Updated advice on eating and drinking for a person with dementia

Helping a person with dementia to maintain a healthy diet can be difficult for the people caring for them. This newly updated leaflet from Dementia UK aims to provide some positive tips on ways to help.

People with dementia may experience problems with eating and drinking. There are many reasons this might happen. They might:

  • forget to eat or drink
  • experience difficulties preparing food or drinks
  • have difficulty recognising food items
  • have a change in appetite or taste

Eating a healthy and balanced diet is important for a person’s physical and mental health. Not eating and drinking enough can increase the risk of dehydration, weight loss, a urinary tract infection and constipation. These health problems can be particularly problematic for someone with dementia as they can increase confusion and the risks of delirium, and sometimes make the symptoms of dementia worse.

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This leaflet aims to provide some positive tips on ways to help including:

  • Setting the scene for mealtimes: A familiar, sociable environment can help a person with dementia to feel more comfortable eating and drinking
  • Encouraging a person with dementia to eat: Involve the person by asking them what they would like to eat. If they struggle to decide, you could give them two options of simple things you know they like and can manage. If appropriate, you could involve them in the food preparation
  • Encouraging a person with dementia to drink: A person with dementia may not always be able to recognise when they are thirsty, or they might not be able to communicate their thirst. But nevertheless, it is recommended to aim for about eight glasses of fluid per day
  • Stocking up and storing food: A person with dementia might need help keeping track of what food they have at home and storing food safely
  • Weight gain or weight loss: Some of the eating and drinking issues associated with dementia can lead to weight loss. Pureed food is less nutritious, and people with dementia are at risk of malnutrition.

Full leaflet: Eating and Drinking. Staying well with dementia | Dementia UK

Alzheimer’s study to look at gut health link

University of Aberdeen | December 2018 | Alzheimer’s study to look at gut health link

A new study led by experts at the University of Aberdeen will recruit patients in the local are to its study which will determine if there is a link between diet in managing the behavioural and psychological symptoms of the disease. 

There is increasing evidence that suggests the gut microbiota is a key link between specific nutrients and brain function.

The study will collect samples from three groups of people: people with dementia and challenging behaviour; people with dementia without challenging behaviour; and a control group of people without dementia.

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Professor Alex Johnstone from the University of Aberdeen said:

“This study is the first of its kind and could lead to the possibility of dietary intervention as a solution to prevent behavioural and psychosocial issues which are associated with adverse outcomes as well as distressing to people with dementia, their family and carers.

“We want to explore whether or not the gut-brain axis plays a key role in behavioural changes in dementia.” (Source: University of Aberdeen)

For further details of this study read the release from University of Aberdeen

Interventions maintaining eating independence in nursing home residents

Palese, A. et al. | Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study | BMC Geriatrics | 2018 18:292 | published online 27 November 2018

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Background
Despite 32 years of research and 13 reviews published in the field, no intervention can be considered a gold standard for maintaining eating performance among residents with dementia. The study aim was to highlight the interventions derived from tacit knowledge and offered daily in assisting eating by healthcare professionals (HCPs) in nursing homes (NHs).

Method
A multicentre descriptive qualitative study was performed in 2017. Thirteen NHs admitting residents with moderate/severe functional dependence in eating mainly due to dementia, were approached. A purposeful sample of 54 HCPs involved on a daily basis in assisting residents during mealtime were interviewed in 13 focus groups. Data analysis was conducted via qualitative content analysis.

Results
The promotion and maintenance of eating performance for as long as possible is ensured by a set of interventions targeting three levels: (a) environmental, by ‘Ritualising the mealtime experience by creating a controlled stimulated environment’; (b) social, by ‘Structuring effective mealtime social interactions’; and (c) individual, by ‘Individualising eating care’ for each resident.

