Good nutrition for people living with
Dementia
Good nutrition
Is essential for health at any age
Fuels, repairs & maintains our body
Eating a variety of foods
Three meals a day with nourishing snacks
Enjoyment
Does nutrition matter ?
• Makes people feel awful
• Affects their quality of life
• Starts deterioration in a downward cycle
• It’s associated with illness and cause of death
• Is much harder and more expensive to treat than
prevent
Falls Risk Need more
help Pressure
Areas Infections
Increased dependence
Hospital Admissions
Is the person living with
Dementia consuming
adequate food and
fluids to support their
needs?
Carer
Nutrition and Dementia
“A healthy diet is only as good
as the food that is eaten.” Food for Thought Fact Sheet, Alzheimer’s Society UK
Nutrition at Different Phases
NUTRITION GOALS
Promote adequate hydration, nutrition and healthy body
weight
Promote nutrition
for quality of life
Changes in the type and amount of food consumed
Changes affecting nutrition
• Reduced variety of foods
• May be unaware of spoiled food in refrigerator
• May forget that food is cooking on stove
• Restrict, overeat and / or forget to eat &/or drink
• May skip meals or not eat when meals are delivered
Judgment
• Trouble with complex meal preparation
• Problems with grocery shopping
Complex Tasks
• Person’s testimony about food eaten and when, may be unreliable
Communication
Unintentional changes to weight
MIL
D
Changes affecting nutrition
• Lose interest in food / Forget to eat and drink
• Leave food to spoil e.g. delivered meals
• Eat spoiled food or non-food items or hiding/saving food
Judgment
• Unable to prepare and shop for food without supervision
• Unable to open delivered meals
• May be overwhelmed by many foods on plate
• May begin to use inappropriate table manners, not recognize utensils or how to use them etc
Complex Tasks
• Person’s testimony about food eaten and when is unreliable • Unable to communicate hunger
Communication
Difficulty maintaining weight
MO
DE
RA
TE
Changes affecting nutrition
• Person may pocket / throw food
• May not recognize food or what to do with it
• May refuse to wear dentures, loose fitting, or cause discomfort
Judgment
• Forget how to eat and may need to be fed, prompting
• Forget how to chew and swallow
• May still be able to participate in the eating process
Complex Tasks
• Unable to communicate food and hunger
Communication
Ongoing weight loss
AD
VA
NC
ED
Cascade of poor nutrition
Reduced Food Intake
Reduced muscle and fat stores
Unintentional weight loss
Malnutrition
Weight loss is
present before
the diagnosis
of dementia in
nearly 50% of
cases
What can we do?
Monitor Screen
Enrich Refer
Monitor changes
Weight
Food intake / food changes
Clothing and accessories e.g. belt,
watch, bra, ring
Dentures
Monitor Screen
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Monitor changes Monitor Screen
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Screen for malnutrition Monitor Screen
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Screen for malnutrition
1. Have you lost weight recently without trying (in the last 6 months)?
– No 0
– Unsure 2 Score:__
– If Yes: How much weight (kg) have you lost?
• 1 - 5kg 1
• 6 - 10kg 2
• 11 - 15kg 3
• > 15kg 4
• Unsure 2 Score:__
2. Have you been eating poorly because of a decreased appetite?
– No 0
– Yes 1 Score:__
TOTAL:__
Score 2 or more at risk of malnutrition
Adapted from Ferguson et al. (1999)
Monitor Screen
Enrich Refer
Screen for malnutrition Monitor Screen
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Enriching foods Monitor Screen
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Enriching foods Monitor Screen
Enrich Refer
– Builds and repairs muscle (but not the main fuel source)
– The basis of our body’s organs, hormones, enzymes & antibodies to fight infection
– Emergency fuel in the absence of sufficient carbohydrate & fat
Inadequate protein
Muscle Weakness
Reduced Strength
Reduced Immunity
Increased risk of:
- falls, fractures
- infections, poor healing
- hospitalisation
Cost
Reduced Intake
Chewing / Swallowing
Preferences
Ageing Process
Inactivity
Illness / Disease
Enriching foods Monitor Screen
Enrich Refer
• 20g per meal for well older adults
• 30g per meal to build muscle up for recovery.
