Better health for people living
with dementia
Eating well – food and nutrition
Food is one of the pleasures of life. Yet for many people living with dementia, the pleasure of eating is undermined by changes dementia brings about. These changes can be compounded by isolation, leading to weight loss and malnutrition for many.
The physical signs of malnutrition include:
- weight loss, as shown by loose clothes, loose rings or dentures, or prominent bones
- slow chewing, dribbling and difficulty swallowing.
The psychosocial signs include:
- depression, sadness or grieving
- not having enough money to purchase food and other essential items
- embarrassment about eating difficulties or avoiding eating with others.
There are also environmental signs such as:
- empty fridge and pantry, or an overly full fridge and pantry
- leftover meals or out of date food
- poor personal hygiene
- empty alcohol containers
- the need for multiple medications. (6)
Meal environment
Many people living with dementia will eat better if they have their meals in a suitable environment, such as their own home or a pleasant homelike environment with minimal distractions from TV, radio, mobile phones and loud conversations. The physical layout of the dining space, the features of the table setting, and the presentation of the food are all important, particularly as changes occur in visual perception, cognitive processing and the skills of sequencing tasks.
Many people living with dementia will also eat better if they share their meals with others. Difficulty with the sequence of eating or drinking can be helped by taking their cue from others. Allowing plenty of time is important.
On the other hand, overnutrition and obesity is a problem for some.
The causes of both undernutrition and overnutrition are usually multifactorial and a range of strategies are needed. Allied health professionals can drive many of these strategies.
Practice points
Occupational therapists:
- provide advice on the meal environment, particularly issues such as comfortable seating, easy layout, use of colour in the table setting and food presentation,adequate lighting, modified cutlery,and making food and drink easy to find and prepare
- work with carers, so that they are aware of the importance of the meal environment and eating with others
- work with and train community service and aged care providers.
Shopping and cooking
Some people living with dementia can no longer shop and/or cook as they once did. Or there might be carers involved who are new to the idea, or the repetitiveness, of shopping and cooking.
Also, many people living with dementia find that their food preferences change. They might develop a sweet tooth or a liking for food previously disliked, or vice versa. They might find it hard to eat a large meal.
Practice points
Dietitians:
- work with the person living with dementia to discover current preferences for types of food, size of meals and more
- give tips on shopping and cooking when the capacity for independence is declining
- advise on modification of existing routines to suit the changing circumstances
- advise on the fortification of foods to increase protein and energy value
- provide culturally appropriate food ideas to people from culturally and linguistically diverse backgrounds
- train and support carers new to regular shopping and cooking
- provide written education materials
- advise how to provide smaller meals more often, including finger food
- advise how to establish or re-establish regular meal routines
- organise alternative such as online shopping or home delivery
- work with and support carers
- work with and train community service and aged care providers.
Aboriginal and Torres Strait Islander health workers:
- provide culturally appropriate information and support for healthy nutrition
- link people to other allied health workers and programs
- work with and support carers
- work with and train community service and aged care providers.
Occupational therapists:
- review the setup of the kitchen
- encourage independence by working out ways to continue to be involved in shopping and cooking tasks
- educate and support carers to provide an appropriate level of supervision or assistance, such as setting up and initiating meals
- advise on assistive technology to make finding things easier and cooking food safer
- organise alternatives such as online shopping or home delivery.
Social workers:
- provide links to meal services that support or replace the need to shop and cook.
Weight management
Weight loss is very common for people living with dementia. While for some this can seem, at first, to be reasonable, it can be a sign of inadequate energy intake and undernutrition. It can be due to many different, yet often interrelated, factors.
Practice points
All allied health professionals:
- ensure people are checked for treatable medical conditions.
Dietitians:
- screen for malnutrition
- provide advice and assistance around food planning, choosing and buying dietary supplements and choosing foods with high energy and protein
- checking whether previous dietary restrictions still apply, and how to manage them if they do
- ensure nutritional and fluid intake is adequate for a person on a texturemodified diet
- work with and support carers
- work with and train community service and aged care providers.
Swallowing
Some people living with dementia develop dysphagia, which is distressing for both the person living with dementia and their carer and family.
Practice points
Speech pathologists:
- diagnose treatable conditions
- provide advice on modifying the texture and thickness of food and drink
- provide strategies for swallowing medications
- provide advice on maintaining the social aspects of mealtime
- look at routines, communication and maintaining cues in a mealtime context
- work with and train community service and aged care providers.
Oral health
Poorly fitting dentures, damaged teeth and gum disease can all contribute to poor nutrition and poor health overall.
Practice points
All health professionals:
- can observe oral issues that affect eating and advise a dental check-up. Dental professionals:
- screen for oral health problems
- examine people with known issues
- provide strategies and helpful hints for teeth-cleaning
- assess and provide advice about a dry mouth
- work with and train community service and aged care providers.
Yang's story
Yang was hospitalised after a fall at home. Her low weight concerned the hospital staff, so after she was discharged, a dietitian did a home visit.
Yang’s husband Soo has some health problems of his own, and was finding the extra care Yang needed plus the preparation of food quite overwhelming. To take some of the stress off him, Yang was spending several days a week in the homes of different relatives.
Yang and Soo were going to the club daily for fish and chips, just to get a cooked meal, and eating biscuits between meals. Their daughter Jin helped where she could – with shopping, transport and dropping in home-made meals – but Jin also worked full time and had a family.
The dietitian made lots of suggestions, which the family took on board. These included:
- arranging more in-home care so Yang could spend more time at home, eating in an environment that was familiar and consistent
- changing the table setting – for example, removing the highly patterned place mats which were distracting Yang
- offering smaller and more nutritious meals
- adding high energy snacks between meals
- adding a high protein drink two to three times a day.
Jin says she’s learned a lot. Her mother loves the high protein drink, and now has more energy and sleeps better. She’s also putting on some weight.
Comment from dietitian Vicky
The main nutrition intervention and education was provided through Yang’s daughter Jin. It involved:
- education about the importance of nutrition in ageing, dementia, muscle strength, health and wellbeing; and about the different stages of dementia and how it affects the person’s eating and behaviours
- discussion about culturally appropriate high protein and high energy food ideas and provision of a translated pictorial resource – the family incorporated these ideas as snacks
- discussion of ways of fortifying current meals
- discussion about appropriate table setting, regular mealtime routine and familiar eating environment
- the use of a high protein supplement.
The National Dementia Helpline is an Australian Government funded initiative.