Conclusions
In NHs, the eating decline is juxtaposed with complex interventions regulated on a daily basis and targeting the environment, the social interactions, and the residents’ needs. Several interventions that emerged as effective, according to the experience of participants, have never been documented before; while others are in contrast to the evidence documented. This suggests the need for further studies in the field; as no conclusions regarding the best interventions have been established to date.

Full document: Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study

Eating and drinking for a person with dementia

Helping a person with dementia to maintain a healthy diet can be difficult
for the people caring for them. This leaflet aims to provide some positive
tips on ways to help | Dementia UK

People with dementia may experience problems with eating and drinking.
There are many reasons this might happen. They might:

  • forget to eat
  • experience difficulties preparing food
  • have difficulty recognising food items
  • have a change in appetite or taste
eating dementia
Image source: http://www.dementiauk.org

Eating a healthy and balanced diet is important for a person’s physical and mental health. Not eating and drinking enough can increase the risk of dehydration, weight loss, a urinary tract infection and constipation. These health problems can be particularly problematic for someone with dementia as they can increase confusion and the risks of delirium, and sometimes make the symptoms of dementia worse.

This leaflet from Dementia UK provides useful tips on the following:

  • Setting the scene for mealtimes
  • Encouraging a person with dementia to eat
  • Encouraging a person with dementia to drink
  • Stocking up and storing food
  • Weight gain or weight loss
  • Swallowing

Full resource: Eating and drinking: Staying well with dementia

Related:   ‘Eating and Drinking Well: Supporting People Living with Dementia’ |Bournemouth University

Current evidence on diet, cognitive impairment and dementia.

The Scientific Advisory Committee on Nutrition (SACN) position statement on current evidence on diet, cognitive impairment and dementia.

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This position statement by SACN provides an overview of the currently available evidence on nutrition and cognitive impairment and dementia (including Alzheimer’s disease) in adults. It considers evidence relevant to the prevention – not the treatment – of cognitive impairment or dementia.

The position statement concludes that:

  • the evidence base in this area is very limited
  • there is no evidence that specific nutrients or food supplements affect the risk of cognitive impairment or dementia
  • there is some observational evidence that greater adherence to a Mediterranean dietary pattern may be associated with reduced risk of mild cognitive impairment and dementia

While there is no single Mediterranean diet, such diets tend to include higher intakes of vegetables, fruit, legumes, cereals, fish and monounsaturated fatty acids; lower intakes of saturated fat, dairy products and meat; and a moderate alcohol intake. Mediterranean type diets broadly align with current UK healthy eating recommendations as depicted in the Eatwell Guide (PHE, 2016).

Full document: SACN statement on diet, cognitive impairment and dementias

You can find more information about SACN online.

Sugary beverage intake and preclinical Alzheimer’s

Excess sugar consumption has been linked with Alzheimer’s disease (AD) pathology in animal models | Alzheimers & Dementia

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We examined the cross-sectional association of sugary beverage consumption with neuropsychological (N = 4276) and magnetic resonance imaging (N = 3846) markers of preclinical Alzheimer’s disease and vascular brain injury (VBI) in the community-based Framingham Heart Study. Intake of sugary beverages was estimated using a food frequency questionnaire.

Relative to consuming less than one sugary beverage per day, higher intake of sugary beverages was associated with lower total brain volume (1–2/day, β ± standard error [SE] = −0.55 ± 0.14 mean percent difference, P = .0002; >2/day, β ± SE = −0.68 ± 0.18, P < .0001), and poorer performance on tests of episodic memory (all P < .01). Daily fruit juice intake was associated with lower total brain volume, hippocampal volume, and poorer episodic memory (all P < .05). Sugary beverage intake was not associated with VBI in a consistent manner across outcomes.

Higher intake of sugary beverages was associated cross-sectionally with markers of preclinical AD.

Full reference: Pase, M.P. et a; (2017) Sugary beverage intake and preclinical Alzheimer’s disease in the community. Alzheimers & Dementia. Vol. 13 (Issue 9) pp. 955–964.

