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

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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

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Screen for malnutrition Monitor Screen

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Enriching foods Monitor Screen

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Enriching foods Monitor Screen

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– 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

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• 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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Dessert

Variety of Colours

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

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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

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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

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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

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Finger Foods

Milk & Milk Products

• Poppers of plain / flavoured milk

• Tubs of yoghurt

• Cheese cubes

• Slices of cheese on toast

Monitor Screen

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Refer to a Dietitian

• Unintentional weight changes

• Changes in food intake

• Problems swallowing / chewing

• Management of medical

conditions

Monitor Screen

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My Aged Care

GP Chronic Disease

Management Plan

Local hospitals or

community health

centres

Refer to a Dietitian Monitor Screen

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Refer to a Dietitian Monitor Screen

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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

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Enjoy Social

Contact Details

• Sharon Lawrence

– Senior Commonwealth Home Support Dietitian

– Hunter New England Local Health District

– Ph. 02 49312000

Thank You