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How Can A Dietitian Help Someone With Dementia

How To Help People With Dementia

Nutrition and The Ageing Brain – Can The Right Diet Help Prevent Dementia?

To families and friends, caring for a loved one with dementia faces several difficulties. Dementia patients from disorders like Alzheimers and related illnesses are undergoing a gradual biological brain disorder that makes it increasingly difficult for them to think about things, think clearly, interact with others, and take care of themselves. You can maintain an element of control as a caregiver by teaching yourself about dementia and having a positive but practical attitude. It can take the sting out of the remarkable challenges you face and enhance the care you provide as well.

Here are some key facts to recognize when you approach someone with dementia to take care of your role:

Dementia And Eating Issues Conclusion

Well, we sure have covered alot! Weve discussed the different types of dementia, nutrition concerns in patients with dementia, decisions around tube feeding, and the prevention of dementia.

After reading this post, hopefully you walk away with an overall understanding of dementia. Of how you can help an individual affected by dementia with their nutrition. And what your role in the a patients nutrition care is.

Food and nutrition are powerful in improving and supporting our health. Additionally, it enhances our quality of life. And it sustains dignity and independence. We hope the information in this post was helpful. And added a few tools to your toolbox so that you can provide the best care possible when it comes to dementia and eating issues.

Eat Small All Day Long

Contrary to what we believe, we do not need 3 main meals a day. Research shows that there is no major differences between 3 regular meals a day, 2 large meals a day or 5 little ones. In fact 5 little meals can help to regulate steady blood pressure which is an added bonus.

If you can only get your parent to eat small amounts, thats not a problem as long as this is at regular periods throughout the day. Its all about finding what works best for you.

Eating smaller portions can also benefit people living with dementia who have difficulty swallowing. Difficulty swallowing is a symptom of some types of dementia, including Alzheimers and Lewy Body Dementia.

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Communicate Patiently Slowly And Clearly

Use physical touch to help communicate. For instance, if a person with dementia is having a hallucination, a gentle pat from you might draw them back to reality and out of their frightening hallucination.4 Sometimes holding hands, touching, hugging, and praise will get the person to respond when all else fails.

Communication or more specifically failed communication can be the crux of problems for many caregivers. Weve whittled it down to some of the key aspects that you could focus on to make it easy for you and the person with dementia:5

Nutrition Concerns For Individuals With Dementia

Dementia: How The Condition Affects Your Nutrition

Individuals with dementia experience forgetfulness and memory loss. They may also have personality changes and impaired thinking. Many people with dementia do not follow a special diet. However, it’s not uncommon for people with dementia to struggle to maintain a healthy body weight.

Eating Challenges with Dementia

Weight loss is common and tends to become more severe as dementia gets worse. In addition to simply forgetting to eat, there are other reasons weight loss might occur:

  • Appetite triggers in the brain may not be working normally or medications may impact the desire to eat.
  • Food may taste bland due to changes in sense of smell and taste.
  • Difficulty focusing may cause an individual to spend less time eating and therefore consume fewer calories.
  • Coordination skills might decline, making use of eating utensils or feeding oneself difficult.
  • Chewing and swallowing problems can make it difficult to eat. Some individuals may be prescribed diets that include softer foods to help encourage intake or thickened liquids for easier swallowing.

With severe dementia, individuals may also lose the ability to distinguish food from non-food objects. This might lead to replacing food intake with items that can’t be digested or may even be toxic.

Healthy Eating for Individuals with Dementia

The Healthcare Team

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How Dementia Impacts Health

You now know what dementia is, the different types of dementia, a few statistics, and the different stages. You are probably reading this post because you want to learn about how dementia impacts the health of loved ones, patients and clients, or yourself or maybe all of the above!

A good starting point is the symptoms, signs, and complications of dementia.

