Nutritional Needs in Dementia: Best Practices for nutrition.
Eating and drinking is not only about health and energy but is also a big social factor in all of our lives. As well as nutrition it is about the pleasure of eating. This blog is about older people with dementia. Older people with dementia are faced with particular problems in their diet.
As you get older your appetite is reduced because of physiological changes in your body. There is a change in the how much energy you need. If the person is still living at home their capacity to prepare a meal may reduce. As your sense of smell changes, food doesn’t taste right. How often have you heard an older person say, “The fruit we had in the old days tasted much better than this….”
An older person might be put off by a large plate of food, so you need to make sure that all the nutrients that are required are available in small portions. These nutrient rich dishes are often those that we avoid if we are trying to lose weight. So, in some sense we’ve started to think of them as being unhealthy. Porridge with cream in it, full fat milk, sugary cakes, – these are things that we should all avoid if we are trying to stay trim and healthy in adult life. When someone becomes older and frailer it’s important to pack in the calories and vitamins in any way that appeals to them. So those “unhealthy” drinks and snacks become a vital part of the plan. Keep things like biscuits, sweets, bananas…anything nice - in full view for temptation. If a sit down meal is overwhelming, encourage snacking and eating on the move.
We do not fully understand the mechanism but there is a tendency for older people to lose muscle mass and poor nutrition definitely contributes to this. Not eating enough can be directly associated with a fall and that may be the start of a slippery slope that leads to the person losing their independence. An older person may have worsening of a chronic illness associated with age such as arthritis. Living with pain does affect your appetite. The pain may be quite specific such as the pain of ill-fitting dentures. In dementia the person may not have the energy to make a dental appointment or be organised enough to get to their appointment with the dentist, even if they have tooth pain. It is worth making sure that oral health is not part of the issue when food and drink is refused.
Towards the end of life the person with dementia might stop understanding that they should chew and swallow food. There is a danger of choking at this stage. Dementia affects the brain areas that are associated with swallowing, which requires coordination with the muscles involved in breathing. If you have ever been distracted or tried to speak while eating or drinking and the food goes down the wrong way you will know exactly what kind of result will take place if you completely lose the capacity to coordinate your swallowing. A speech and language therapist often is needed to do a swallowing assessment and suggest foods that are easier to consume safely because of their texture.
There is much more to be said about eating and drinking and you will find this in my audiobook about dementia, including ideas for stimulating appetite.
