As Alzheimer's disease progresses, it can have a profound impact on nutrition. Swallowing difficulties, physical limitations and a failure to understand that eating is important are just some of the challenges. Caregivers must pay close attention to ensure that adequate calories, protein, fluid and other nutrients are consumed to maintain adequate nutritional status.
Food Texture
Swallowing is something most of us do without thinking, but it's a complex process. When the muscles involved with swallowing don't function normally, food can pass directly into the lung (known as aspiration) rather than through the esophagus and on to the stomach. Aspiration can lead to pneumonia and, in some cases, even death. To reduce the risk of aspiration, foods may need to be ground or pureed, and liquids may need to be thickened. A Speech-Language Pathologist (SLP) specializes in swallowing disorders and can perform tests to determine whether altered food textures are necessary.
High Calorie Foods
Individuals with Alzheimer's disease often have increased calorie needs. Behaviors such as wandering and pacing require additional calories, and confusion may interfere with hunger awareness. Insufficient consumption of nutrients can lead to weight loss, dehydration or the development of pressure sores. There are many creative ways to increase the calorie content of foods, and a registered dietitian can help develop an appropriate meal plan.
Finger Foods
Even the simplest of tasks, such as using silverware at meals, can be daunting for the Alzheimer's patient. Finger foods (such as sandwiches or other foods that can be picked up with fingers) are often helpful. Providing verbal instructions throughout the meal, such as "take a bite," "chew" and "swallow," may help preserve a patient's ability to feed himself. In the later stages of the disease, however, it will probably become necessary for caregivers to assist with feeding.
Supplements
Fluids are often more readily accepted than solid foods. For this reason, liquid supplements can help fill the nutritional gaps when meal acceptance is poor. Many supplements, such as Ensure® or Glucerna®, can be purchased over the counter and are available in a variety of flavors. It's generally recommended that these supplements be provided between, rather than with, meals to avoid interfering with appetite. Discuss all supplement use with your physician.
Alternative Nutrition (Feeding Tubes)
When a person is unable to consume enough nutrients by mouth, a physician may recommend an alternative form of nutrition. Feeding tubes, which are surgically inserted directly into the stomach or small intestine, are the most common form of alternative nutrition used to deliver essential nutrients.
References
- National Dysphagia Diet: Standardization for Optimal Care; National Dysphagia Task Force of the American Dietetic Association; 2002
- Hard Choices For Loving People; Hank Dunn; 2001
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