Divide Tasks Into A Number Of Steps

This makes it much more accessible for many jobs. You should motivate your loved one to do what he can, inform him kindly of steps he appears to neglect, and support him with steps he can no longer do on his own. It can be very helpful to use visual indications, such as demonstrating him with your hand where to place the dinner plate.

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Medicines To Slow Their Cognitive Decline Or Manage Behavioural And Psychosocial Problems

Patients living with more advanced dementia are more likely to be using medicines to slow their cognitive decline or manage behavioural and psychosocial problems associated with cognitive decline and these medicines bring their own challenges to prescribing and pharmacy practice,.

The use of memory drugs such as donepezil, galantamine, rivastigmine and memantine have increased for a number of reasons including a growing level of awareness among the general public, partly a result of campaigns like the Department of Health campaign for earlier diagnosis of dementias, the off-licence use of these drugs and a recent significant financial investment in research into memory problems.

When a patient stops taking their memory drug, or misses a few doses because of inaccurate medicine reconciliation at transfer of care, their rate of cognitive decline increases. Once cognitive function is lost, it can never be regained and many hospitals treat memory drugs as critical medicines that must not be missed.

Box 2: Anticholinergic burden of medicines

Long term use of medicines with anticholinergic side effects by older people can impair cognition and increase falls risk, morbidity and, possibly, mortality. It can also cause constipation and urinary retention. Each person is susceptible to anticholinergic side effects to a different degree but people living with mild dementias appear to be more susceptible to the cognitive side effects.

ACB score 1 :

  • beta-adrenoceptor blockers

Q What Practical Advice Can Dietitians Give If Someone Is Losing Weight Without Trying To Or Has A Reduced Appetite To Maintain Their Weight And Strength

How to have a good conversation with someone with dementia

1.10.6 Encourage and support people living with dementia to eat and drink, taking into account their nutritional needs.

1.10.7 Consider involving a speech and language therapist if there are concerns about a persons safety when eating and drinking.

  • Address underlying barriers to eating and drinking with the person and MDT dysphagia, constipation, poor dentition, oral thrush, depression, infection, dexterity, social context and environment for example.
  • Food First 1,2,3 approach increase protein, calories and nutrient density. This can include one pint of fortified milk or homemade fortified milkshake, two nourishing snacks and three fortified meals.
  • Consider trialling finger foods, assistance with eating and drinking , adapted cutlery and crockery , foods previously liked in the past, sweet foods.
  • Consider recommending a vitamin D supplement 10ug if the person isnt already taking one.
  • Encourage the person to be active and to do activities they enjoy.
  • If food first and nourishing drink approaches do not meet the goal of care consider if a trial of prescribable nutritional supplements is indicated for a specific goal and timespan.

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Q What Are The Risk Factors For Developing Dementia

Some dementia risk factors are non-modifi able for example age and genetics, however many risk factors may be modifi able through lifestyle alterations and/or pharmacological treatment. Possible nutrition related risk factors include: nutrition prior to birth low birth weight and stunting in early life are independently associated with lower cognitive ability in adulthood longer leg length and larger skull circumference are associated with lower dementia prevalence obesity in midlife may be a risk factor for developing dementia in late life but evidence is confl icting. Potential mechanisms include: insulin resistance, infl ammation and cardiovascular disease .

There is currently no evidence that specifi c individual nutrients such B vitamins, antioxidants or omega-3 Polyunsaturated Fatty Acids can reduce our risk of developing dementia .

