nutritional challenges of dementia presented by: pam polk, rd, ld healthcare account mgr
TRANSCRIPT
Nutritional Challenges of Dementia
Presented by: Pam Polk, RD, LD
Healthcare Account Mgr.
Objective
Discuss nutrition interventions to help maintain optimal nutritional status &
hydration status at different stages of Dementia
Est. 24 MM people living with some type of dementia
By 2015 could be epidemic numbers Many types of Dementia –
Alzheimer's main type we hear about
Most Important Goal:
Prevent weight decline Maintain hydration
General Symptoms
Loss of interest agitation Withdrawal Changes in eating habits in hygiene / self-care habits Repetition
VERY IMPORTANT!!
Rule out other things that might be causing changes in weight, behavior, etc.
Poor dentition Mouth sores Limited use of extremities Diabetes Heart Disease CVA Depression Constipation Agitation
May be difficult for them to express pain….
Only indication of PAIN may be that they stop eating
EARLY STAGES
Goal: hydration, nutrition, independence
Few interventions Confuse foods with non-foods May have to alter environment Low tolerance for new ideas (menu
changes, etc.)
EARLY CONTINUED
SYMPTOMS: food intake cereal consumption sweets Excessive sodas ( in caffeine may have
incontinence, agitation) Forget to eat or drink (or forget they already
have) May have weight loss or weight gain
EARLY CONTINUED
RESULTS: Vitamin deficiency
What looks like dementia??
UTILow PotassiumLow B12Low Iron
EARLY STAGES
INTERVENTIONS: nutritious foods fluids Simple menus
Entree:
Roast Beef
Turkey Cacciatore
Chef Salad“
Catch of the Day”
Sides:
Mashed Potatoes with Gravy
Seasoned Rice
Zucchini
Seasoned Sugar Snap Peas
Vegetable Beef Soup w/ Crackers
Dinner Roll
Garlic Bread
Bread (white / wheat)
Dessert:Yellow Cake with Chocolate IcingFresh FruitPuddingIce Cream (Vanilla, Strawberry, Choc)Sherbet (Lime, Orange, Rainbow)
Beverages:Milk (1%,2%, Whole, Skim, Choc)Juice (Orange, Grape, Cranberry, Apple, Prune)Iced Tea (Sweet, Unsweet)Hot TeaCoffee
LUNCH
MIDDLE STAGES
GOAL: Nutrition Hydration Weight maintenance
General Symptoms
Forget to eat Not find way to dining room Forget table manners Forget they have already eaten caloric needs due to walking Unable to recognize utensils sugar intake smell effective communication LATER MAY HAVE CHEW / SWALLOW ISSUES
MIDDLE STAGES
INTERVENTIONS: Finger foods Season and color on foods Small plates to prevent being
overwhelmed Serve one item at a time Don’t over stimulate
Finger Food Examples
Meats cut into Bite – Sized Pieces
Gravy and Sauces on the Side for Dipping
French Fries Green Beans Roll / Bread Cake Bites Pineapple Chunks Breaded Squash Bites Rotini Pasta Cookies
•Cheese Sandwich Bites•Vegetable Sticks•Baby Carrots•Dressing Balls•Brussels Sprouts•Sliced Apples•Sliced Peaches•Broccoli•Baked Potato Bites w/ Sour Cream for Dipping•Sliced Peaches•Chicken Salad Sandwich Bites•Meatball Bites and Rotini•Banana Bites
Finger Food Examples
Cabbage Wedge Fresh Fruit Cheese Sandwich Bites Vegetable Sticks Baby Carrots Dressing Balls Brussels Sprouts Sliced Apples Hot Cereal in Mug Soup in Mug Buttered Biscuit Corn Fritters Fruited Gelatin Cubes Brownie Sweet Potato Bites
•Chicken Salad Sandwich Bites•Meatball Bites and Rotini•Banana Bites•Hot Cereal in Mug•Soup in Mug•Buttered Biscuit•Corn Fritters•Fruited Gelatin Cubes•Brownie•Sweet Potato Bites
LATE STAGES
GOAL: Maintain weight Dignity Quality of life
LATE STAGES
Chew / Swallowing Difficulty May pocket food Forget to chew or swallow Refuse food Not recognize food Weight loss
Know / Understand the Resident
Resident may not be the best source L/D/A
Environment: May have decreased attention span Problems focusing
Communicate clear, calm, neutral tone
Consistency Well-lit area Avoid patterns on table cloths/ china Extra time to eat Have only needed utensils at the
table
STAFF
Well-trained staff can calm agitated residents and make meals pleasurable
Monitor resident self-feeding Verbal & tactile cueing Name, eye contact, compliment Calorie dense finger foods Coach to use utensils Remind to chew / swallow Encourage independence BE POSITIVE ABOUT THE MEAL (even
Puree)!!
Hydration
Water plays a CRITICAL role in these body functions:
•Transfer nutrients and oxygen to cells•Acts as a solvent for most nutrients•Remove waste from cells•Lubricant in joints•Regulate body temperature•Prevent constipation•Assist digestion & absorption•Maintain blood volume
Sources
Liquids are most obvious sourceSolids do provide some water
Reasons elderly have decreased fluid intake:
Fear of incontinence Not like taste of water Thirst mechanism decreases with age Chronic illness interfere with normal eat &
drink Alcohol increases fluid requirement Decreased renal concentrating ability Do not conserve water well Handling cups is difficult
Risk Factors: Confusion Fever Diarrhea Bed bound Previous episodes of dehydration / vomiting Diuretics Aspiration High protein diets
Symptoms: Fatigue Thirst Headache Dry nasal passages Dry cracked lips Overall discomfort Swollen tongue Mental confusion Decreased skin turgor Constipation
- UTI- Fever- Decreased appetite- Nausea- Changes in lab values- Decreased BP- Urine concentration