Nutrition and Dementia Care
After treating likely thousands of dementia patients at this point in my career, I am convinced now more than ever that every Dietitian needs to take a course on it.
Dementia patients are increasing at a rapid pace in long term care due to the aging population, patients being admitted at older ages, patients with more diagnoses and more complexity, all result in increased health care needs.
Instead of long term care homes we should be changing the name to dementia care homes.
Dementia care requires a lot from the Dietitian, as their nutrition needs are constantly changing throughout the diagnosis, and the nutrition interventions change with it.
The good news is there are a lot of methods that we can use to help older adults with dementia meet their nutrition needs.
I’ll give you the top 5 foods a dementia patient needs to eat, so YOU can improve their nutrition health!
Dementia in the Elderly
Dementia can go by a few names in long term care. But we typically refer to it as Dementia, Alzheimer’s Disease (the most common form of Dementia), or a Cognitive Impairment.
You may wonder why these names are used interchangeably, it’s simply because they’re all correct ways to refer to a patient with Dementia.
A patient with dementia has a cognitive impairment. Cognitive impairments are measured on a scale from no cognitive impairment, mild cognitive impairment to severe cognitive impairment (with intermediate levels in between).
In my history it’s common that patients are diagnosed with dementia in the mild to moderate cognitive impairment stage. This is due to the fact that the early stages don’t show many signs of dementia.
It’s typical that memory problems give some indication that a patient is starting to have impaired brain function.
I don’t want to get too in the weeds about defining dementia here, because this will be covered in our Dementia and Nutrition course coming out. But it is important that if you are a dietitian working with the elderly, you have a solid knowledge base on the disease.
Dementia is a terminal diagnosis, though it is not usually described that way. But it is progressive brain damage that impairs optimal body function. The brain function and brain cells are essentially dying.
It is not terribly common to see a death certificate say dementia, but dementia impairs so much of the bodily functions as it progresses, that someone diagnosed with dementia will likely die from the side effects of it.
Take for example if someone gets aspiration pneumonia due to Dysphagia secondarily caused by dementia. The patient may die from pneumonia, but it was the dementia that caused the brain to no longer be able to swallow properly.
This is why as dietitians, we need to try very hard to manage the nutrition side effects of dementia.
We all want our patients to live out their last years comfortably, which means the nutrition care plan will likely change significantly as they age.
I’m going to lay out the best foods to offer patients with dementia to:
Increase intake
Manage nutrition side effects
Improve their overall health
Understanding the Nutritional Needs of Dementia Patients
While we cannot stop the progression of brain damage we can provide a well-balanced diet that manages the areas that dementia patients struggle with.
If a patient has higher cognitive function or they aren’t quite showing symptoms of dementia, you may not see any of the following challenges. Some patients see a slower cognitive decline even after being diagnosed. All older people diagnosed will progress at different rates.
It’s important to monitor for nutrition challenges all throughout their journey.
These are common nutrition issues that we observe:
- Loss of appetite, decreased food intake and weight loss
- Dementia can lead to a loss of interest in food, reduced appetite, and altered taste perceptions, making it challenging for patients to consume an adequate amount of nutrients.
- This decreased food intake can result in weight loss, malnutrition, and deficiencies in essential nutrients.
- Swallowing difficulties/Dysphagia
- Dementia can affect the muscles involved in swallowing, leading to difficulties in chewing and swallowing food safely.
- Dysphagia increases the risk of aspiration, where food or liquid enters the lungs, potentially causing pneumonia and further impacting nutritional intake.
- Impaired memory affecting intake
- Dementia-related memory loss and cognitive decline can make it difficult for patients to remember when and how to eat, resulting in irregular or skipped meals.
- Forgetfulness may also lead to inadequate hydration and reliance on convenience foods that lack proper nutrition.
- Poor food choices/imbalanced intake
- Dementia patients may demonstrate a preference for sweet or highly processed foods, leading to imbalanced diets with insufficient intake of fruits, vegetables, whole grains, and proteins.
- Lack of variety in food choices can contribute to nutrient deficiencies and compromise overall health.
- Disrupted mealtimes/agitation
- Dementia can disrupt daily routines, including regular mealtimes, leading to erratic eating patterns and missed meals.
- Behavioral changes associated with dementia, such as restlessness, agitation, and difficulty sitting still, can further hinder mealtime engagement and proper nutrition.
How to Manage the Nutrition Issues With Dementia
- Loss of appetite and decreased food intake:
- Offer small, frequent meals and snacks throughout the day to encourage regular food intake.
- Provide nutrient-dense foods that are appealing, flavorful, and easy to eat, such as smoothies, soups, and finger foods.
- Optimize the nutritional content of meals by adding higher calorie foods, such as peanut butter, whole milk, cheeses, and fortify foods to increase caloric density.
- Incorporate familiar and preferred foods to stimulate appetite and increase interest in eating.
- Swallowing difficulties (dysphagia):
- Collaborate with speech therapists to assess swallowing function and determine appropriate food textures and consistencies.
- Modify food textures to ensure safe swallowing, while also ensuring the acceptance of new food texture.
- Offer thickened liquids if thin liquids pose a swallowing risk, following recommendations from speech therapists.
- Provide foods that are easier to chew and swallow, such as cooked vegetables, soft fruits, ground meats, and moistened bread.
- Impaired memory and cognitive function:
- Establish a consistent and structured mealtime routine to help patients anticipate and remember when to eat.
