Information and resources that support your role in caring for a loved one.

A dementia diagnosis for a loved one brings with it many challenges and a need to adapt almost every facet of life to the changing conditions brought upon by the progression of the condition.

One area of concern that may get overlooked is one of the most basic and important – making sure your loved one with dementia maintains a healthy diet and is getting proper nutrition.

In the latest edition of our Caregiving Chronicles Q&A series, we speak with Traci Robidoux, RD, LND, the Dietitian and Nutritionist at BayPath Elder Services, Inc., about what older adults and caregivers should know about nutrition and dementia.

Caregiving MetroWest: To start, could you discuss a little about your background and your role here at BayPath? And how often do you deal with issues concerning dementia in the course of your duties?
Traci Robidoux: 
I graduated with my Bachelor’s Degree in Nutrition & Dietetics from Gannon University in 2002.  Over the course of the past 15 years, I have primarily worked in the hospital setting as a clinical dietitian, specifically in units such as ICU, Med/Surg, TCU, Med psych, Geriatric Psych, Oncology and Acute Rehab.  Two years ago I joined the team at BayPath as a community dietitian/nutritionist.  My role here consists of four primary duties: community education at the various senior/community centers, high risk nutrition home visits, Meals on Wheels (MOW) menu writing, and kitchen inspections for our MOW sites.

I probably see a client with dementia once every 3-4 months or so.  When I get a referral for a client with dementia, I am primarily working with the caregiver to devise a care plan that works for the client to optimize their nutritional status.

CGMW: You have mentioned the MIND Diet before. What exactly is that and how does it work?
The MIND diet refers to the Mediterranean-dietary approaches to stop hypertension Intervention for Neurodegenerative Delay.  It is based on years of cumulative research findings on which foods and nutrients benefit and harm brain function.  The research suggests that what you put on your plate can help or hinder cognitive abilities such as memory, language, attention, and more.  By following the MIND diet, it’s possible to reduce the risk of Alzheimer’s by 35 to 53 percent and reduce cognitive age by seven and half years.  There are benefits even when moderately followed.

In a nutshell, The MIND diet covers 15 food groups, including five types to avoid, but twice as many to enjoy. The best foods for your brain include green, leafy vegetables, nuts, beans, berries, poultry, fish, whole grains, olive oil and wine.  The worst foods for your brain include red meat, butter and stick margarine, whole-fat cheese, pastries and sweets, and fried fast food.

CGMW: Are there other foods you recommend to help reduce the risks or effects of dementia?
 In addition to the brain-healthy foods mentioned above, dark chocolate, tea, and avocados are full of anti-oxidants, which we know are protective of the brain.  The research shows that moving towards a more plant-based diet (vs. animal-based) is protective against many chronic diseases of our time, not just dementia.

Keep in mind that good food choices are most beneficial when combined with adequate sleep, physical activity, mental stimulation and social activity.

CGMW: Are there foods that you recommend to avoid or cut down on because of potential links to developing dementia?
 It really comes down to added sugar, saturated fat, trans fat and excess sodium, all of which can be found in many processed & packaged foods.

CGMW: What about after the onset of Alzheimer’s or another form of dementia, are there any special dietary or nutritional concerns a caregiver should be aware of?
People with Alzheimer’s disease or dementia do not need a special diet.  That being said, poor nutrition can increase behavioral symptoms and may contribute to weight loss.  Provide a well-balanced diet that emphasizes fruits and vegetables, beans, whole grains, nuts and seeds, low-fat dairy products, olive oil and lean proteins.

In addition to the normal physiological changes that happen with age, such as decreased hunger and thirst perception, dementia patients may forget to eat and drink and have difficulty expressing likes and dislikes.  Dementia can also have a negative impact on the ability to self-feed and to swallow safely.   Certain behaviors associated with dementia, such as pacing and wandering, also can lead to increased energy expenditure and short attention span during meals.

These factors elevate the risk of dehydration and weight loss in dementia patients.  Fortunately, there are many strategies to manage some of the common nutrition problems associated with dementia.

