In a previous article, DietDoc discussed the first of two dietary aspects to be considered in patients with Alzheimer’s disease, namely nutrients and special diets that are being investigated as potential cures.
Advertisement
There is, however, a second way in which dietary interventions can assist patients, as well as caregivers, and this is by means of dietary support.
Eating aberrations a) Overeating
Some patients with Alzheimer’s disease have gluttonous appetites, and are capable of eating amazing quantities of food. This behaviour may be alarming to caregivers and cause clashes when concerned spouses try to limit the patient’s excessive food intake, particularly of foods that are regarded as “fattening”, “high in cholesterol” or “junk food”.
It may help to keep in mind that gorging behaviour on the part of the patient is probably involuntary and that admonitions will have very little effect. Limiting the supply of food that is high in trans- and saturated fats and processed carbohydrates in the household is probably the most effective way of controlling this eating obsession. Engaging in fruitless arguments will only exhaust the concerned caregiver and should be avoided.
b) Weight loss
A more common aspect of Alzheimer’s disease is weight loss, which is either due to inadequate intake of food, or excessive energy expenditure. The latter may be caused by the repetitive movements (aimless pacing, fidgeting) that these patients engage in. Inadequate food intake may be exacerbated by inability of the patient to feed himself. Patients who suffer from repeated infections may also have an increased energy requirement that is not met by their dietary intake.
Expert assistance
Patients with Alzheimer’s disease need to be periodically assessed by a clinical dietician to determine if their food intake is adequate. The dietician should determine if energy and nutrient intakes are adequate to prevent malnourishment that is common in these patients, and provide caregivers with advice for correcting deficiencies or overeating and/or unbalanced eating.
If you are caring for a patient with Alzheimer’s disease you need all the help you can get, so consult a clinical dietician when it comes to feeding your loved one adequately.
Neurological fallout
Alzheimer’s disease progressively destroys different regions of the brain that are involved with all the processes related to eating and food selection.
Cognitive losses
Cognitive fallout can cause decreased attention span, and impair reasoning and judgement. Patients may thus not be able to recognise feelings of hunger, thirst or satiety (the latter may be one factor influencing abnormally large food intakes).
1) Forgotten meals
As the patient loses more and more cognitive function, she may forget that she has just eaten a meal or refuse to eat anything. This type of situation is particularly trying to caregivers and a method of indicating to patients that they have eaten a meal may be helpful (e.g. getting the patient to tick off meals that have been eaten on a daily meal list).
2) Dehydration
As patients may not be aware of thirst or forget to drink fluids, they can easily become dehydrated. Care should be taken to ensure that Alzheimer’s patients have an adequate liquid intake of about 2,5 litres a day.
The liquid intake can include all beverages such as tea, coffee, milk, liquid yoghurt, cold drinks, fruit juice, smoothies, and water. Resistance to drinking fluids may be overcome by offering palatable drinks.
The use of energy drinks, which also supply the patient with some carbohydrate that contributes to energy intake, may be helpful. Cool, but not icy drinks are usually more palatable. Care should also be taken to ensure that hot beverages are at a temperature that does not burn the mouth and throat as patients may not be able to judge this for themselves.
3) Distractions
Alzheimer’s disease patients may have a very short attention span and meals should be served with a minimum of distractions. Don’t have the TV or radio blaring during meals to restrict noise distraction as much as possible. Use small plates or bowls for serving food and hand these to the patient one at a time to prevent him from becoming confused. Dish food up for patients as having to select food from a variety of serving dishes can be most stressful.
4) Vigilance
Be vigilant because patients may consume food that is spoilt or inedible, or drink hazardous liquids (paraffin, methylated spirits). Dispose of all food that is not fit for eating and keep all
hazardous liquids locked up.
5) Inability to recognise food
Alzheimer’s patients may develop a condition called ‘agne’ (distortion of visual, auditory or tactile signals). This often manifests in the patient’s inability to recognise food so that the person stops eating. It may be necessary for the patient to actually taste or touch a food item before she will start eating it. Caregivers may have to initiate feeding behaviour.
These patients may also become confused if food is presented to them on plates or dishes with the same colour as the food (mashed potatoes on white plates). For this reason, it can be helpful to serve food on plates or in bowls with a contrasting colour.
6) Inability to use utensils
As the disease progresses, patients may lose the skill to handle eating utensils. Eating may have to be initiated by the caregiver and followed up with verbal prompts. Eventually the patient may only be able to use a spoon, so that food should be cut up by the caregiver to make eating easier.
Tips for increasing food intake
The use of finger foods (wholewheat crackers, cheese cubes, carrot sticks, fruit pieces, dried fruit without pips etc), frequent snacks, nutrient-dense foods and nutritional supplements can help caregivers to feed Alzheimer’s patients who have lost the ability to feed themselves.
There are a variety of liquid supplements available, which have increased energy and protein contents to boost inadequate food intake. Patients who have difficulty with swallowing may benefit if thickeners are used to partially solidify liquids. Ask your pharmacist and dietician about the various products that are available.
When you can’t cope anymore
There comes a time in the relentless progression of this dreaded disease when even the most loving caregiver can no longer cope with the physical and psychological demands of caring for patients with Alzheimer’s disease.
Remember that the patient may benefit from institutional care and that dietary support such as tube or IV feeding can be more easily applied in a clinical setting. Be guided by the advice of health professionals (your doctor or dietician) and when the time comes to relinquish care to others, be brave and do so gracefully for the good of the patient. – (Dr I.V. van Heerden, DietDoc)
Bookmark with:
What are social bookmarks?