Tackling Malnutrition in Dementia Patients

By Gillian Farren, Registered Dietitian

NUTRITIONAL CHALLENGES

Patients with dementia face numerous challenges, all of which can have a signifi- cant impact on their ability to eat and drink. In the UK alone, it is estimated that 3 million older people are malnourished or at risk of malnutrition.1 Alongside weight loss, key micronutrient deficiencies are recognised, with an estimated 35% of older people show- ing deficiencies in vitamins A, B12, iron and zinc.2 Although weight loss is part of the nat-

ural ageing process, dementia is recognised as a key contributor.3 Moreover, the link between dementia and weight loss strengthens as dementia becomes more severe.4,5

It is important to support dementia patients in eating and drinking well, as inadequate nutritional intake can make a person with dementia more confused.6 Recent guidance from NICE recommends that carers “encourage and support people living with dementia to eat and drink, taking into account their nutritional needs” and “consider involving a speech and language therapist if there are concerns about a person’s safety when eating and drinking”.7 However, dementia carers face spe- cific challenges in supporting patients to eat and drink enough.8

DYSPHAGIA: A BARRIER FOR DEMENTIA SUFFERERS

Dysphagia is a term used to describe difficulty or discomfort in swal- lowing food, fluids and saliva. Dementia is a well-recognised cause.9 Signs of dysphagia in people with dementia include coughing or choking; difficulties chewing; spitting out food; wet gurgling voice after eating; and food/drink spilling from or residue in the patient’s mouth after eat- ing.10 If dysphagia is not managed appropriately, patients can suffer severe health consequences such as chest infections, aspiration pneu- monia and choking-related death 9.

PROMOTING A SAFE SWALLOW

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard that describes correct and appropriate thickening of liq- uids and food texture modification, to ensure that they are safe to offer to patients with differing degrees of dysphagia.11 IDDSI gives clear descriptors for all levels of consistency, from level 0 (thin/unthickened) up to 4 (extremely thick) for fluids, and from level 7 (regular) down to level 3 (liquidised) for foods.11 It is vital that patients with dementia are only offered foods and drinks that are a safe and appropriate texture for their current level of dysphagia. This should be assessed and regularly monitored by a registered speech and language therapist.

Many dementia patients dislike the taste and texture of thickening agents. Thus, products which do not require added thickener may be more acceptable, and can make it easier when patients with dementia are preparing their own drinks. Interestingly, research suggests that use products which do not require added thickener can lead to increased food and fluid intake.12

PERCEPTION, DEXTERITY AND DISTRACTIONS

Dementia often changes how patients recognise once-familiar foods, drinks and utensils.6 Additionally, preference for sweeter tastes and contrasting colours are commonly observed 3. Involving patients in preparing their own foods and drinks, alongside the use of adapted utensils and cutlery, and a reduction in distracting sounds, sights and objects at mealtimes, can encourage independence and focus, while preventing wandering off during mealtimes.13

USING THE “FOOD FIRST APPROACH”

For patients with small appetites, foods and drinks can be enriched by adding foods rich in fats and sugars – such as butter, jam, cheese and cream – to increase energy and protein intake without increasing the amount of food eaten. This is referred to as a “food first” approach.14 While this is the preferred first-line strategy to tackle malnutrition, dementia patients can still struggle to meet their needs from food alone, and oral nutritional supplements or nutrition shakes such as NuVu Life are often recommended to fill the gap.15

HOW NUVU LIFE CAN HELP

Made up with 200ml whole milk, one 50g sachet of NuVu Life delivers an impressive 362 kcal and 27.5g protein. When mixed with water or milk, it is IDDSI level 2 consistency. For patients requiring level 2 thickened fluids, NuVu Life removes the need for added thickening agents, thus sav- ing time and reducing risk of error for carers and patients alike. Moreover, NuVu Life is enriched with vitamins and minerals, including those identified earlier in the article (i.e. vitamins A, B12, iron and zinc), which are a specific concern for older people. Just one 50g sachet on NuVu Life provides 100% of the recommended daily intake for these key micronutrients.

