Minimising undernutrition in older adults with dementia

Jennie Jackson, Jayne Brown, Yvonne Robb, Kay Currie and Cheryl Graham

Glasgow Caledonian University

Background to our review

• Dementia– a collective term for a number of conditions– progressive decline in an individual’s

functioning• Demographic ageing

– by 2025 one million people in the UK will have dementia (Alzheimer’s Society, 2007)

• People with dementia often experience difficulty eating and may have poor intake

Reasons for poor intake

Nutritional Requirements

• May be increased energy requirements due to pacing, wandering and increased activity

• Older adults have similar or increased requirements for vitamins and minerals but generally smaller appetite– Nutrient-dense diet required– Appealing and enjoyable food

Effects of undernutrition

• Unintentional weight loss

• Dehydration

• Pressure sores

• Increased susceptibility to infections

• Poor wound healing

Meaning and Importance of Food

• Mealtimes should be enjoyable

• Social interaction

• Promoting autonomy

• Involvement in preparation of food

Interventions to minimise undernutrition in older adults with cognitive impairment

There are numerous possible interventions ranging from dietary advice to assistance with feeding to percutaneous endoscopic gastronomy (PEG) feeding

Objective of the review

This review seeks to establish what is best practice in preventing under-nutrition in older adults with dementia– The review will focus on older adults who

are not living independently– It will not include studies of the effect of

particular nutrients on cognitive function– It will not include enteral tube feeding

Criteria for selecting studies for this review

To investigate the effectiveness of interventions to improve nutritional intake:– RCTs– Quasi-experimental studies– Cohort studies– Case control studies– Observational studies without control group– Qualitative studies

Types of participants

• Adults over the age of sixty

• Exclusions– People with alcohol-related dementia– People with dementia living independently

Types of interventions

• Nursing practices• Educational interventions for healthcare

staff• Medical practices• Food service practices• Dietetic practices• Dietician assistant practices• Occupational therapy practices

Types of interventions contd.

• Inclusion or exclusion of family carers

• Speech therapy practices

• Volunteer practices

Types of outcome measures

• Dietary intake

• Anthropometry eg weight, BMI, mid-arm muscle circumference

• Biochemical indicators

• Clinical outcomes: length of hospital stay, mortality, prevalence, and incidence of malnutrition

What do we hope to achieve?

• Use review to inform best practice

• Identify under-researched areas for future research projects

• Promote multi-professional/ multidisciplinary care

• Put into practice our systematic review training

Food provision for older adults with dementia at Marcus Humphrey Residential Home and Daycare Centre,

Bridge of Weir