Animal Foods = 10g Plant Foods = 10g
2 small eggs
40g (2 slices) cheese
5Tb milk powder
3-4Tb cottage cheese
300ml milk
35g beef, lamb or pork (cooked weight)
40g chicken (cooked weight)
50g fish, canned tuna or salmon
125g cream cheese
200g yoghurt
4 slices (120g) wholemeal bread
3 cups (90g) wholegrain cereal
2 cups (330g) cooked pasta
3 cups (400g) cooked rice
3/4 cup (150g) lentils or kidney beans
200g baked beans
120g tofu
60g nuts or seeds
300ml soy milk
100g soy meat
Enriching foods
Oral nutrition supplement
• Mix of nutrients (macro and micro nutrients)
– Contain 1000–2000 kJ and 10-20g protein per serve and a range of vitamins and
minerals
• Various flavours
• Various styles (milk, juice, yoghurt, savoury etc)
• Various formats (liquid, powdered, pudding, biscuit, pre-thickened etc)
• Various types (high protein, high fibre, low volume etc.)
Monitor Screen
Enrich Refer
Enriching foods Monitor Screen
Enrich Refer Functions: • Carbohydrate
– main fuel supply for the brain, muscles and body
– If not eating enough will draw fuel from muscles to feed the brain
• Fat – Helps the absorption of vitamins A,D,E & K
– Most concentrated source of calories
Fats and Carbohydrate foods stop protein being ‘wasted’ as fuel
Monitor Screen
Enrich Refer
Enriching foods
Cereal +
full cream milk
Energy 1155kJ
Protein 12g
Cereal + full cream milk
+ (P) skim milk powder
Energy 1467kJ
Protein 26g
Add fresh, stewed, dried fruit to increase
energy
Breakfast Monitor Screen
Enrich Refer
2 Toast
Energy 1505 kJ
Protein 18g
Energy 970kJ
Protein 6g
Energy 1935kJ
Protein 26g
Add a thick spread of margarine increase the energy and / or sprinkle with grated cheese to increase the protein
(P)Eggs/(P)beans
(1 cup) on 1 toast
Monitor Screen
Enrich Refer
Breakfast
6 Crackers 6 (P)Cheese &
crackers
Energy 424kJ
Protein 1g
Energy 1104kJ
Protein 12g
Add dip, avocado, cream cheese to
biscuits to add energy
Snacks Monitor Screen
Enrich Refer
1 cup Fruit
Energy 850kJ
Protein 7g
Energy 310kJ
Protein 1g
Add custard/yoghurt to
fruit to increase protein
and cream to increase
energy
1 cup Fruit +
(P)custard/(E)cream
Monitor Screen
Enrich Refer
Snacks
Energy 2193kJ
Protein 8g
Energy 940kJ
Protein 7g
2 Plain scones 2 Scones with (E)jam
and (E)cream
Add jam and cream to
plain scones to
increase the
energy intake
Monitor Screen
Enrich Refer
Snacks
Energy 305kJ
Protein 2g Energy 1345kJ
Protein 7g
1 slice (E)Fruit cake with
(P)custard 1 slice Plain cake
Choose a higher
energy cake like fruit
cake and increase the
protein content by
adding custard
Monitor Screen
Enrich Refer
Snacks
Vegemite sandwich
(P)Egg or (P)salmon
sandwich
with cream cheese
Energy 1963kJ
Protein 12g
Energy 1968kJ
Protein 30g
Energy 1119kJ
Protein 7g
Spread margarine,
mayonnaise, cream
cheese avocado on
bread to add
extra energy
Cold Lunch Monitor Screen
Enrich Refer
1 cup Vegetable soup 1 cup (P)meat & (E)pasta
soup
Energy 550kJ
Protein 7g
Energy 313kJ
Protein 1g
For extra energy add a
dollop of cream and or
bread/croutons
Hot Meal Monitor Screen
Enrich Refer
Energy 1984kJ
Protein 27g
Energy 1422kJ
Protein 12g
1.5 cup Pasta with tomato
sauce 1.5 cup (P)Cheesy Tuna
Pasta
Add cheese, meat or fish
to pasta for extra protein