Help Them Stay Organized But Without Doing Everything For Them

Having a nighttime routine also helps with sleep problems that some seniors with dementia encounter. Doctors suggest non-drug options to manage sleep issues in those with dementia-related sleeping issues. The right room temperature, comfortable bedding, nightwear, and a soft light that isnt too dark can help. So can reading or listening to music to wind down instead of television or a drink which can act as a stimulant and disrupt sleep.9

A person with dementia may need help with their daily tasks and life which theyd managed alone until now. Having a set routine can help. Dont do everything for them though it might make them feel unwanted or useless. Instead, have them do things with you or assist with little jobs around the house. If tasks seem daunting, break it down into simpler steps for them. You could even use notes or little posters at critical locations to help them remember what to do or how to do something.10

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Check First With The Doctor

There may be an underlying medical cause for behavioral problems: the patient may be in pain or have an adverse side effect from medication or lack of sleep. In some cases, such as incontinence or hallucinations, some medication or treatment may be available that can help manage the problem. Sometimes it is difficult to handle and you would need a doctor.

Q What Impact Can Dementia Have On An Individuals Nutritional Status

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Malnutrition risk increases as dementia progresses . People who have dementia have been found to account for ten times more admissions to hospitals when compared to age-matched controls . This may be due to an increased risk of dehydration, dysphagia, falls, chest infections, and malnutrition which can be related to dementia progression.

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Do The Changes That Occur In People With Alzheimers Disease Make Healthy Eating More Difficult

Yes. First, the normal aging process itself can change eating habits. For example, a persons sense of taste and smell may change as one ages, which can affect what he or she chooses to eat and impact overall health. There can also be problems with teeth or gums or dentures that make eating more uncomfortable. Diseases affecting vision are also common in the elderly. This can make preparing, recognizing, and enjoying foods more difficult.

In addition to these typical age-related changes, the changes in a persons ability to function as Alzheimers disease progresses makes maintaining health even more difficult. Persons with Alzheimers disease may:

  • Forget to eat and drink
  • Forget the steps involved in cooking
  • Lose their appetite due to the medications they are taking, change in medication dosage, or due to depression
  • Forget how to hold and use utensils
  • Have difficulty communicating their desire for foods they would like to eat or recognize that they are hungry or thirsty
  • Develop difficulty chewing and swallowing

Position On Tube Feeding In Advanced Dementia

The American Geriatrics Societys position on tube feeding in advanced dementia states:

when feeding difficulties arise, feeding tubes are not recommended for older adults with dementia and that health care providers should promote choice, endorse shared and informed decision making, and honor preferences regarding tube feeding .

Healthcare providers have the responsibility to inform patients about the science, then support and reinforce the patients wishes. They should be considerate of the fact that a patients choice may not be the choice that you would make personally, and that support for the patient is necessary regardless.

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Monitor Burns From Hot Water

Dementia and Alzheimers disease can reduce a persons sensitivity to pain. The person might not realize how bad the burn is. The water heater should be checked to ensure that the temperature is not set too high. Having a kitchen faucet where hot and cold water are combined into one can be quite helpful since it makes it much easier to adjust the water temperature.

Tips On How To Care For Someone With Dementia

5 TIPS FOR TALKING TO YOUR LOVED ONE WITH DEMENTIA

With one person in the world developing dementia every 3 seconds and an estimated 50 million or more people living with the condition globally, dementia is a very real problem.1 Getting the right care is crucial to maintaining a good quality of life for those coping with this problem. To add to it, dementia doesnt just affect the individual but also those around them. Navigating what can sometimes be a very emotional and difficult path may seem daunting, but there are some ways to make it easier. What follows is a look at how to care for someone with dementia, ways to keep them happier, and for you to cope too.

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Emotions And Caregiver Guilt

A common caregiver response to poor food intake in patients with dementia is guilt. Caregivers feel as though they are responsible for how much and what their patient or loved one eats. This is a huge weight for the caregiver to carry.

In addition, when a patient struggles with eating this can cause them to eat less and lose weight. This can create a lot of different emotions for the caregiver. Feelings of sadness, hopelessness, frustration, and grief are common.

These are normal feelings in caregivers. However, keep in mind the limitations of your role in feeding. And that several dementia and eating issues are not within your control.

