dementia and nutrition - aged care diet consultants · 2018-10-21 · dementia and nutrition ......
TRANSCRIPT
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DementiaandNutrition
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Overview
• Dietandcognition
• Malnutritionanddementia
• Dementiaandfoodrefusal
• Strategiestoincreaseoralintake
AimandObjectives
Aim: • Toincreasegeneralknowledgeofnutritionalneedsfor
peoplewithdementiaObjectives: • Toidentifyreasonsformalnutritioninpeoplewith
dementia• Toidentifynutritionalstrategiesforfoodrefusalin
dementia• Toidentifystrategiestoimproveoralintakeforpeople
withdementia
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DietaryInfluenceonCognition
• HTN,highcholesterol,diabetes,highBMIandmetabolicsyndromeassociatedwithdevelopmentofsomedementias
• HeartDiseaseandT2DMlinkedtoAlzheimer’sDisease
• AMediterranean-styleDietmayhelpdecreaseriskofcognitiveimpairmentanddementiainhealthyolderadultsØ Protectagainstoxidativestressandinflammation
TheMediterraneanDiet
• Highintake:vegetables,fruit,nuts,legumes,cereals,fish,olive
oil
• Moderateintake:alcohol
• Lowerintake:meatanddairyproducts
• OilyFish consumed>1perweekdecreasesriskofcognitive
impairmentanddementiainhealthyolderadults
MalnutritionandDementia
• Gradualdeclineinbodymass
• Anadequatedietischallenging
• Aggravatessomebehaviouraldisordersassociatedwith
progressionofdementia
• Riskofmicronutrientdeficiencies
• Utiliseanutritionscreeningtooltoidentifythoseatrisk
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MalnutritionandDementia
• Malnutritionresultsin:• Weightloss&musclewasting• Subcutaneousfatlosses• Reducedmobility• Lossofindependenceindailyliving• Increasedriskoffalls/fractures• Increasedriskofinfections• Poorwoundhealing• Skinfragility• Frailty
ReasonsforMalnutritioninDementia
• Weightlosswithdepressioninearlystages
• Weightlosswithconstantpacing,wandering
• Poordentalhealth
• Certainmedications
• Bowelissues eg.constipation
ReasonsforMalnutritioninDementia
•Tooagitatedtofinishmeals
•Lackofconcentration
•Reducedappetite(lossofsmellandtaste,impairedbrainfunction)
•Inabilitytoeatindependently
•Difficultychewingand/orswallowing
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ReasonsforMalnutritioninDementia
•Lackofinterestinfood
•Texturemodifieddiet/fluidsnotvisuallyappealing
•Unabletousecutlery
•Difficultieswithcoordinationtogetfoodtomouth
•Unabletounwraporpeelfooditems
•Foodrefusal
DealingwithFoodRefusal
• Explorereasons• Dislikesfood?• Unfamiliarwithfood?• Doesnotrecognisefood/utensils?• Physicalproblems. e.g.soremouth,dentition?• Lackofunderstandingofeatingprocess?• Thinkingtheyhavetopaymoneyformeals?• Painand/oranxiety?• Noappetite?
StrategiesforFoodRefusal
• Offeralternativefoods
• Encourageandprompt
• Involveotherpeople;maytakefoodfromothers
• Interaction;holdhand,quietchattingoreatingwiththeperson
• Demonstrateeating,talkthroughstepbystep
• Considercurrentmedicationsaffectingappetite
• Considermealvouchers
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StrategiesforFoodRefusal
•Provide‘cues’thatappealtothe5senses
•Liquidsmaybebettertolerated,highcaloriedrinks
•Keepfoodonhandatalltimes
•Ifagitated,offerfoodatlatertime
•Tryfingerfood
•Providemainmealearlierinday
AsDementiaProgresses….