and cream and oil for
extra energy
Monitor Screen
Enrich Refer
Hot Meal
Energy 711kJ
Protein 15g
Energy 201kJ
Protein 7g
Add grated cheese,
cheese sauce or
cream for extra
energy
1 cup Plain vegetables 1 cup Vegetables and
(P)cheese
Vegetables Monitor Screen
Enrich Refer
¼ cup Raisins
Energy 376kJ
Protein 1g
Energy 1140kJ
Protein 8g
1 cup (P)Creamed Rice
with raisins Add
cream/custard or
ice cream to
desserts
Dessert Monitor Screen
Enrich Refer
1 scoop Ice Cream 1 cup Trifle
Energy 408kJ
Protein 2g
Energy 834kJ
Protein 5g
Add extra cream or
fruit to dairy based
desserts for extra
energy
Monitor Screen
Enrich Refer
Dessert
Finger Foods
Breads & Cereals
• Buttered toast, crumpets, muffins or bread fingers, bread rolls
• Sandwiches
• Crackers with butter or soft cheese
• Biscuits
• Scones, malt loaf, fruit loaf, teacakes or hot cross buns
• Slices of fruit cake or ginger bread
• Waffles
• Soft cereal bars
• Chapatis or small pitta breads
Monitor Screen
Enrich Refer
Finger Foods
Meat & Alternatives
• Meat, sliced and cut into pieces
• Chicken breast (moist), cut into pieces
• Hamburgers, meatballs, sausages, chipolatas, hotdogs or slices of meatloaf
• Pieces of fish fillet (boned), fish fingers, small fishcakes or crabsticks
• Slices of pie / quiche
• Vegetable burgers or vegetarian sausages
• Slices of quiche or pizza
• Hard-boiled eggs, quartered
• Kebabs
Monitor Screen
Enrich Refer
Finger Foods
Fruit
• Slices of apple or pear
• Melon wedges
• Pineapple chunks or rings
• Orange segments
• Slices of kiwi fruit
• Strawberries or raspberries
• Apricots (stone removed), cut into halves
• Nectarines or peaches (stone removed), cut into slices or chunks
• Seedless grapes
• Bananas, whole or sliced
• Dried fruit - Ready-to-eat apricots, pears, apple rings or stoned prunes
Monitor Screen
Enrich Refer
Finger Foods
Vegetables
• Broccoli or Cauliflower florets
• Carrot, swede or parsnip, cut into sticks or cubes
• Brussels sprouts, green beans
• Cucumber and celery slices or sticks
• Cherry tomatoes and capsicum, sliced or cut into
wedges
• Zucchini slices or sticks
• Mushroom cups
• Corm on cob
• Potato wedges or chunky chips, oven baked or
fried (you can also use sweet potatoes)
• Small roast or boiled potatoes, pumpkin, sweet
potato
Monitor Screen
Enrich Refer
Finger Foods
Milk & Milk Products
• Poppers of plain / flavoured milk
• Tubs of yoghurt
• Cheese cubes
• Slices of cheese on toast
Monitor Screen
Enrich Refer
Refer to a Dietitian
• Unintentional weight changes
• Changes in food intake
• Problems swallowing / chewing
• Management of medical
conditions
Monitor Screen
Enrich Refer
My Aged Care
GP Chronic Disease
Management Plan
Local hospitals or
community health
centres
Refer to a Dietitian Monitor Screen
Enrich Refer
Refer to a Dietitian Monitor Screen
Enrich Refer
Work with client and
carer
Identify likes /
dislikes
Usual eating and
meal behaviours / patterns
Monitor
Identify solutions
and barriers
Consider factors
affect food & fluid intake
Take home messages
Monitor Screen
Enrich Refer
Enjoy Social
Contact Details
• Sharon Lawrence
– Senior Commonwealth Home Support Dietitian
– Hunter New England Local Health District
– Ph. 02 49312000
Thank You