Nutritional Challenges of Dementia
 Presented by:
 Pam Polk, RD, LD
Healthcare Account Mgr.
Objective
 Discuss nutrition interventions to help
maintain optimal nutritional
status & hydration status at
different stages of Dementia
 Est. 24 MM people living with some type
of dementia
 By 2015 could be epidemic numbers
 Many types of Dementia – Alzheimer's
main type we hear about
Most Important Goal:
 Prevent weight decline
 Maintain hydration
General Symptoms
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Loss of interest
agitation
Withdrawal
Changes in eating habits
in hygiene / self-care habits
Repetition
VERY IMPORTANT!!
 Rule out other things that might be
causing changes in weight, behavior, etc.
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Poor dentition
Mouth sores
Limited use of extremities
Diabetes
Heart Disease
CVA
Depression
Constipation
Agitation
May be difficult
for them to
express pain….
Only indication of
PAIN may be that
they stop eating
EARLY STAGES
 Goal: hydration, nutrition, independence
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Few interventions
Confuse foods with non-foods
May have to alter environment
Low tolerance for new ideas (menu
changes, etc.)
EARLY CONTINUED
 SYMPTOMS:
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food intake
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cereal consumption
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sweets
 Excessive sodas ( in caffeine may have
incontinence, agitation)
 Forget to eat or drink (or forget they already
have)
 May have weight loss or weight gain
EARLY CONTINUED
 RESULTS:
 Vitamin deficiency
What looks like dementia??
UTI
Low Potassium
Low B12
Low Iron
EARLY STAGES
 INTERVENTIONS:
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nutritious foods

fluids
 Simple menus
LUNCH
Entree:
Roast Beef
Turkey Cacciatore
Chef Salad“
Catch of the Day”
Sides:
Mashed Potatoes with Gravy
Seasoned Rice
Zucchini
Seasoned Sugar Snap Peas
Vegetable Beef Soup w/
Crackers
Dinner Roll
Garlic Bread
Bread (white / wheat)
Dessert:
Yellow Cake with Chocolate Icing
Fresh Fruit
Pudding
Ice Cream (Vanilla, Strawberry,
Choc)
Sherbet (Lime, Orange, Rainbow)
Beverages:
Milk (1%,2%, Whole, Skim, Choc)
Juice (Orange, Grape, Cranberry,
Apple, Prune)
Iced Tea (Sweet, Unsweet)
Hot Tea
Coffee
MIDDLE STAGES
 GOAL:
 Nutrition
 Hydration
 Weight maintenance
General Symptoms
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Forget to eat
Not find way to dining room
Forget table manners
Forget they have already eaten
caloric needs due to walking
Unable to recognize utensils
sugar intake
smell
effective communication
LATER MAY HAVE CHEW / SWALLOW ISSUES
MIDDLE STAGES
 INTERVENTIONS:
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Finger foods
Season and color on foods
Small plates to prevent being overwhelmed
Serve one item at a time
Don’t over stimulate
Finger Food Examples
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Meats cut into Bite – Sized
Pieces
Gravy and Sauces on the
Side for Dipping
French Fries
Green Beans
Roll / Bread
Cake Bites
Pineapple Chunks
Breaded Squash Bites
Rotini Pasta
Cookies
•Cheese Sandwich Bites
•Vegetable Sticks
•Baby Carrots
•Dressing Balls
•Brussels Sprouts
•Sliced Apples
•Sliced Peaches
•Broccoli
•Baked Potato Bites w/ Sour Cream for Dipping
•Sliced Peaches
•Chicken Salad Sandwich Bites
•Meatball Bites and Rotini
•Banana Bites
Finger Food Examples
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Cabbage Wedge
Fresh Fruit
Cheese Sandwich Bites
Vegetable Sticks
Baby Carrots
Dressing Balls
Brussels Sprouts
Sliced Apples
Hot Cereal in Mug
Soup in Mug
Buttered Biscuit
Corn Fritters
Fruited Gelatin Cubes
Brownie
Sweet Potato Bites
•Chicken Salad Sandwich Bites
•Meatball Bites and Rotini
•Banana Bites
•Hot Cereal in Mug
•Soup in Mug
•Buttered Biscuit
•Corn Fritters
•Fruited Gelatin Cubes
•Brownie
•Sweet Potato Bites
LATE STAGES
 GOAL:
 Maintain weight
 Dignity
 Quality of life
LATE STAGES
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Chew / Swallowing Difficulty
May pocket food
Forget to chew or swallow
Refuse food
Not recognize food
Weight loss
Know / Understand the Resident
 Resident may not be the best source
 L/D/A
 Environment:
 May have decreased attention span
 Problems focusing
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Communicate clear, calm, neutral tone
Consistency
Well-lit area
Avoid patterns on table cloths/ china
Extra time to eat
Have only needed utensils at the table
STAFF
 Well-trained staff can calm agitated residents and
make meals pleasurable
 Monitor resident self-feeding
 Verbal & tactile cueing
 Name, eye contact, compliment
 Calorie dense finger foods
 Coach to use utensils
 Remind to chew / swallow
 Encourage independence
 BE POSITIVE ABOUT THE MEAL (even Puree)!!
Hydration
Water plays a CRITICAL role in these body
functions:
•Transfer nutrients and oxygen to cells
•Acts as a solvent for most nutrients
•Remove waste from cells
•Lubricant in joints
•Regulate body temperature
•Prevent constipation
•Assist digestion & absorption
•Maintain blood volume
Sources
Liquids are most obvious source
Solids do provide some water
Reasons elderly have decreased fluid intake:
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Fear of incontinence
Not like taste of water
Thirst mechanism decreases with age
Chronic illness interfere with normal eat &
drink
Alcohol increases fluid requirement
Decreased renal concentrating ability
Do not conserve water well
Handling cups is difficult
 Risk Factors:
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Confusion
Fever
Diarrhea
Bed bound
Previous episodes of dehydration / vomiting
Diuretics
Aspiration
High protein diets
 Symptoms:
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Fatigue
Thirst
Headache
Dry nasal passages
Dry cracked lips
Overall discomfort
Swollen tongue
Mental confusion
Decreased skin turgor
Constipation
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UTI
Fever
Decreased appetite
Nausea
Changes in lab values
Decreased BP
Urine concentration