What Is Medical Nutrition

Medical nutrition has been specifically designed for those who find it difficult to get adequate nutrition from a normal diet alone. Medical nutrition is a scientifically formulated liquid food that is available in the form of a drink containing energy, protein, vitamins and minerals. There are also options available for specific types of dementia, such as the early stages of Alzheimers disease. Speak to your pharmacist about these options.

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How Allied Health Can Help

In the first of a two-part series, geriatrician Dr Clair Langford discusses the vital contribution that allied health professionals make to the support of people living with dementia and their carers , while three allied health professionals explain what this support looks like in practice. Part two, in the next issue of AJDC, will focus on the role of physiotherapists, speech pathologists, clinical nurse specialists and dementia advisors

Allied health is a term used to describe a range of health professionals who are not doctors, dentists or regular nurses. Allied health professionals aim to prevent, diagnose and treat a range of conditions and illnesses and work with doctors and nurses to optimise patient outcomes.

They include: physiotherapists and exercise physiologists, occupational therapists, social workers, neuropsychologists and clinical psychologists, dietitians, speech pathologists, Aboriginal and cultural and linguistically diverse health workers, counsellors, podiatrists, dental hygienists, dementia advisors, diversional therapists, music therapists, pharmacists, optometrists and audiologists.

The different types of dementia and different stages of dementia may require the input of different allied health professionals at different times.

It is not uncommon for dementia to be first flagged by an allied health professional while seeing a person for a routine issue. For example:

Encouraging A Person To Eat And Drink

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When the person you are caring for begins to eat, you can help by:

  • feeding only when they’re alert and can swallow safely
  • being as relaxed and flexible as possible when sitting down to help them to eat and drink
  • avoiding rushing them
  • telling them about their food
  • sitting facing them, or slightly to their side so that you can make eye contact
  • placing food where they can see it
  • encouraging their attempts to feed themselves
  • helping where necessary but not forcing
  • giving prompts to chew and swallow
  • watching closely and waiting for each swallow – only giving another mouthful when they have swallowed

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What Are Some Basic Food

  • Eat a variety of foods from each food category fruits, vegetables, protein , dairy, grains, and oils. Many dietitians recommend following a heart-healthy diet such as the DASH diet or Mediterranean diet.
  • Avoid fried foods with high saturated fat and cholesterol.
  • Cut down on sugars.
  • Limit salt intake.
  • Drink eight, 8 oz glasses of water per day. Its very important that older persons drink enough liquids. Lack of enough liquids can result in dehydration, which can lead to confusion, urinary tract infections and constipation. Make sure a beverage is always provided with all meals and snacks. Make sure the cup holding the beverage is easy to handle and not too heavy. Offer different kinds of fluids throughout the day beverages, soups, water, tea, shakes, smoothies, fruit juice.

Be sure to ask your doctor about possible food interactions with the medications a person with Alzheimers disease is taking.

How To Motivate A Person To Do A Medical Check

It is vital to consult a doctor as soon as possible. Healthcare providers emphasize that early diagnosis can extend the years of a fulfilling life. Unfortunately, many people seek help too late, when the few medications that could slow the development of dementia and improve their health condition no longer work.

The common reasons for denying help among dementia patients are:

  • Lack of understanding of their condition
  • The feeling of being forced into something
  • Denial of health issues due to fear of diagnosis
  • Genuine disbelief in the severity of their case

Unfortunately, there is no universal guide on how to help elderly parents who dont want help. People are all different: for some, experiencing the fear of getting lost on a familiar street is enough, and someone is happy to check their health with their spouse. It is necessary to show understanding and, if possible, not to deceive your loved one, because the doctor at the reception will need consent for the examination. The sooner you manage to convince the patient to start treatment, the less likely the condition will get out of control.

If a parent with dementia refuses help, you must be extremely careful and gentle in how you suggest a visit to the doctor. Remember to choose the approach while taking into consideration the mental condition of the person and their personal traits. Here are some tips on how to convince a person to seek medical treatment:

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