Nutritional Interventions
Seniors have a special relationship with food. Each phase of the aging process presents different nutritional challenges. Although good nutrition is not a treatment for memory loss, it does improve quality of life dramatically. Good nutrition helps to combat infections, depression, skin breakdown, pneumonia, confusion, as well as risks for falls and urinary tract infections. Here are some of the changing nutritional needs presented with the three general progressive phases of Alzheimer's Disease.
In phase one, loss and confusion typically fuel depression, which causes changes in appetite. Weight changes may occur. People with AD may anxiously eat nonstop, or they may forget to eat all together. They may forget how to shop for food, or how to prepare a meal. They may forget how to use kitchen equipment, like a microwave or toaster, and become frustrated.
The increased activity, agitation and wandering that is prominent in phase two increases residents' energy needs. Active residents in this phase may require an extra 1600 calories per day just to maintain their body weight. Getting those extra calories may be challenging if the resident loses interest in food. Swallowing difficulties, inability to recognize or distinguish foods, tasting difficulties, shortened attention span, physical changes like tremors or Apraxia and the inability to cope with the stimulation at the meal site all work against a confused resident.
In phase three, people with AD are usually confined to a wheelchair. Typically, they forget how much food to put in their mouths or how to swallow. Most people in phase three need to be fed. In order to ensure the maximum nutritional intake, caregivers should take their time, offering cues, coaxing and proper positioning. Appropriate food consistency is essential, as there is a risk for choking. Having the main meal midday helps, too, because that is typically when the resident is at his sharpest.
Alternatives for nutritional intervention:
Have foods available at all times.
Include the resident in choices, preparation and clean up.
Encourage hydration at least six times per day.
Have portable/ finger foods available for residents who wander, have limited attention spans, have difficulty using utensils and/or would benefit from six meals per day. (Examples of finger foods: hardboiled eggs, bananas, baby carrots, orange sections, graham crackers with peanut butter, cookies, cheese, chicken nuggets, etc.).
Offer smaller portions of food frequently throughout the day.
Offer favorite foods, with a preference on nutrients. (If a resident likes both brown and white rice, serve the nutrient-rich brown rice.)
“Bulk Up” snacks with peanut butter, cheese and margarine. Use dry milk in sauces and soups. Add ice cream and chocolate syrup to milkshakes and desserts. Sprinkle sugar over everything (unless a no concentrated sweet diet is needed).
Choose dinnerware for special needs: large handles on mugs and bowls to increase steadiness; plates with a lip to help get food on a spoon or fork; solid colored dishes to highlight food and minimize confusion; contrasting linen colors to make food easy to see.
Move the plate a ¼-turn to compensate for vision problems. Use dark table linens, so spills won’t show up easily. Use aprons, not bibs, at mealtimes if necessary.
Consider a swallowing evaluation for residents who are observed doing the following: pocketing of food, coughing or choking after meals or liquids, frequent throat clearing, drooling, gurgly voice quality, effortful chewing, complaining of pain while swallowing, watery eyes or running nose while eating, reflux, prolongation of meals. Implement diet modifications, positioning and swallowing techniques, and modify food consistencies.
Positioning techniques: keep the resident’s head and upper trunk as upright as possible with head at midline; the head should be slightly forward in relation to the neck and shoulders; the hips and small of the back should be centered at the back of the chair; arms should be resting on the table to facilitate proper shoulder posture; keep residents feet flat; adjust the table height; and have the resident sit close up to the table.
Serving and Food preparation techniques: Talk to the resident, tell her who you are and what you will be doing; speak slowly and clearly, feed slowly while alternating foods; don’t startle the resident with the feeding utensil; feed small amounts of food at a time; alternate sides of the mouth; offer sips of liquid often and tell the resident when you are done to put closure on the activity.
Nutritional strategies: Remove or substantially modify dietary restrictions; encourage the use of flavor enhancers; encourage more frequent small meals; offer liquid nutritional supplements for use between (not with) meals; improve protein intake by adding meat, peanut butter or protein powder; treat depression with antidepressants that do not aggravate nutritional problems; remove or replace medications that may have anorexia-producing side effects.
Staff Interventions: Ensure that residents are equipped with all the necessary sensory aides (dentures, hearing aide, glasses); ensure the resident is seated upright at 90 degrees preferably out of bed in the dining room in a chair (residents eating in the dining room are much less likely to have low intake); remove or minimize unpleasant sights, sounds and smells.
The Mini Nutritional Assessment - The Mini Nutritional Assessment is an effective, easily administered tool designed to identify older adults who have or are at risk for developing malnutrition. It consists of 18 questions and can be completed in about 15 minutes. A short form, containing the first six questions, can be used for screening.
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