Ensuring that my mother was getting balanced nutritious meals and enough food to eat was a consistent worry of mine, even when she was residing in an assisted living facility. This effort was complicated because Mom also wore dentures. I had to replace them when we couldn’t find them. Eventually the new dentures also became lost.
In the later stage of the dementia, Mom became less able to chew. She was thin to begin with and was losing weight. Before I headed off to work on weekday mornings I tried to be at the facility to ensure Mom ate her breakfast. At the end of the day before going home after work, I re-visited to help feed her supper. The pureed food she was served not only looked unappetizing and unappealing, but tasted bland to me.
Dietary issues are influenced by diverse factors, from food availability and preparation, to appetite, to taste, to depression, to swallowing problems common in advanced dementia. These are only a few of the many difficulties that caregivers can face. Malnutrition may occur at any stage of dementia. It is important to detect it and try to remedy this as early as possible.
What is malnutrition?
Malnutrition is a lack of proper nutrition, caused by not having enough to eat or not eating enough of the right things. It can happen in people with dementia for a range of reasons including loss of appetite, forgetting to eat, or not being able to feed oneself. In some cases, the brain’s regulation of appetite and the person’s metabolism is actually disturbed because of the disease. Malnutrition comprises both overnutrition (excess food/calorie intake) and undernutrition (the depletion of body energy stores and loss of body mass.) Alzheimer’s International organization reported, “Undernutrition is particularly common among people with dementia in all world regions. It tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace across the disease course.”
There are things you can try to help your loved one get sufficient daily nutrition. Here are some suggestions, based on the United Kingdom’s Alzheimer’s Society website.
- Ask them to help you with meal preparation, if they are still able to do so. Help them maintain as much independence as possible. Involve them with various tasks such as washing vegetables, stirring the pot of soup, making a sandwich, setting the table, etc.
- Serve five or six very small meals each day. A plate full of food can be overwhelming to them. Make food look and smell appealing. Use different tastes, colors, and smells.
- Make mealtimes simple and relaxing. Ambience with soft music might help, but too much noise can be distracting.
- Make sure dentures fit comfortably. Check for other dental problems such as sores in the mouth. These can be painful and interfere with their ability to eat.
- Eat with your loved one, using mealtime as an opportunity for social stimulation. Describe and talk about the food that is being served.
- Place the dish and a utensil about six inches back from the edge of the table so they are more likely to see them.
- Set out only one utensil – either a fork or a spoon. You may have to cue them to start eating by spearing an item with the fork or placing the spoon under the food.
- If they have problems with coordination, and difficulty using cutlery, chop up the food into smaller pieces so they can use a spoon or their fingers.
- Ensure that there is a visual contrast between the color of the food and the plate; e.g., rice pudding in a white bowl may be difficult to see.
- Don’t assume that your loved one has finished their meal if they stop eating. They may just find it difficult to concentrate on the task. Gently encouraging them may allow them to finish the meal. You may have to prompt them by merely saying, “Eat your food,” or “Here are your favorite mashed potatoes and gravy.”
- Don’t assume that when your loved one does not eat, that they do not want to eat. They may not be able to recognize food or be able to feed themselves any longer. Giving them a choice of food or using prompts and pictures of the food may help.
- If your loved one is agitated or distressed, don’t put pressure on them to eat or drink. Wait until they have calmed down.
- Provide nutritious snacks, such as fresh fruit, raw vegetables and cheese. Ensure that access to food and drinks are visible and available throughout the day so that they can eat and drink whenever they feel hungry or thirsty.
- Difficulties in swallowing can lead to risk of aspiration. It is important that your loved one is alert, comfortable, and sitting up in a good position before feeding is attempted. The advice of an appropriate specialist (speech and language therapist, occupational or physiotherapist) may be needed.
Over time you may find that your loved one’s appetite declines or the taste of food doesn’t appeal to them. Sensory changes in sight and smell can impact their ability to enjoy food and mealtimes. Their likes and dislikes for food and drink may be quite dramatic and different from the ones they held for many years. They may also find it difficult to tell you what they want to eat. Try your best to determine what foods will deliver the most nutrients. If nothing seems to be working, consult a nutritionist for suggestions.
Should you give your loved one vitamins or dietary supplements? Check with their doctor before doing so. Some vitamins and supplements interfere with medicines your loved one may be taking.
If you are concerned about the nutrition needs of your loved one, the Nestle Nutrition Institute provides caregivers of elderly persons a tool called “The Self Mini-MNA.” This is a nutrition screening and assessment tool used to identify if persons 65 and above are malnourished or at risk of malnutrition. You complete the six questions and share the results with a doctor to help guide the discussion about your loved one’s nutrition needs. It is available in ten different languages and there is even a free app for use with an I-phone. (http://www.mna-elderly.com/mna_forms.html). I have not used this tool nor do I advocate that you do, but I wanted you to know that this is available so you can judge for yourself how helpful it will be regarding your situation.
I wish you peace, patience, and joy in your caregiving today and every day!
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The National Institute on Aging has a handout on healthy nutrition that you can download: https://www.nia.nih.gov/alzheimers/publication/healthy-eating.
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The Alzheimer’s Association website has detailed information regarding nutrition: https://www.alz.org/care/alzheimers-food-eating.asp#minimize.
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The Social Care Institute or Excellence (SCIE) has an article on “Activities for People with Dementia based around Food:” http://www.scie.org.uk/dementia/living-with-dementia/eating-well/activities-around-food.asp.
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In this brief video, Teepa Snow, noted dementia care trainer and advocate, describes visual processing problems that might affect persons with dementia getting proper nutrition: https://youtu.be/KGhPkV2roVc.