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Nutrition support in individuals with dementia

By October 11, 2022October 12th, 2022No Comments

As a result of the current ageing population, it is estimated that 1/6 of the worldwide population will be at least 60 years of age by 2050 (WHO, 2011). Ageing occurs at the biological level with the accumulation of molecular and cellular damage over time (WHO, 2011). It leads to a decline in mental and physical capacity, and an increased risk of disease and illness. Ageing also impacts nutrient absorption, appetite, and oral health amongst other effects, yet good nutrition is essential to mediate the ageing process (The Nutrition Society, 2019). Many elderly individuals will be living with numerous comorbidities, including diabetes, heart failure, and frailty (Murad et al, 2012).

Dementia refers to a condition of declining brain function with symptoms of memory loss, reduced understanding, and altered mood (NHS, 2020). Dementia is another associated condition in this population group and is both a cause and consequence of malnutrition (Kimura et al, 2019). Within care homes, the prevalence of dementia is estimated to be 80% (Bunn et al, 2016). The positive association between good nutrition and cognitive functioning means that it is highly important to assess and address malnutrition in elderly individuals at risk of or living with dementia to prevent cognitive decline (Borda et al, 2020).

Food and fluid intake is negatively impacted in individuals with dementia due to a disinterest in eating, forgetfulness, increased difficulty with food preparation and eating, and as a result of changing food preferences. Increased confusion will also limit the ability to express an individual’s needs. Decreased mobility, sensory impairment and increased isolation further impact dietary intake (The Nutrition Society, 2019).

Although no individual with dementia will be the same, there are numerous different approaches to preventing malnutrition in this population group. The current guidelines on nutrition in dementia recommend regular malnutrition screening and weight monitoring alongside the provision of adequate and appealing food in appropriate, supporting environments (ESPEN, 2015). The list below offers some suggestions to encourage food and fluid intake.

· Fortify food. Adding milk powder, extra butter, cream or using full fat milk are all great methods to enrich food with additional energy and protein. A worthy tactic for individuals with small appetites.

· Use different eating apparatus. If someone is a slow eater, try insulated plates and cups. If they struggle holding glasses, get hold of some two-handed cups. To reduce the weight of glasses, switch to plastic or look into different kinds of adaptive cutlery.

· Talk to people as they eat. As we age, eating can become more of a chore so sometimes distractions such as conversation can increase the amount of food eaten. Otherwise, encourage food intake through activity.

· Encourage shared mealtimes with staff members, family, or friends. People tend to eat more when they are surrounded by people eating alongside them, a process known as social facilitation (Ruddock et al, 2019).

Adequate nutrition is incredibly important to encourage healthy ageing. The same approach will not work for every individual and the decreased independency will increase the level of care required. If you’re interested in learning more about the nutrition-related caused of Alzheimer’s, a subtype of dementia, then take a further look at the Nutritank website including a blog post on Diet and Alzheimer’s Disease or join the community to find out more.

References

Borda, M.G., Aarsland, D., Tovar-Rios, D.A., Giil, L.M., Ballard, C., Gonzalez, M.C., Bronnick, K., Alves, G., Oppedal, K., Soennesyn, H., Vik-Mo, A.O. (2020). Neuropsychiatric Symptoms and Functional Decline in Alzheimer’s Disease and Lewy Body Dementia. Journal of the American Geriatrics Society 68(10): pp. 2257-2263.

Bunn, D.K., Abdelhamid, A., Copley, M., Cowap, V., Dickinson, A., Howe, A., Killett, A., Poland, F., Potter, J.F., Richardson, K., Smithard, D., Fox, C., Hooper, L. (2016). Effectiveness of Interventions to Indirectly Support Food and Drink Intake in People with Dementia: Eating and Drinking Well IN Dementia (EDWINA) Systematic Review. BMC Geriatrics 16: 89. WHO (2011). Ageing and Health [online]. Available from https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=Every%20country%20in%20the%20world,in%202020%20to%201.4%20billion. [accessed 23/09/2022].

The Nutrition Society (2019). Healthy Ageing: What Role Can Nutrition Play? [Online] Available from https://www.nutritionsociety.org/blog/healthy-ageing-what-role-can-nutrition-play [Accessed 23/09/22]

Murad, K., Kitzman, D.W. (2012). Frailty and Multiple Comorbidities in the Elderly Patient with Heart Failure: Implications for Management. Heart Failure Reviews 17: pp. 581-588.

Kimura, A., Sugimoto, T., Kitamori, K., Saji, N., Niida, S., Toba, K., Sakurai, T. (2019). Malnutrition is Associated with Behavioural and Psychiatric Symptoms of Dementia in Older Women with Mild Cognitive Impairment and Early Stage Alzheimer’s Disease. Nutrients 11(8): 1951.

NHS (2020). About dementia [online] Available from https://www.nhs.uk/conditions/dementia/about/ [accessed 23/09/22]

ESPEN (2015). ESPEN Guidelines on Nutrition in Dementia. Clinical Nutrition 34(6): pp. 1052-73.

Ruddock, H.K., Brunstrom, J.M., Vartanian, L.R., Higgs, S. (2019). A Systematic Review and Meta-Analysis of the Social Facilitation of Eating. American Journal of Clinical Nutrition 110(4): pp. 842-861.

Other useful links: BDA – Eating and Drinking Difficulties in Dementia – https://www.bda.uk.com/resource/eating-and-drinking-difficulties-in-dementia.html Dementia UK – https://www.dementiauk.org/

Charlotte Ripley

My name is Charlotte and I'm a currently doing a Masters in Dietetics at King's College London. As part of my public health placement, I'm working with Nutritank. So far it has involved looking into partnerships with different organisations and reviewing and writing different nutrition pieces for some of Nutritank's current partnerships and for the blog. It's great to meet such a welcoming team of nutritionists, dietitians and medics, and to get involved with an organisation with such an important mission! I completed my Nutrition BSc at Newcastle University before deciding I wanted to pursue a career as a dietitian. Upon completion of the masters, I'm hoping to start as a band 5 dietitian in the NHS. I'm hugely interested in gastroenterology, including IBS, IBD and weight management. I'm very outdoor-sy and in my spare time I love running, long walks and spending time with friends. As a student living in London, there's also always exciting things happening to get involved with.

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