Nutrition for the Dementia Resident
|BY BECKY DORNER, RD, LD|
|Nutrition for the dementia resident|
How to handle common challenges
| Anna was a delightful lady who everyone quickly fell in love with, myself included. Like many other residents with dementia, Anna spent her days wandering around the facility, visiting and charming everyone with warm smiles, conversation, and her joy of life. At mealtimes, she was distracted and had a hard time sitting still long enough to finish a meal. Because she was walking constantly, Anna was always hungry. She would come to me and say, “Do you know where I can get something to eat? I haven’t had a thing to eat all day,” even though I knew she always ate well. Somehow Anna knew I would provide her with compassion, care and, best of all, food!|
Residents with dementia may suffer from anorexia, undernutrition, and involuntary weight loss. In fact, approximately 90% of all patients with Alzheimer’s disease lose weight.1 Studies indicate that unintentional weight loss may increase mortality, reduce resistance to infections, and increase risk of pressure ulcers.2 Residents with advanced stages of dementia also are at risk for malnutrition, dehydration, and dysphagia. Good nutritional care can help to prevent these serious complications and others, such as poor wound healing.
Good eating habits may help prevent complications, prolong independence, and improve quality of life. But facilities must first have good preventive systems in place: Effective interdisciplinary communication systems to share important information, effective weight-tracking systems to identify significant changes, and efficient methods of tracking food and fluid intake are essential. Moreover, nutrition screening tools for early identification and intervention help to prevent problems and tailor interventions for each individual.
Strategic seating. Concentrate on appropriate and strategic seating to meet each resident’s needs. Family-style seating may be good for one resident, but another may benefit from being in a smaller dining area with fewer people or even one-on-one dining with staff. Provide a regular routine: Present meals at the same time and in the same place each day, with a variety of favorite foods presented appetizingly.
Encouraging independence. Encourage independent eating through the use of adaptive feeding devices, finger foods, verbal or physical cueing, hand-over-hand assistance, and proper positioning for eating. Supervise, monitor, and redirect as needed, providing gentle reminders to eat.
Adequate staffing. Eating assistance is needed for residents who lose the ability to use eating utensils, have difficulty focusing on eating, or are unable to feed themselves. Ensure adequate staffing at mealtimes to assist those who need help. Take an “all hands on deck” approach to dining services-involve all department heads and office staff in helping pass trays, opening packages, cutting foods, and pouring beverages. This will free up nursing assistants to help residents with their needs. Staff must be alert to warning signs of resident malnutrition and dehydration, such as leaving >25% of food uneaten, having difficulty chewing/swallowing, refusing substitutions, hiding food instead of eating it, and/or wandering away before finishing the meal.3 Use the information CMS offers on its Web site for nutrition and hydration, www.cms.gov/partnerships/tools/materials/nutrition, as a good basis for training. Make sure staff understands that they should pass on any concerns to a supervisor for referral to the dietetics professional and care team. Finally, offer food replacements for uneaten foods (offer food first, supplements last). And most importantly, allow adequate time to eat.
Creative Solutions for Specific Problems
Weight loss and malnutrition. Studies indicate that residents with Alzheimer’s disease are more likely to lose weight compared with control groups.5 This may be caused in part by increased energy requirements as a result of increased activity (walking, pacing, or agitation). Couple this with forgetting to eat, forgetting how to eat, or being distracted from eating, and the result is a dangerous combination for health. Prevent unintentional weight loss by identifying residents at risk and intervening appropriately. Some suggestions:
Dehydration. Dehydration may be caused by an altered thirst sensation, fear of incontinence, an inability to request adequate fluids, and medication side effects. Encourage at least six to eight 8-oz glasses of fluid each day. Also:
Advance directives. When a resident is malnourished, has lost weight, and is unable to maintain or improve at the current rate of food intake, and when all normal interventions have been exhausted, some difficult decisions must be made. Residents have the right to make their own informed medical decisions-after first being given adequate information regarding the disease and the treatment options. For residents with dementia, it is often the person having durable power of attorney who will make these decisions. A special meeting with this person (and/or the family) should be offered to discuss the resident’s status and treatment options in order to assist in the decision making process. It is important to know what the resident’s wishes are regarding feeding tubes, IVs, and total parenteral nutrition. Many facilities struggle with decisions regarding the “to feed or not to feed” dilemma. The interdisciplinary team should develop protocols to address these difficult challenges.6,7
Becky Dorner, RD, LD, is a speaker and author who provides publications, presentations, and consulting services to enhance the quality of care for older adults. This article was adapted from her presentation, “Do You Know Where I Can Get Something to Eat?: Nutrition for the Dementia Resident.” Visit www.beckydorner.com for free articles, newsletters, and information, or call (800) 342-0285. To send comments to the author and editors, please e-mail firstname.lastname@example.org. To order reprints in quantities of 100 or more, call (866) 377-6454.
Topics: Alzheimer's/Dementia , Articles , Nutrition