What is an important nutrition concern for the person with Alzheimers disease?

Good nutrition is vital for the health, independence and wellbeing of people with dementia. However, maintaining a healthy weight can be a challenge for many people with dementia. Difficulties eating and drinking are more noticeable as dementia progresses and unwanted weight loss is a common problem.

We all have likes and dislikes and eating habits that are particular to us as individuals.

Weight loss

Losing weight is not an inevitable part of having dementia. With time, effort and knowledge of the person, food and/or calorie intake can be increased. It is helpful to be aware of some of the changes that can occur as dementia progresses, such as difficulties with using cutlery, recognising food or taste changes. These changes can result in a person eating and drinking less than they need to stay healthy and well nourished.

Measuring a person’s weight regularly and recording this can help to indicate any changes over time that need attention. Weight measurements are also used as part of a process called ‘nutritional screening’, used to identify people who are at risk of malnutrition. The Malnutrition Universal Screening Tool (MUST) is one example of a nutritional screening tool.

Poor nutritional intake and lack of fluids can contribute to the development and severity of delirium – sometimes referred to as ‘acute confusional state’. Delirium often occurs when a person is unwell, and can lead to a rapid decline in mental state and behaviour. People with dementia are at a greater risk of developing delirium. For more information on delirium, see NICE (2010).

Preferences

It is not uncommon to notice a person’s likes and dislikes for food and drinks change as dementia progresses. These may be quite dramatic and very different to the preferences a person may have held for many years. It is wise to expect change and not make assumptions that everything will stay the same.

Asking a person with dementia about the food they like to eat is vital to ensure we provide options at mealtimes that they enjoy and are familiar with. Families and carers can be a valuable source of information if the person with dementia is struggling to communicate their eating habits and preferences for food and drinks. It is important to review preferences for food regularly and record changes.

Individual routines

We all have likes and dislikes and eating habits that are particular to us as individuals. People with dementia are no different. As well as knowing what type of food a person likes to eat, we also need to know where they like to eat it and when they like to eat.

For example, a person with dementia may be used to eating their main meal in the early evening by themselves, sitting in a comfortable chair listening to the radio. If this person is suddenly offered their main meal at lunch time and expected to sit at a dining table with others it would be no surprise if they walk out of the dining room or leave the food uneaten. This new situation may be confusing and unfamiliar to the person or they may just not be hungry at that time of the day.

Finding food and drinks

People with dementia may struggle to ask for food if they have difficulty finding the words to express themselves. Food and drinks need to be visible and available throughout the day so that people can eat and drink whenever they feel hungry or thirsty.

Ensure that snacks and drinks are easy to access and see so that people with dementia can take a drink or eat without having to wait for it to be offered.

Small appetites

A flexible approach to providing food and supporting the person at mealtimes is vital. As with any one of us, the appetite of a person with dementia may vary from day to day. For people with smaller appetites, large portions at mealtimes may be off-putting. Offer smaller portions at mealtimes with frequent nourishing snacks throughout the day including supper time, before a person goes to sleep.

A person with dementia may start to lose their sense of smell, which can also be affected by ageing (see Peters et al, 2003). Losing the ability to smell will have a direct effect on the taste of food and can impact on a person’s appetite. Ensure food is flavoursome and tasty; some food may need extra seasoning or stronger flavours may tempt the person. The aroma of food or baking may also help to promote appetite and enhance connection to mealtimes.

Innovative research is currently underway to examine the impact of using aroma to help stimulate appetite for people living with dementia. It is funded by the Design Council and Department of Health. To find out more, go to Ode case study

Excessive weight gain

Not every person with dementia will lose weight. Some people with dementia may start to gain excessive weight – and this can be unhealthy and uncomfortable for the person. It is important to identify what the causes are and support the person appropriately with assessment and advice from a dietitian.

The person may develop a preference for sweet flavours or savoury snack food. Such foods can be high in calories and may be eaten in addition to or instead of normal meals.