• Forgettoeat• Forgethowtochewandswallow• Forgethowtouseutensils(Dyspraxia)• Forgetwhatfoodanddrinkare(Agnosia)• Eatthewrongfoods• Forgettodrinkfluids• Forgettheyhavealreadyeaten• Developacravingforsweetfoods• Lossofinterestineating
Strategiestoincreaseoralintake
• Dietmodification
• Feedingassistance
• Environmentalalterations
• Supplementation
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DietModification
• Offerfoodsfromthe5foodgroupsdaily
• Ifcravingsweetfoods,offersweetpreferenceserved
alongside1-2othervariedfoods
• Providefamiliarfoods
• Texturemodifiedfoodandfluidsifrequired
• Aimtomakelookasappealingaspossible
• Offerfoodmoreofteninsmallquantities
DietModificationcontinued
•OfferHigh-Energy,HighProteindietandincludesnacks•Encourage:
•Meat,fish,chicken,eggs•Dairyproducts(milk,cheese,yoghurt)•Bakedbeans,fortifiedsoupswithlentils/beans•Desserts eg.mousse,icecream•Snacks eg.cake,biscuits,cheeseandcrackers•Nourishinghighcaloriedrinks eg.flavouredmilks,juice,smoothies
DietModificationcontinued
• Fortifyfoodsandmeals
• Addmilk,creamormilkpowder
• Servefruitswithicecream,yoghurtorcustard
• Enrichmilkwithextramilkpowder
• Addbutter/margarine/plantandseedoilstovegetables,
soupsandcasseroles
• Usemayonnaise/avocado/cheeseonsandwiches
• Offerfingerfood
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FingerFoods
•Offernutritionontherun
•Assisttomaintainindependenceineating
•Helpsmeetenergyrequirementsnotreceivedatsitdownmeal
time
FingerFoods
• Butteredtoastfingers&Frenchtoast• Pancakes&Pikelets• Rollswithbutter/avocado• Sandwiches• Pastaspirals• ButteredEnglishmuffins/crumpet
fingers• Biscuits• Fruitloaf• Cakes/scones/muffins– includebeans,
vegetables• Slicedmeats&Sausages• MiniHamburgers• Meatballs• Minipizzas• MiniQuiche
• Pies/sausagerolls• Chickennuggets&drumettes• Fishcakes/fishfingers&crumbedfish• Cheeseontoast• Cheesecubes• Quarteredboiledeggs• Vegetablesticks(mayneedtobecooked
untilsoft)• Quarteredtomatoes/avocados• Hotchips,potatogems&potatowedges• Vegetablefritters• Pinwheels• Fruitpieces• Jellycubes• Icecreamincones
FeedingAssistance
•Involverelatives
•Remind'itismealtime‘
•Feedwithdignity,notasachild
•Allowenoughtimetofinishmeals
•Reassureandencourage
•Demonstrateeatingprocess
•Tryusingbowlsratherthanplates
•Placespooninhandwhilebeingfed
•Seatatdiningtableasfoodarrives
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EnvironmentalAlterations
• Calmenvironment
• Reducedistractions eg.TVoff
• Quietbackgroundmusic
• Comfortabletableandchairheight
• Goodlighting
• Avoidsmellsofcleaningfluidsorodours
• Encouragecookingaromastohelporientate
EnvironmentalAlterations
• Avoidgarnishes- canconfuse
• Considerspeciallydesignedcutlery/plates
• Usecrockeryeasilydistinguishablefromtableortablecloth
• Simplifytablesetting
• Avoidpolystyrenecups,serviettestoreduceconfusion
• Offermealsatconsistenttimes
NutritionalSupplementation
• Rangeofproducts
• Helpsmaintainweight
• Helpsachievenutritionalrequirements
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NutritionalSupplements
• Powders• Canbeaddedtomilkshakes,
porridge,desserts,soups,baking,casseroles,mashetc.
• Fruitdrinks• Often 1cal/ml• Notgenerallynutritionally
complete• Addtosoftdrinks,makeinto
jelly
•Milkdrinks•1.5cal/ml or2cal/ml•Nutritionallycomplete•Utilisedasa‘medication’•Usuallygivenas60-80mlsTDSorQID
Summary
Bytheendofthissession,haveyouachievedthefollowing...
Increased generalknowledgeofnutritionalneedsforpeoplewithdementia?
Identifiedreasonsformalnutritioninpeoplewithdementia?
Identified nutritionalstrategiesforfoodrefusalindementia andstrategiestoimproveoralintake?
Pleaserefertothequizquestionstoassessyourknowledge.
References
1.JoannaBriggsInstitute.Interventionstoreduced undernutrition andpromoteeatinginolderadultswithdementia.BestPractice15(15);2011.2.Morgan-JonesP,etal.Don’tgivemeeggsthatbounce. HammondCareMedia,2014.3.DietitiansAssociationofAustralia.DAAsubmissionforActiononDementia2013-2017.May2013.4.Alzheimer’sAssociation– SouthCentralWisconsinChapter,theWisconsinAlzheimer’sInstituteandtheWisconsinBureauofAgingandLongTermCareResources,DivisionofDisabilityandElderServices,DepartmentofHealthandFamilyServices.PlanningGuideforDementiaCareatHome:AReferenceToolforCareManagers.Revised3/2004.5.Alzheimer’sAustralia.Nutrition(webpage).Accessibleathttps://fightdementia.org.au/support-and-services/families-and-friends/personal-care/nutrition6.Coppede F,etal.NutritionandDementia.CurrentGerontologyandGeriatricsResearch.V2012;2012.7.PrinceM,etal.NutritionandDementia:Areviewofavailableresearch.Alzheimer’sDiseaseInternational,London;2014.