Overcoming Nutrition Challenges for Memory Care

Developing strategies to feed people living with dementia has multiple benefits—their well-being and the healthcare community’s bottom line.

Dementia cases are expected to triple worldwide by 2050, according to Leadingage.org, and that will have a big impact on healthcare and senior-living providers. As the bubble of baby boomers ages, the number of people with memory-care needs will increase—and so will the costs of caring for them. For care providers and their bottom lines, paying attention to food and nutrition needs can make a big difference.

While there’s no cure for dementia and Alzheimer’s disease, some diets are believed to delay the onset of memory decline. While further research is needed, beneficial diets are positive news for senior-living communities, which are committed to keeping residents active and healthy. For assisted-living communities, administering proper diet and nutrition can have a positive effect on quality of life for patients living with dementia. Ultimately, improved resident and patient health results is not only good for the person living with dementia, it also benefits the care community in areas such as patient satisfaction scores, reimbursement rates and reduced readmissions.

How dementia affects food intake

Dementia frequently leads to nutrition problems. At its earliest stages, it can lead to difficulty shopping for groceries or following recipes. As dementia progresses, it can result in inconsistent eating patterns—skipping meals, forgetting to eat and drink—and, eventually, confusion about using silverware, difficulty chewing and swallowing, and even an inability to recognize food. All of these contribute to weight loss, dehydration, delayed wound healing, risk of infection, muscle weakness, etc.

“About 40% of dementia patients experience weight loss,” says Amy Gautraud, RD, Manager of the Gordon Food Service Nutrition Resource Centre. “This not only affects patient well-being, but it also impacts the community, with more hospitalizations, urinary tract infections due to dehydration, expensive antibiotics and readmissions.”

Nutrition and hydration problems are the result of a number of obstacles that confront people living with dementia. Caregivers should be aware of the following signs of a diminished desire or ability to eat:

• Poor appetite. Failure to sense hunger, poor-fitting dentures, medications, lack of exercise.
• Cognitive difficulties. Failure to recognize food or drink, concentration issues.
• Motor-skills difficulties. Not being able to direct a fork to the mouth, problems chewing or swallowing, taking longer to find words and organize food requests.
• Sensory difficulties. Decreased senses of smell, taste, vision, an inability to regulate thirst, difficulty distinguishing food temperature.
• Behavioural difficulties. Throwing food, temper issues, wandering, frustration and isolation.
• Eating behaviours. Changes in eating habits, food preferences, overeating.

To keep on top of eating issues, care communities constantly need to conduct resident assessments that are shared with the entire staff, says Amy Kotterman, RD, LD, Director of Hospitality Services at Ohio-based United Church Homes. She says finding patient likes and dislikes can make a big difference, but you won’t know unless you ask.

Food and nutrition: simple steps go a long way

“I’m very excited about all of the diets and what they have to offer for memory care, but by the time most of our residents come to us they have memory impairment at a significant level,” Kotterman says. “I want them to eat whatever makes them happy, comfortable and is going keep them at an optimal weight.”

Improving quality of care and health outcomes can be accomplished with a number of steps at the community level:

• Offer flavourful and nutritious meal options.
• Accommodate individual preferences and routines to offer a sense of comfort and control.
• Offer choices (with appropriate limits) that include favourite foods.
• Provide small, frequent meals.
• Use texture modification, including puréed foods and handheld foods.
• Use fortified foods and nutrition supplements when needed.
• Promote self-feeding, with visually contrasting dishes and adaptive equipment.
• Create a calm dining environment by limiting visual and auditory distractions.
• Offer appropriate social interaction between the residents and caregivers.
• Offer personal assistance, when needed.

Why the right options matter

The goal is to get the individual to eat. The key word here is individual, says Samantha Thelen, the Regional Director of Operations for Michigan-based Leisure Living. She advocates making sure people eat what they want to eat when they want to eat it.

“Families don’t want to hear that our food is awful and that their loved ones were woken up at 8 a.m. for breakfast when they wanted to sleep until 10,” she says. “Happy residents equals happy families equals happy communities.”

Creating new and unique dining designs are a key to achieving success, Thelen says. She recommends minimized institutional cooking with more individual choices, making the dining experience more like home. “People always need access to food, so don’t make them wait until the chef comes in. Always have high-impact, quality snacks available.”

At Leisure Living, making sure residents get their calories and nutrition starts with breakfast. There are lots of calories that can be put into breakfast, Thelen says, and it’s a great mood stabilizer. Kotterman agrees. Because most residents sleep well, breakfast is the most accepted meal of the day—and there are ways to deliver calories and nutrition at the same time you’re providing options.

“We took basic plain oatmeal and added some brown sugar and cream and butter and took it from about 100 calories to 320 calories for four ounces—and residents loved it because it’s sweet and good,” Kotterman says. “You can do the same thing with milkshakes and cookie bars.”

Meaningful mealtime strategies

A calm, quiet environment—without the distraction of television or music with words—can be very important. Because people living with dementia can’t process too much stimulation at once, it can also be helpful to limit the number of items on the table, the number of people eating together, or to even serve one or two foods at a time.

The type of food and how it’s presented matters, too. Finger foods are a good strategy for making it easier for residents with dementia to eat. Picking up food by hand is easier for many residents than using utensils. Snack bars and raw vegetables with a fortified dip might quickly come to mind, but there’s no need to be so limiting says Jesse Waalkes, an NRC Dietitian.

“Even if you can’t eat with silverware, you still want to be part of the dining atmosphere,” she says. “Handheld foods are a potential solution.”

Here are a few examples that turn regular meals into handheld foods:

• Scrambled eggs and toast. Substitute a hard-boiled egg, ham pieces and toast or an egg sandwich on a croissant.
• Spaghetti and meatballs. Try a meatball slider, and Italian sausage Briolle, or a spaghetti and spinach frittata.
• Chicken and Vegetable Stir Fry. Try an Asian chicken empanada or chicken-vegetable egg rolls.
• Meatloaf and mashed potatoes. Use meatloaf cubes and tater tots or serve meatloaf muffins.
• Tuna-noodle casserole. Offer a tuna melt sandwich, a tuna quesadilla, or tuna mac and cheese bites.
• Salad and veggies. Substitute juice cups and smoothies, or offer iceberg lettuce wedges with a dipping sauce.
• Desserts. Cookies, fruit smoothies, chocolate mousse in a mini tart shell, or a fruit kebab with yogurt dip.

Encouraging the ability to eat

Encouraging people to feed themselves for as long as they can provides a sense of dignity and happiness, and adaptive dining tools make it possible. A simple change to using dishes with colour contrast can make it easier for people living with dementia to see their food.

“Chicken, mashed potatoes and cottage cheese and yogurt can be hard to distinguish on a white plate,” says NRC Dietitian Alison Stock. A brightly coloured dish—red is popular—helps residents with diminished vision recognize the foods they like.

Other adaptive dishware also has an impact. Plates with rims prevent food from getting pushed off. Silverware with easy-grip handles promote self-feeding. Cups with two handles increase stability and reduce spillage.

Building better outcomes

The goal of recognizing memory-care eating issues and implementing solutions is to optimize the dining environment in healthcare and senior living. Doing so improves the quality of life for patients and residents at the same time it protects a care community’s bottom line.

As hospitals and care communities are looking to provide transparency by showing people the quality of care they provide, dining plays a big role. That’s why it’s essential for caregivers at every touchpoint should be educated on the critical importance of good nutrition and the strategies that encourage adequate intake for those with dementia.