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?? UTI Low Potassium Low B12 Low 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 Icing Fresh Fruit Pudding Ice 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 Tea Coffee 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 source Solids 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