Over time, dementia will most probably affect a person’s ability to cook and prepare food. Shopping for food may be confusing and understanding meal planning – say, working out what to buy or cook – may be difficult. The person may find it easier to buy and eat snack or convenience foods such as biscuits and crisps rather than a balanced meal.

A person may become less active too: for example, mobility problems may restrict walking, or they may feel anxious about going out alone. Subsequently they may eat more food and calories than they need.

A person may be bored, lonely or depressed: if they are isolated or spending a lot of time alone that person may gain some comfort from food and eating.

Suggestions to consider

Determining the reason why a person with dementia puts on weight may take some time. But it is worth considering some of the suggestions below.

Healthier snack options may help, for example a varied platter of chopped ripe fruit can be attractive, tasty and easy to eat. Dried fruits such as apricots, apple rings or large raisons are sweet-tasting alternatives.

Consider the person’s social circumstances: are these contributing to loneliness and isolation? Would a befriender or access to local groups or luncheon clubs help? Could local volunteer groups or charities such as the Alzheimer’s Society or Age UK help?

Is the person depressed? Do they need a referral to their GP?

Are there any recent medication changes that could be having an impact on appetite or weight?

Would ready-made meals help with difficulties preparing food? They may be purchased from a supermarket or from a home delivery company. These are easy to heat and a nourishing alternative to convenience food.

Does the person need assistance to shop and choose food or would help to prepare and cook meals be beneficial?

Important considerations

It is vital to determine if the person is aware of the changes in their eating habits and how they feel about this. Food should not be taken away or hidden from a person who has capacity to make choices about what they want to eat.

Dementia is a complex condition and the risk of malnutrition and weight loss is significant as it progresses. It is much better for a person to have a little extra weight and a good appetite than restrict food intake unnecessarily to maintain an ideal weight. As food intake and appetite can vary from day to day and meal to meal, make the most of opportunities where appetite and interest in food is good!

Eating more than usual or having extra portions of food should only be a concern if it is causing health-related problems for the person. Understanding the possible cause for the excessive weight gain and working closely with the person and a dietitian, can help to ensure the appropriate advice and support are provided.

Getting help

A GP or consultant can refer a person with dementia to a dietitian if they are concerned about that person’s nutritional health; this usually follows a process of nutritional screening and/or concerns raised by the person or carer.

A dietitian will complete a comprehensive nutritional assessment and can then offer advice and support for people with dementia who are experiencing weight loss or excessive weight gain.

Downloads

All SCIE resources are free to download, however to access the following downloads you will need a free MySCIE account:

Available downloads:

• Activity: Importance of nutrition for people with dementia
• What the research says: Eating well

• Further reading Open

  Berg, G. (2006) The importance of food and mealtimes in dementia care, London: Jessica Kingsley Publishers.

  British Association for Parenteral and Enteral Nutrition (BAPEN), ‘Introducting MUST’, online information. The Malnutrition Universal Screening Tool is also available to download for free from the BAPEN website, www.bapen.org.uk.

  Coleman, G. (2009) Alzheimer’s Society guide to catering for people with dementia. London: Alzheimer’s Society.

  Crawley, H. and Hocking, E. (2011) Eating well: Supporting older people and older people with dementia, London: The Caroline Walker Trust.

  Malnutrition Task Force (2013) Malnutrition in later life: Prevention and early intervention, London: MTF.

  Marshall, M. (ed) (2003) Food glorious food: Perspectives on food and dementia, London: Hawker.

  National Institute for Health and Clinical Excellence (2010) Delirium: Diagnosis, prevention and management, Quick reference guide, London: NICE.

  Peters, J.M., Hummel, T., Kratzsch, T., Lotsch, J., Skarke, C. and Frolich, L. (2003) ‘Olfactory function in mild cognitive impairment and Alzheimer’s disease’, American Journal of Psychiatry, vol 160, no 11, pp 1995–2002.

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