Loss of appetite over an extended period of time can lead to malnutrition, a very serious problem in those with dementia or Alzheimer’s.
Indeed, hundreds of thousands of people with dementia suffer from malnutrition, according to a March 2014 study from Alzheimer’s Disease International and the Compass Group. The report said malnutrition affects up to 10 percent of older people living at home, 30 percent of those living in care homes and 70 percent of older people in hospital.
“Consequences include frailty, reduced mobility, skin fragility, an increased risk of falls and fractures, exacerbation of health conditions and increased mortality,” the report said (to read the report, click here)
What’s more, three French studies have shown that, in people with mild to moderate Alzheimer’s disease, clinically significant weight loss was observed in about 45 per cent of patients.
Here are some tips on spotting and curbing malnutrition:
Know the causes and warning signs
There are many factors that can cause undernutrition in elderly people with dementia. Here is what you should be aware of.
1) Losing interest in food
Many older people find themselves uninterested in eating. But the factors that cause this loss of interest can often be managed:
- Mental health issues like anxiety and depression can suppress appetite. Therapy or medication may be effective in treating these problems
- Mouth pain (mouth ulcers, tooth pain, issues swallowing, gas, constipation, loose bowels or digestive conditions) may make eating uncomfortable for some. Talk to a doctor if you suspect this is a problem
- Loss of interest in food can be a symptom of the early stages of Alzheimer’s. Some psychological issues with food may be related to the disease. Take comments about food and appetite seriously
- Low iron levels and thyroid issues can suppress appetite
- Medication can cause drowsiness or alter people’s appetites. Talk to a doctor about reviewing medication
2) Bowel Problems:
Constipation is a common problem. If ignored, it can lead to hospitalization or further health issues. Constipation is often caused by a lack of fluid and dietary fiber. But there are other factors that put people at risk:
- Medications such as strong analgesics, tranquilizers and those used to suppress convulsions, tremors and shaking. Make sure to check with the person’s doctor about side effects each time new medication is prescribed
- Thyroid disorders can lead to slower gut movement
- Anxiety
- Overuse of laxatives in the past, which can reduce a person’s ability to function without stimulation
- Poor dental health can cause people to stick to softer foods and avoid chewier high-fiber fare such as fruits and vegetables
- People might believe if they eat less they will function better, but greater bulk is needed to relieve constipation
3) Change in Mobility:
- Being less mobile means that a person will consume fewer calories—and be less hungry. They may also have difficulty getting food and drink when they want it, or might only choose to make meals that are easy to prepare. Less mobility can lead to constipation.
- Lower mobility can also cause pressure sores (which require nutritious foods to help in the healing process). If you notice your loved one’s mobility is reduced, encourage them to continue to eat healthy foods and be as active as possible—through sitting exercises, for example.
4) Loss of independence in eating:
If a person struggles to feed her- or himself, or can no longer eat independently, they may be unmotivated to eat well. This is one of the most common factors that causes malnutrition in elderly people with dementia. People may have difficulty eating independently due to:
- Inability to use utensils as a result of physical impairment, or tremors and shaking
- Muscle weakness
- Inability to sit up without support
- Disorientation or wandering during mealtimes
Caregivers should try to help their loved ones to stay as independent as possible. They may offer finger foods instead of those that require utensils. Another possibility is to use specialized equipment to make eating and drinking less difficult.
In order to help loved ones maintain control and dignity at mealtimes, caregivers should let them decide what foods they eat, how much they consume and when.
Watch out for plate waste:
Food left regularly on the plate is a strong sign that a person is at risk for malnutrition. If you notice smaller portion intake, and less consumption of food throughout the day, it may mean the person isn’t getting enough nutrients and calories.
Make food more nutritious:
If your loved one is eating less food, and is becoming underweight, you can adjust their diet to include food with more calories and nutrients. Here are some ways to maximize the nutritional value of meals and snacks and add calories.
Especially for those in later-stages Alzheimer’s, the goal may ultimately be come to keep calories on, rather than get dangerously underweight.
- Use cream to add calories, fat and vitamins A, D, E and B2 (riboflavin). Stir cream into oatmeal, soup, milky desserts, sauces and hot drinks. It can also be added to top desserts. High-fat yogurts, and cheeses like full-fat cream cheese or mascarpone are great for adding calories
- Add cheese and butter to vegetable dishes
- Use mayonnaise in sandwiches, salads, vegetables and dips
- Spread calorie-rich chocolate nut spreads or nut butters on toast and bread
- Add extra yolk to omelets and scrambled eggs for additional calories, protein, vitamins and minerals
- Prepare foods and salads with avocados, which are high in fat and protein
- For vegans and those who are lactose-intolerant: make fruit smoothies using silken tofu for a high-iron and protein snack that’s easy to swallow and digest
Megan Jones is a reporter based in Toronto, Canada
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