Dementia related diseases. One of the silent and often overlooked risks for people living with Dementia is WEIGHT LOSS. The medial temporal cortex, which is involved in feeding behaviour and memory, is affected in the early stages of the disease. In today’s society weight loss is considered a good thing, something to aspire to, but as you become older that changes. Obesity carries its own risks, but for a person living with dementia, and even a healthy elderly person, there is a clear risk to losing weight. Often the weight being lost is muscle loss and not fat. The loss of muscle makes the person unable to carry their own weight and unsteady on their feet and the person becomes a fall risk. Falls can cause anything from skin flaps, broken hips to concussion. The consequence of repeated falls can become severe.
We do not have to accept the weight loss as a normal consequence of the illness. As caregivers, we have some simple tricks in our bag to combat dementia-associated weight loss:
- Keep the person as active as possible, encourage them to exercise in any way that they are able. Swimming, dancing, walking, anything, and as much as what they are able to do. The more active they are the more enhanced their appetite will be. The increased movement will also help to improve their sleep.
- Make sure that the meal with the highest caloric load is served at the time that they are the most alert. For most of Dementia patients this is at breakfast. There are some persons who are more alert later in the day, for them lunch can be the meal with the highest caloric load.
- Don’t give them food they don’t like. This seems like an obvious, easy and silly point but people who live with dementia are often stubborn. If there is one thing on their plate that they do not like they can often discount the whole plate. The happier the person, the more likely they are to eat.
- More herbs, more spices- over time and with age our taste buds ability decreases. This can be exacerbated by dementia. By using extra flavouring when cooking you can combat the problem of flavourless food and give the person more incentive to eat.
- Make sure that the food is cooked to be tender and easily chewed and swallowed. Cutting the food into bite sized pieces before delivering it, will reduce the need to cut or handle the food which can frustrate or irritate the person.
- Reduce the distractions in the dining room and over mealtimes. Turning off the television, making sure that your voice is kept low during meal times and ensuring that the table is clear of all unnecessary clutter will improve the focus on the meal and the eating process.
- Make sure that the food is placed within the visual field of the person and that they are cued to start their meal. A person with a certain level of dementia will not initiate the eating process on their own, they will also stop and start eating and will need to be reminded to eat. Avoid interrupting the process or they might lose interest in the meal. Serve the pudding separately.
- Frequently check the person’s mouth. Pain in their mouth or teeth can cause the person to lose their appetite and refuse to eat. Dentures that do not fit can cause frustration while eating and cause the person to stop eating.
- Another obvious idea is to serve smaller more frequent meals with high calorie snacks in-between.
- Champion independence. As the disease progresses the person will lose their ability to feed themselves little by little. The loss of independence can be devastating and depressing. Every scrap of independence that can be kept or regained will improve the person’s emotional wellbeing and, in turn, their appetite. There are many ways to offer the person’s independence back to them depending on their ability:
- Make sure that the person can see the food i.e. do not put food on an overly patterned plate, this could cause the food to disappear into the pattern.
- Make sure that the food colour contrasts with the colour of the plate.
- Use cutlery crockery and glasses that are easy to lift and grip.
- Give the person one item at a time with the appropriate utensil.
- Make sure that the person is seated comfortably.
- There are specific aids that can be bought to improve the person’s ability to eat on their own, plate guards to help scoop food on to the spoon or fork, utensils with plastic handles that are either molded to the person’s hand or that grip easier and will angle the spoon or fork into a better angle to easily fit into their mouth even with limited range of movement. Neck bibs that catch spills and. Hand wipes to reduce the tactile distraction if the person used their fingers to eat. Conversation may support distraction if they eat reluctantly.