- Use visual aids, such as pictures or written meal schedules, to remind patients about mealtimes and food choices.
- Serve meals in a calm and familiar environment, minimizing distractions and reducing anxiety during mealtimes.
- Offer assistance and cues for eating, such as guiding patients through the meal and using utensils, if needed.
- Poor food choices and dietary imbalance:
- Provide a variety of nutritious and visually appealing foods to increase interest and engagement in eating.
- Incorporate colorful fruits and vegetables, whole grains, and proteins into meals to ensure a balanced diet.
- Disrupted mealtime routines and increased agitation:
- Use gentle music to create a pleasant atmosphere that can enhance the dining experience.
- Encourage social interaction during meals by facilitating communal dining or arranging for dining companionship, as appropriate.
- Offer finger foods if the person is not willing to stay sitting during meals.
- Have staff that have a familiar relationship with the person provide gentle reminders to come sit down.
In all cases, it is important for dietitians to collaborate closely with the interdisciplinary team, including speech therapists, occupational therapists, physicians, and caregivers, to ensure comprehensive care and address the unique needs of each dementia patient.
Regular monitoring and reassessment of the nutrition interventions are essential to optimize the nutritional well-being of individuals with dementia
Foods for Dementia Patients
I have been asked by loved ones before if there are any foods that can lower their risk of dementia or slow down the progress of dementia. The short answer is, not after they’ve been diagnosed, but possibly yes if they’re asking for themselves.
Sometimes you will get asked nutrition questions by the family members for themselves. You can provide general nutrition information without getting into medical nutrition therapy.
Diets to Prevent Dementia
The MIND diet and Mediterranean diet have been shown to improve cognitive function and slow the progression of decreased brain function.
Recent studies suggest that it is due to the high omega-3 (healthy fats) in the diet. A diet rich in fatty fish, olive oil, whole grains, green leafy vegetables, and low in red meat, have been shown to be great for brain health, heart disease prevention, decreased risk of Alzheimer disease and overall health.
Dietary approaches to have better brain health continue to evolve in the research community. But we do have it on good authority at this point that a mixture of the Mediterranean-Dash intervention diet can help to have a positive impact with lifestyle changes, on future health.
So while if a person already has dementia we can’t change that, we can give information to family members that are at increased risk of developing it themselves.
Top 5 Foods a Dementia Patients Needs to Eat
The goal of giving you a list of the top foods a dementia patient needs to eat, is to get the most calories and protein into a person, with the least amount of food.
With Dementia, not every person wants to sit or even can sit for a full length meal. So we need to change the way their meals are built.
Dietary approaches will be different based on the patient’s food preference, side effects, and level of cognitive impairment. But the following list should have a positive impact on:
Combat unintentional weight loss
Prevent further weight loss
Maintain muscle
Maintain quality of life
Maintain adequate food and fluid intake
- High Protein High Calorie breakfast cereals
Whether the individual is on a pureed, minced, or regular diet, they can have some type of breakfast cereal. The type of diet will simply determine their options.
For example, pureed and minced can have blenderized oatmeal or cream of wheat. These can be fortified with whole milk, protein powder, nut butters, ground flax seeds, pureed smoothies, ground pumpkin seeds, or oral nutrition supplements.
These are a few easy ways to make breakfast a high protein and high calorie meal for anyone. - Mashed Potatoes
Another option that can be fortified and flavoured to the max.
Depending on their taste preferences, not only can you season it so well with extra herbs and spice (try dill and garlic powder – yum, yum, yum). You can also add in butter, protein powder (Beneprotein dissolves well), and whole milk.
No one needs bland potatoes, so try to get creative with recipe development. This can be another great way to have protein and calories added with small amounts. - Smoothies
If a person with dementia is really struggling with meal times, smoothies are a great way to get a lot of calories in, in a smaller amount.
If you’re looking for some great smoothie recipes for this population, you can find them here. - Their Favourite Foods!
I can’t emphasize this point enough. We can give all the generic food advice that we want as Dietitians. But at the end of the day, it really comes down to tailoring our nutrition care plans to the individual.
My grandfather until the day he died loved donuts. Now when his appetite started to decrease as his disease progressed, would I have wanted the Dietitian to continue to offer him vegetables?
No, my family and I cared about his quality of life. That meant offering him foods that he loved. Sometimes this will require the family to provide, as facilities don’t have endless funds.
But reach out to the family, see if you can acquire some food preferences, and try your best to get them in. If your facility can’t afford them, discuss with the family bringing them in, and the staff can hand it out. - Milkshakes
Have you ever had anyone turn down a milkshake?
I highly recommend that your facility has an in-house milkshake recipe. These don’t have to be expensive, or have a lot of ingredients.
Sometimes it can be as simple as milk, ice cream, and some frozen fruit to flavour it.
Another high calorie, high protein offering, that can be handed out at snack time so it doesn’t interfere with the overall meal.
Dementia and Nutrition
We will be launching a great Dementia and Nutrition course and I highly recommend that ALL Dietitians working with the older adult population take some type of education in this area.
These patients can be incredibly complicated and seemingly hard to figure out. But getting some tools in your tool belt on how to anticipate the changes, nutrition interventions that actually work, and how to put loved ones at ease during the difficult transition can be an incredible opportunity.
If you want to be the first to on the Dementia list, simply sign up for our subscription list! We already have a lot of people, and look forward to furthering Dementia and Nutrition care!
As always, let me know your thoughts below. Are there any other foods that you would add to the list?
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.
