Nutrition

I just drove 10 hours from NC and am very thankful for the time in the car and the extra hour this weekend to think about and write the blog. I said we would return to challenging behaviors. It seems as though the topics arise as matters are addressed in my personal life during the week and although I contemplated different directions, nutrition surfaced as the winner. I think seeing all the Halloween candy and “sweets” in general last evening heightened the topic because sweets is an issue countless people have when coping with dementia.

Eating can be difficult from both ends of the scale on several levels. First, if the brain is not sending signals that indicate to the person that they are satiated, and the memory is diminished so that they do not remember having eaten, then they may be making repeated trips to look for food or asking continually for something to eat, which is a challenge in itself.

On the other hand, the inability to recognize hunger or the lack of memory to know that they haven’t consumed anything can result in someone not eating at all. I can’t even count the number of times I’ve heard family or care providers report that food was made but sat untouched (sometimes for days) while the person living with dementia insisted they ate.

Both areas are of concern and as in other behaviors it helps to look at the challenges as a form of communication. When eating too much some things to look for: could it possibily be boredom, depression , medication changes or are they stress eating due to anxiety? What was their past history with food? Did they graze during the day or did they have a voracious appetite?

With lack of consumption, some of the things to question are again depression and change of medication but also sores in the mouth, or dentures that don’t fit properly. In addition, distractions, poor vision, and the inability to remember how to eat can be contributing factors.

I learned from a speech therapist something that helped me better understand why sweets, especially ice cream, seem to be a gravitational pull for many. The taste buds are the weakest of the five senses and they diminish as we age The ones that seem to stay in tact the longest are the sweet taste buds which are mostly on the front of our tongue. In addition, part of our taste comes from the sense of smell. Studies are showing that the sense of smell is reduced in people living with dementia. So sometimes eating isn’t happening because it has no taste. Spicy foods rev up the nerve endings in the mouth so some spicy foods can taste appetizing.

The Alzheimer's Association has additional help. http://www.alz.org

Once any possible medical issues are addressed, some activities that may help, depending upon the person and the situation are:

• Use soft relaxing music during the meals.
• Use placemats that are contrasting to the bowl or plate so they can be seen.
• Divide meals into small portions and then portion out for more frequent eating.
• Use Carnation Instant or Boost or Ensure to make a nutritious milk shake or frostie for the person who will eat ice cream.
• Use Carnation Instant or Boost or Ensure to make pancakes or other foods that use milk as an ingredient to increase calories and nutrients.
• Put one item of food on the plate at a time to reduce choice confusion.
• Provide appetizing aromas through potpourri or cooking.
• Use some massage or relaxation techniques on neck & shoulders before eating.
• Consider “food” activities such as stirring, whisking, pulling grapes from their stem, using a rolling pin (even on bread slices), peeling and/or slicing a banana, sectioning an orange, spreading bread or (one I’ve said before) tearing lettuce.
• Reminisce about food (before or during the meal) – shopping, cooking, planting,
• Use picture recipe cards to sort or count.
• Look through a cookbook or food magazine
• Talk about food colors –categorize foods into colors
• Measure an ingredient into a separate bowl

In our Brainy Day Activity Program, www.hippocampus-hq.com we have an imitation, plastic sandwich and nutrition cards to address this behavior in middle to later stages of dementia. There is a template for using the sandwich. The cards have large pictures of different food items which can be matched to the sandwich or can be used for various activity pursuits, all written on the instruction sheet in its bag.
Giving the person who keeps returning for food, something to occupy their time, especially if it is food related, can sometimes delay the trip to the refrigerator. Giving the person who is not eating, something to provide the reminder, can sometimes stimulate the desire for some nutrition and the sandwich can be exchanged for the real thing.

Finally, one of the concerns with nutrition that may happen is what to do if the person can no longer eat. One decision that is offered to the family is tube feeding for failure or inability to eat. One of the booklets that I found helpful for the issue of Feeding Tubes is Hard Choices for Loving People by Hank Dunn. I have the fourth edition which was written in 2002, and this is a website where the fifth edition can be purchased for $6.00 http://www.hospicenet.org/html/choices.html The author helps with understanding artificial hydration and nutrition as well as other hard choices for participating in heath care decisions. http://www.sparrow.org/palliativecare/pc-tubefeeding.asp is another article which was written last year and shares statistics on using the feed tube.

Food supports us both physically and emotionally. The decisions made around nutrition are important to bodies, minds and spirits. Mary Ann