The association between an inflammatory diet, cognitive function and dementia

The Mediterranean and Dietary Approaches to Stop Hypertension diets have been associated with lower dementia risk. We evaluated dietary inflammatory potential in relation to mild cognitive impairment (MCI)/dementia risk | Alzheimer’s & Dementia

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Method: Baseline food frequency questionnaires from n = 7085 women (aged 65–79 years) were used to calculate Dietary Inflammatory Index (DII) scores that were categorized into four groups. Cognitive function was evaluated annually, and MCI and all-cause dementia cases were adjudicated centrally. Mixed effect models evaluated cognitive decline on over time; Cox models evaluated the risk of MCI or dementia across DII groups.

Results: Over an average of 9.7 years, there were 1081 incident cases of cognitive impairment. Higher DII scores were associated with greater cognitive decline and earlier onset of cognitive impairment. Adjusted hazard ratios (HRs) comparing lower (anti-inflammatory; group 1 referent) DII scores to the higher scores were group 2-HR: 1.01 (0.86–1.20); group 3-HR: 0.99 (0.82–1.18); and group 4-HR: 1.27 (1.06–1.52).

Conclusions: Diets with the highest pro-inflammatory potential were associated with higher risk of MCI or dementia.

Full reference: Hayden, K.M. et al. (2017) The association between an inflammatory diet and global cognitive function and incident dementia in older women: The Women’s Health Initiative Memory Study. Alzheimer’s & Dementia. Published online: May 19 2017

Blueberry concentrate improves brain function in older people

Drinking concentrated blueberry juice improves brain function in older people, according to research by the University of Exeter. | ScienceDaily | Applied Physiology, Nutrition, and Metabolism

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In the study, healthy people aged 65-77 who drank concentrated blueberry juice every day showed improvements in cognitive function, blood flow to the brain and activation of the brain while carrying out cognitive tests. There was also evidence suggesting improvement in working memory.

Of the 26 healthy adults in the study, 12 were given concentrated blueberry juice providing the equivalent of 230g of blueberries once a day, while 14 received a placebo.

Before and after the 12-week period, participants took a range of cognitive tests while an MRI scanner monitored their brain function and resting brain blood flow was measured.

Compared to the placebo group, those who took the blueberry supplement showed significant increases in brain activity in brain areas related to the tests.

Full reference: Bowtell, J. et al . Enhanced task related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation. Applied Physiology, Nutrition, and Metabolism, March 2017

 

Nutrition and dementia care

Murphy, J L et al. | Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes | BMC Geriatrics. | DOI: 10.1186/s12877-017-0443-2 | Published: 14 February 2017

Background: There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia.

Methods: We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users.

Results: The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information.

Conclusions: This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.

Is the Mediterranean diet a feasible approach to preserving cognitive function and reducing risk of dementia for older adults in Western countries? New insights and future directions.

Knight, A. et al. Ageing Research & Reviews. 2016 Jan;25:85-101

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Image source: USDA

Abstract:

The rise in the ageing population has resulted in increased incident rates of cognitive impairment and dementia. The subsequent financial and societal burden placed on an already strained public health care system is of increasing concern.

Evidence from recent studies has revealed modification of lifestyle and dietary behaviours is, at present, the best means of prevention. Some of the most important findings, in relation to the Mediterranean diet (MedDiet) and the contemporary Western diet, and potential molecular mechanisms underlying the effects of these two diets on age-related cognitive function, are discussed in this review.

A major aim of this review was to discuss whether or not a MedDiet intervention would be a feasible preventative approach against cognitive decline for older adults living in Western countries. Critical appraisal of the literature does somewhat support this idea. Demonstrated evidence highlights the MedDiet as a potential strategy to reduce cognitive decline in older age, and suggests the Western diet may play a role in the aetiology of cognitive decline. However, strong intrinsic Western socio-cultural values, traditions and norms may impede on the feasibility of this notion.

Read the abstract here