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In the middle stage of the disease • Gradual loss of speech and inabil- take another mouthful before the last
sufferers are likely to: ity to communicate, rendering the one is swallowed, as they can help
• become increasingly forgetful person unable to ask for food or slow down and ‘pace’ eating.
which can include forgetting how drinks; People who continually get up from
to eat - over-chewing food or hold- • Considerable weight loss. the table during a meal or seem un-
ing food in the mouth instead of able to sit down for any length of time
swallowing it; Other types of dementia (such as need a different approach to meal-
• become confused about where vascular dementia, fronto-temporal times and eating. For these people,
they are, or wander off, meaning dementia and Dementia with Lewy eating a normal meal sat at a table
that they have poor concentration bodies) do not follow exactly the is simply not possible, therefore using
at mealtimes or frequently leave same pathway during early to middle finger foods is the ideal alternative, as
the table; stages of the disease, but in late these can be easily eaten while on
• become muddled about time and stage, the symptoms of all dementias the move. With a little thought, many
get up at night, which can result in tend to be similar. meals could be given as finger food
irregular meals; – even a roast dinner (without the
• put themselves or others at risk Nutritional intervention in dementia gravy) is actually made up entirely of
through their forgetfulness by Nutritional intervention in dementia finger foods.
failing to store perishable food is neither unnecessary nor useless and It can also help to keep the eating
appropriately or not cooking food there are many interventions which environment as calm and free from
adequately; can help to improve nutritional status. distractions as possible, and for people
• behave in ways that may seem un- One interesting finding is that lower with dementia to eat with other peo-
usual, such as inappropriate social Body Mass Index (BMI) is associated ple as the visual cue of seeing other
behaviour and challenging eating with higher frequency and severity of people eating can help a person with
behaviour (rejecting food, reject- behavioural problems in people with dementia to understand what they are
ing assistance, spitting food out, dementia (4). Therefore, it is complete- meant to do in that situation.
taking food from other peoples ly appropriate to employ the usual If people with dementia frequently
plates); nutrition support techniques of encour- wake at night, it is worth considering
• experience difficulty with per- aging high energy and protein foods whether this could be because they
ception and in some cases have little and often and use of prescribable are hungry. Also, some people may
hallucinations. People in this stage supplements where appropriate. be at their most alert at night and the
of dementia may be unable to However, it is also essential to help need to provide them with food over-
identify familiar sights or smells people with dementia to maintain night may need to be considered.
or have anxieties and delusional their independence with eating and Challenging eating behaviour can
ideas about food safety, for ex- drinking for as long as possible, as manifest in a number of ways and can
ample fearing that food has been losing these skills may lead to loss of be particularly difficult when people
poisoned; other skills. Well learned skills will be with dementia need help with feeding.
• need frequent reminders or help to participated in with most success (5) – Refusing to open the mouth, spitting
eat and eat very slowly; for example someone with dementia food out and turning the head away
• have difficulties making menu may well still be able to feed them- when food is offered can be seen as
choices and reading small print. selves with their hands even if they are a sign that the person does not want
no longer able to use cutlery. any more food or that they are merely
Poor appetite and weight loss, or Visual menus or showing the food ‘being difficult’. However, the real
conversely over-eating and weight available rather than a long verbal list reason may be a little more involved.
gain can both be seen in early and will be more likely to enable people Any of these behaviours could indicate
middle stages of dementia. who are no longer able to read to presence of dysphagia of which the
Some people with Alzheimer’s dis- make menu choices. A person with person with dementia is aware but is
ease can develop changes in taste, dementia may have forgotten the unable to understand or explain. These
smell and food preferences which beginning of the list by the time they behaviours could also be due to the
can lead to unusual choices and eat- get to the end or may simply repeat person with dementia trying to prolong
ing habits. For example’ some people the last word that was said as they are the amount of time it takes to eat a
can develop a pronounced prefer- unable to remember anything else. meal, to simply spend longer one-to-
ence for sweet foods, even wanting A recent study in Manchester (6) one with another person as mealtimes
to add sugar to savoury foods. found that providing picture card may be the only time during the day
In the late stages of the disease suf- menus, rather than written ones, for when they get the exclusive attention
ferers will tend to have: day centre attendees with dementia, of another person.
• very pronounced loss of memory improved their quality of life. Use of highly flavoured foods and
and inability to recognise familiar At mealtimes, using frequent verbal drinks and foods and drinks that are
objects or surroundings resulting in prompts about the food or drink or to hot or cold (not tepid) may help to
food no longer being recognised; encourage the person to swallow can stimulate a stronger swallow in those
• difficulty initiating movement to help a great deal. Also using gentle, with dysphagia, as these extremes of
open mouth or chew, difficulty eat- physical prompts to encourage self taste and temperature provide more
ing and significant dysphagia; feeding, e.g. putting the utensil/cup stimulation to the brain.
• indifference to food and environ- in the persons hand and guiding it to
ment which can be seen as refusal their mouth. Both of these approaches Tube feeding
to eat or to open mouth, or turning can also help if the person tends to Despite all of these nutrition inter-
head away when food is offered; put too much food in their mouth or ventions, it is important to be aware
NHDmag.com Mar '10 - issue 52 11
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