasion. Just make sure that the normal physical issues they may have, such as any sensory impairments, improper swallowing, or difficulties handling utensils, are not serving as impediments to getting the necessary nutrients. While a healthy meal for a person with dementia won’t cure their disease, unhealthy meals, or in serious cases malnutrition, can be harmful to their mental and physical functioning and hence their quality of life.
- Morris, M. C. (2009). The role of nutrition in Alzheimer’s disease: epidemiological evidence. European Journal of Neurology, 16(Suppl 1), 1–7. http://doi.org/10.1111/j.1468-1331.2009.02735.x