ALZHEIMER'S: THE DINE GUIDE
Facing feeding challenges when caring for someone with dementia or Alzheimer's
BY:HELEN RASMUSSEN, MS, RD, FADA
Those with Alzheimer's disease and other causes of dementia frequently become malnourished as their interest in eating and feelings of hunger diminish. Employing the elements of DINETM (Dignity, Independence, Nutrition, Environment) will go a long way to help you manage their nutritional needs.
DIGNITY
Those of us who are entrusted to care for another are in a unique position to convey genuine respect for our loved one, for the person we remember from better days as well as the person he or she has now become. Every day we should make thoughtful choices that incorporate the preference and needs—and reflect the irreplaceable value—of the person in our care. Keeping the following in mind can help your loved one retain dignity.
Early phases of dementia include problems with memory and judgment. Recognize that difficulties with shopping, preparing and storing food can make people feel less dignified and more vulnerable. However, when you make mealtime important, you enable a person to preserve a sense of self-worth.
When you help maintain the person's meal habits, religious rituals and special dietary preferences, you provide structure, comfort and connections to the patient's fragile sense of dignity.
Note: Whenever you feel frustrated or discouraged, it may sometimes be necessary to remind yourself of how your loved one once was the head of the family, providing nourishment and stability now no longer possible, or of other life contributions the person has made.
INDEPENDENCE
Maintaining independence is a basic human need, and it often falls on the caregiver to find ways of promoting autonomy as eating abilities and interest in food changes, sometimes even over the course of a meal. For example, a person may appear to be eating independently at the start of a meal, but then you notice that he is unable to finish the meal unassisted. This signals the need to create new mealtime strategies.
The following suggestions may make the task of eating more palatable:
Avoid putting too many food items or large portions on
one plate.
Pre-cut food into bite-size pieces before serving.
Initially, offer some liquids to moisten the mouth to prepare
the person for eating.
This will lubricate a dry mouth or stimulate saliva and gastric
juices to make the person more interested in eating. It's also
a safer way to begin a meal than starting with whole food or
food particles.
Encourage independence and reinforce the motion of self-feeding
by offering finger foods, such as tuna-,egg- or chicken-salad
sandwiches; slices of cheese; or sections of oranges. Such
easy-to-eat and nourishing foods also can help slow weight loss.
Invest in self-feeding devices. Providing feeding appliances
for a person creates a simple way to maintain access to food.
(See sidebar for a list of suppliers.)
NUTRITION
With respect to the particular nutrient needs of this vulnerable population, the Tufts University Modified Food Guide Pyramid for People Over 70 is an ideal guide for caregivers to adopt. It suggests providing less food at the base of the food -guide pyramid (bread, cereal group) and concentrating on more fruits and vegetables along with carefully selected foods from the dairy and meat group. Any bread and cereal group choices should be whole grain and fiber rich.
Either food fortification or supplementation in pill form should augment certain nutrient requirements, which may be impossible to obtain when a person is taking in fewer calories. Vitamins B12 and D and calcium are the common nutrients that potentially need to be supplemented. Also, fluid intake is vital—try for 8-10 servings of water (or equivalents) daily.
The following points also will help you maintain optimal nutritional care:
Keep detailed records of the individual's weight history,
food preferences, aversions and food allergies, as well as
a list of vitamins, minerals and other nutritional supplements.
Many people with dementia lose their ability to heed natural
body cues of satiety or hunger. With this in mind, distribute
nutrient-dense food throughout the day at frequent intervals.
Because of age-related decreases in thirst cues, the risk for
dehydration increases. In addition to water, encourage fluid
intake in the form of nutrient-dense juices, soups, milkshakes
and smoothies.
Adjust the volumes and textures of food to provide variety
and help maintain an interest in eating.
Offer reminders to eat and drink as necessary to keep the
person focused on eating.
Note: Difficulty in swallowing (dysphagia) is a common condition in those with Alzheimer's disease or dementia. Have the cause of this condition evaluated by a healthcare provider, because there are different kinds of treatment, including changes in diet or medication. For more on dealing with dysphagia, click here.
ENVIRONMENT
It is important to create a comfortable environment with attention to a person's surroundings, both physical and emotional. To do this:
Minimize distractions in the dining area. Avoid bright, harsh
lighting by using indirect, lower wattage lamps around the table.
Provide comfortable furniture that allows the person to maintain
an appropriate body position for self-feeding.
Because a colorful presentation may prompt a person to focus
on eating, offer a meal containing foods of different colors
and textures. If possible, vary the colors of the dishes
and/or place mats.
Finally, problems of eating do not always stem from the person with dementia; an impatient caregiver can contribute to the unwillingness of a sick person to eat. A sense of being rushed often makes an ill person uneasy, which in turn decreases appetite. While it is not always easy, try to remain patient and give yourself over to the task as you gently encourage your loved one to eat—and eat well.