NuVu Life is available to purchase online (www.nuvulife.com), RRP depends on the quantity purchased. Use voucher code TC30 to claim 30% off your order. For sales enquiries, or to request a sample of NuVu Life, please email sales@nuvulife.com or call: 07740 844 405.

REFERENCES:

1. Stratton R, Smith T, Gabe S. Managing malnutrition to improve lives and save money. BAPEN Report 2018. (available at http://www.bapen.org.uk/pdfs/reports/mag/managing- malnutrition.pdf ) [accessed 07 June 2020]

2. Maggini S, Pierre A, Calder P. Immune function and micronutrient requirements change over the life course. Nutrients. 2018; 10(10):1531. (Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212925/ ) [accessed 07 June 2020]

3. Prince M, Albanese E, Guerchet M, Prina M. Nutrition and dementia: a review of avail- able research. Alzheimer’s Disease International 2014. (available at https://www.alz.co.uk/sites/default/files/pdfs/nutrition-and-dementia.pdf) [accessed 07 June 2020]

4. White H, Pieper C, Schmader K. The association of weight change in Alzheimer’s disease with severity of disease and mortality: a longitudinal analysis. J Amer Geriatrics Soc 1998; 46(10):1223-7. (available at https://onlinelibrary.wiley.com/doi/10.1111/j.1532- 5415.1998.tb04537.x) [accessed 07 June 2020]

5. Albanese E, Taylor C, Siervo M, Stewart R, Prince MJ, Acosta D. Dementia severity and weight loss: A comparison across eight cohorts. The 10/66 study. Alzheimer’s & dementia: the journal of the Alzheimer’s Association. 2013; 9:649-656. (Avaiable at https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1016/j.jalz.2012.11.014) [accessed 07 June 2020]

6. Alzheimer’s Society. Caring for a person with dementia: a practical guide. 2019. (Available at: https://www.alzheimers.org.uk/sites/default/files/2020- 03/caring_for_a_person_with_dementia_600.pdf ) [accessed 07 June 2020]

7. National Institute for Clinical Excellence. Dementia: assessment, management and sup- port for people living with dementia and their carers (NG97). 2018. (Available at: https://www.nice.org.uk/guidance/ng97 ) [accessed 07 June 2020]

8. NHS Education for Scotland. Supporting People with Dementia in Acute Care: Learning Resource. 2016. (available at: https://www.knowledge.scot.nhs.uk/media/11866144/supporting%20people%20with%20dementia%20in%20acute%20care%20final%202016%20web.pdf) [accessed 07 June 2020]

11. International Dysphagia Diet Standardisation Initiative. Complete IDDSI Framework detailed definitions 2.0. 2019. (Available at: https://ftp.iddsi.org/Documents/Complete_IDDSI_Framework_Final_31July2019.pdf ) [accessed 07 June 2020]

12. McCormick S, Stafford K, Saqib G, Ni Chronin D, Power D. The efficacy of pre-thick- ened fluids on total fluid and nutrient consumption among extended care residents requiring thickened fluids due to risk of aspiration. Age and Ageing. 2008; 37(6):714–715. (Available at: https://academic.oup.com/ageing/article/37/6/714/40923 ) [accessed 07 June 2020]

13. Crawley H, Hocking E. Eating well: supporting older people and older people with dementia. Caroline Walker Trust. 2011. (Available at:

http://www.cwt.org.uk/wp-content/uploads/2014/07/EW-Old-Dementia-Practical- Resource.pdf ) [accessed 07 June 2020]

14. Forbes C. The ‘food first’ approach to malnutrition. Nursing and Residential Care. 2014; 16(8): 442-445. (Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/nrec.2014.16.8.442 ) [accessed 07 June 2020]

15. Robinson K. Nutrition and Dementia. Dietetics Today. Sept 2018; 42-43 (Available at: https://www.bda.uk.com/resource/nutrition-and-dementia.html ) [accessed 07 June 2020]

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