Nutritional care of patients with Dementia

Sarah Herbert – Dietitian (BSc, RD) Mental Health Services

Lynn Mockridge - Advanced Mental Health worker and Nutrition Advisor

Contents

Introduction Dementia Effects of dementia on nutritional status Practical advice – support with eating and

drinking Nutritional therapy in Dementia Quiz Questions

Introduction

Based at Callington Road Psychiatric Hospital

Long, enduring mental health conditions

Intensive care, acute, rehabilitation and elderly (one organic, one functional) units

Team of four; three Dietitians, one Nutrition Advisor/Advanced MH worker

Dementia Dementia describes a number of conditions in

which there is a progressive loss of brain function.

About 750,000 people in the UK have dementia and this number is expected to double in the next thirty years (DoH, 2012)

As Dementia progresses, so does an individual’s ability to eat and drink resulting in a decline in nutritional status.

Effects of Dementia on nutritional status

Early stages – weight gain? Poor appetite and dehydration Weight loss Re-feeding syndrome Increased nutritional requirements Vitamin and mineral deficiencies G.I disturbances from medication may affect appetite

What are the common difficulties with eating and drinking?

Lack of recognition

Preparing/cooking food may become

difficult

Environmental issues:

inpatient facilities.

Decreased ability to recognise

hunger and satiety

Dexterity issues

(manual and mental)

Challenge to communicate

likes and dislikes.

Food preferences may change

MotivationConcentration

Cutlery may become difficult

to use or forgotten how to

be used

Preparing for a meal

Encourage the person to go to the toilet before meals if needed

Making sure glasses or dentures are in place for the meal

Consider using adapted cutlery Use plate warmers to help keep food warm Use contrasting coloured plates Avoid distracting items on the meal table Ensure good oral hygiene after eating

Taste changes

Try naturally sweet vegetables Use sweet and sour sauces Add honey to vegetables Add a little sugar to mince, stew or potatoes Encourage milk-based puddings such as:

Refusal of food previously accepted

Strong flavoured foods, spicy foods or previously disliked foods may now be enjoyed

Keep an open mind, don’t exclude any foods Keep a list of current preferences Try adding additional spices, herbs, onion, garlic,

chilli Avoid adding extra salt Offer table sauces – chutney, pickle, relishes,

vinegar, mustard

What if someone struggles to finish a meal?

Allow extra time for meals as needed Serve one course at a time to keep food warm Prompting/Reassuring Dish up a small amount of food at any one time Consider offering 5-6 small snacks during the day

rather than 3 main meals Avoid removing plate early in an inpatient/care

home setting

Wandering/distraction at mealtimes

Leave out snacks along the route the person walk or place foods in their hand to prompt

Try a variety of finger foods

Encourage high energy foods where possible

Change the environment

Change mealtimes to suit the person

Food fortification

Don’t add extra foods but concentrate with energy and protein

5-6 small meals/snacks instead of 3 larger meals per day

Avoid low calorie/reduced fat foods Add extra butter, cheese, cream, sugar to foods Spread jam/honey thickly onto toast/crumpets Fortify full cream milk by adding 2tbps of milk

powder

Quiz!

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