Nutritional care of patients with Dementia

1. Nutritional care of patients with Dementia Sarah Herbert – Dietitian (BSc, RD) Mental Health Services Lynn Mockridge - Advanced Mental Health worker and Nutrition Advisor

2. Contents • Introduction • Dementia • Effects of dementia on nutritional status • Practical advice – support with eating and drinking • Nutritional therapy in Dementia • Quiz • Questions

3. Introduction • Based at Callington Road Psychiatric Hospital • Long, enduring mental health conditions • Intensive care, acute, rehabilitation and elderly (one organic, one functional) units • Team of four; three Dietitians, one Nutrition Advisor/Advanced MH worker

4. Dementia • Dementia describes a number of conditions in which there is a progressive loss of brain function. • About 750,000 people in the UK have dementia and this number is expected to double in the next thirty years (DoH, 2012) • As Dementia progresses, so does an individual’s ability to eat and drink resulting in a decline in nutritional status.

5. Effects of Dementia on nutritional status • Early stages – weight gain? • Poor appetite and dehydration • Weight loss • Re-feeding syndrome • Increased nutritional requirements • Vitamin and mineral deficiencies • G.I disturbances from medication may affect appetite

6. What are the common difficulties with eating and drinking? Decreased ability to recognise hunger and satiety Lack of recognition Preparing/cooking food may become difficult Food preferences may change Challenge to communicate likes and dislikes. Environmental issues: inpatient facilities. Cutlery may become difficult to use or forgotten how to be used Dexterity issues (manual and mental) Motivation Concentration

7. Preparing for a meal • Encourage the person to go to the toilet before meals if needed • Making sure glasses or dentures are in place for the meal • Consider using adapted cutlery • Use plate warmers to help keep food warm • Use contrasting coloured plates • Avoid distracting items on the meal table • Ensure good oral hygiene after eating

8. Taste changes • Try naturally sweet vegetables • Use sweet and sour sauces • Add honey to vegetables • Add a little sugar to mince, stew or potatoes • Encourage milk-based puddings such as:

9. Refusal of food previously accepted • Strong flavoured foods, spicy foods or previously disliked foods may now be enjoyed • Keep an open mind, don’t exclude any foods • Keep a list of current preferences • Try adding additional spices, herbs, onion, garlic, chilli • Avoid adding extra salt • Offer table sauces – chutney, pickle, relishes, vinegar, mustard

10. What if someone struggles to finish a meal? • Allow extra time for meals as needed • Serve one course at a time to keep food warm • Prompting/Reassuring • Dish up a small amount of food at any one time • Consider offering 5-6 small snacks during the day rather than 3 main meals • Avoid removing plate early in an inpatient/care home setting

11. Wandering/distraction at mealtimes • Leave out snacks along the route the person walk or place foods in their hand to prompt • Try a variety of finger foods • Encourage high energy foods where possible • Change the environment • Change mealtimes to suit the person

12. Food fortification • Don’t add extra foods but concentrate with energy and protein • 5-6 small meals/snacks instead of 3 larger meals per day • Avoid low calorie/reduced fat foods • Add extra butter, cheese, cream, sugar to foods • Spread jam/honey thickly onto toast/crumpets • Fortify full cream milk by adding 2tbps of milk powder

13. Quiz!

14. Thanks for listening! We hope you enjoyed it and found it helpful