CGMW: Among the effects of dementia can be a loss of appetite, decreased sense of smell and taste, a lack of recognition of different types of food and even difficulty performing the functions of eating. Do you have any advice for caregivers to help with these issues?
 Preparing favorite foods can help with appetite loss; even if it means serving breakfast foods several times a day.  Keep in mind that food preferences can change dramatically and suddenly, so be patient and flexible.  Large meals can also be overwhelming, so consider five or six small meals/snacks a day, rather than three large ones.

To combat self-feeding difficulties, finger foods that are easy to pick up are a great way to encourage independence.   You can also encourage independence by using a plate with rims and large-handled silverware.  An occupational therapist can provide guidance as to what may be helpful.

If weight loss becomes a concern, oral nutrition supplements are always an option to help meet calorie and protein needs.  They are most beneficial when provided in between meals, not as a meal replacement.  Talk with their primary care physician or a dietitian before starting one.

CGMW: Confusion, and the fear it produces, is the central problem in dementia, and it is the cause of many of the difficult behaviors a person with dementia can exhibit. Limiting distractions and trying to create a sense of contented involvement in a task is one of the primary strategies a caregiver can use to combat that confusion. When it comes to meals and making sure your loved one is getting the nutrition they need, are there any tips or techniques you can suggest to help in that process?
Robidoux: To optimize nutrition intake, consider the following:

1. Simplify mealtime by serving meals in a quiet environment & keep the table setting basic, using only what is necessary for that meal. For example, just put a spoon out if the meal is a soup and sandwich.  If there is a fork and knife also at the place setting, the person with dementia may not know what utensil to use for the soup.
2. Use high-contrast tableware so that the food can be distinguished from the plate.  For example, white rice on a white plate will be difficult to see, so consider using a bright red or bright blue plate.  Avoid patterned tableware as well.
3.  Consider serving only one food at a time.  Too many foods at once may be overwhelming and distracting.  Also, allow plenty of time to finish a meal – it could take an hour or longer.
4.  Provide foods at a comfortable texture and temperature.   If he or she has missing or broken teeth, or ill-fitting dentures, try cutting food into small pieces, serving softer foods like eggs, yogurt, oatmeal, well-cooked vegetables, or even grinding or pureeing food and mixing it with sauces and gravies. Always check the temperature of foods and beverages before serving.
5.  Eat together! Most people eat more in the company of others, dementia or no dementia.  It provides a nice social experience and if necessary, you can provide gentle reminders to encourage intake.

CGMW: Are there any additional resources you would recommend to anyone caring for a loved one with dementia or concerned about developing dementia?
Here are a few places online that you can get some good information:

Academy of Nutrition and Dietetics: www.eatright.org and www.foodandnutrition.org

USDA MyPlate: www.choosemyplate.gov

Alzheimer’s Association: www.alz.org/national/

National Institute on Aging: www.nia.nih.gov/alzheimers/

Memory Preservation Nutrition: http://brainwellness.com/

In addition, here are a couple of books worth checking out as well:

Moon, M. (2016). The MIND Diet: A Scientific Approach to Enhancing Brain Function and Helping Prevent Alzheimer’s and Dementia. Berkeley: Ulysses Press.

Isaacson, R. and Ochner, CN. (2016). The Alzheimer’s Prevention & Treatment Diet: Using Nutrition to Combat the Effects of Alzheimer’s Disease. Garden City Park: Square One Publishers.

CGMW: Part of your job is to work directly with consumers and make assessments. How can people get in touch with you if they would like to learn more about these issues or meet with you?
 I am available to do in-home nutrition assessments and can be reached by calling 508-573-7258 or via email at trobidoux@baypath.org.  There is no cost associated with my visit.

CGMW: Is there anything else that we haven’t covered that our readers should know about nutrition and dementia?
 People with dementia can present with unique nutrition challenges and unfortunately there is no “one-size-fits-all” solution.  Nutrition is a key component to the care of a patient with dementia or Alzheimer’s.  A Registered Dietitian can provide a thorough nutrition assessment & make recommendations to maintain nutrition and hydration status, thus improving overall quality of life.

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