There is no doubt that good nutrition can have a really significant part to play in improving quality of life for the elderly or people living with the challenge of Dementia or Alzheimer’s.
A healthy balanced and enjoyable diet is the key to wellness and vitality at every stage of life as well as being crucial to a sense of well-being.
This group of vulnerable people are coping with many different factors that conspire to result in poor nutrition and or hydration. They may well have been struggling for a long time to maintain a nutritious diet before they come into residential or care services. Which means they are likely to have been undernourished with low levels of hydration for some time. Fortunately with just a bit of extra thought and intention this can be improved. The goal now is to enable them to be, as healthy as they can be, within the limitations or restrictions of their condition.
We know that eating and drinking difficulties are common in dementia. This can be because of cognitive impairments, physical disabilities and psychological factors like depression and agitation. Behavioural challenges also impact on this such as mealtime wandering, pacing, refusal indifference, amongst many others. Practical and direct assistance may become necessary to help maintain adequate nutritional intake.
Within a ‘Care setting’ these challenges are particularly acute as it requires careful organisation to cater for each resident / client’s individual preferences.
However some basic principles can be identified, which if applied could bring about a significant improvement to quality of life.
The National Association of Care Catering describes 10 key characteristics required for achieving an optimum nutritional approach which need to be embedded in the polices and practices of the Care Environment.
This Blog however is geared towards the practicalities of delivering healthy, appetising food, snacks and beverages based on solid nutritional principles.
Part 1 will focus on the rationale behind some of these important principles. Part 2 will offer some practical suggestions and Part 3 will look at other simple strategies beyond nutrition for enhancing well being.
Personalised meal plans
The overarching theme that emerged from the interviews and focus groups undertaken by Quality Compliance Systems was person-centred nutritional care and individualised meal plans. https://www.qcs.co.uk/improving-nutrition-dementia-care/
This requires understanding the importance of each dementia stage and the impact on eating and drinking. As dementia progresses, there can be a reduced comprehension of mealtimes whether that’s with the crockery used, or the environment in which meals are eaten. Furthermore swallowing ability can deteriorate as disease progresses. In Part 2 of this blog series I shall address the issues around dysphagia more specifically.
In addition to the technical aspects associated with disease progression there are the social and life history elements which are very important. A regularly updated part of their care plan must take into account their personal preferences and favourite foods which are likely to be those they remember from their youth or childhood.
Finger food has been identified as a practical way to overcome the difficulties of managing cutlery etc. as well as providing an attractive presentation.
Focus on fresh.
Fresh fruit and vegetables are important in so many ways for the elderly and those who are confused, forgetful or otherwise cognitively impaired. The fibre alone is crucial for bowel health and maintaining regular bowel habits as well as contributing to overall hydration. Fibre can also help stabilise blood sugar levels. An added benefit of fibre is that the indigestible cellulose fibres and the sugars in them feed the healthy bacteria that colonise the gut. These are known as Prebiotics.
As a general rule dark fruits and dark green vegetables are the best source of vitamins and nutrients. Soft fruit such as blueberries, raspberries, strawberries, grapes, cherries (de-stoned) are excellent and do not contain high levels of sugar.
Veggies such as spinach, greens, kale, rocket, watercress and Swiss chard are all great sources of magnesium and folate, or Vitamin B9, which is shown to improve cognition in older adults. Folate can also help ward off depression (a common dementia side-affect) by contributing to serotonin levels. (Serotonin is required for good sleep and is one of the ‘happy chemicals in the brain). The Vitamin E in leafy green vegetables has also shown positive affects on the brain.
Cruciferous Vegetables such as broccoli, cauliflower, bok choy, cabbage and brussel sprouts help retain memory. They contain carotenoids and folate, which lower levels of homocysteine, an amino acid linked with cognitive impairment.
Just a little sweetness.
Everyone loves a little sweet treat every now and then but a diet too high in sugar can lead to cognitive impairment. Processed sugary foods are implicated in many inflammatory conditions. Increasingly researchers and scientists are realising that Alzheimer’s and Dementia are strongly linked to diabetes and insulin resistance. Some even calling these conditions ‘diabetes of the brain’. The best advice is to reduce the amount of sugar in the diet to a minimum, especially added sugar in drinks, commercial biscuits etc. However a little sweetness in the form of home baked food treats, fresh berries, dark chocolate will be important components of a healthy balanced diet. Not to mention the enjoyment and pleasure of such foods.
Good quality fats are essential for optimal brain and nervous system function. In spite of the rights and wrongs of the low fat advice these last 4-5 decades no one can dispute that for this population group of vulnerable people good quality, healthy fat provides food for their brains and maximum calories for their whole body.
Healthy Fats would include : Whole milk, Butter, Avocados, Olive Oil, Eggs, Dark Chocolate, Coconut oil.
Coconut oil is an amazing oil and has particular properties due to its unique structure (medium chain triglycerides or MCT) which are very beneficial to the brain. Dr Mary Newport (see YouTube link) below has done much work in this field since her own husband who had developed early onset dementia was greatly helped by coconut oil in his latter years of the disease. The short clip below is both informative and inspiring. Coconut oil can easily be added to most foods especially hot food: porridge, soup, stews, etc. It can be used instead of vegetable oils for frying. It can be used instead of butter in baking. It’s very versatile. The advice is start small, 1 teaspoon 3 times a day and gradually work up to 1tablespoon 3 times a day.
Some links to more information on the benefits of coconut oil for people with Dementia and Alzheimer’s:-
Dr Mary Newport. https://m.youtube.com/watch?v=8DfZnS4hYBs
Dr Bruce Fife has written extensively on the many health benefits of coconut oil
Protein for power and strength.
Another important part of a healthy balanced diet is eating enough protein. Protein builds and maintains muscle, which is crucial at every stage of the life span. Researchers at Texas University (7) found that consuming enough protein may prevent or delay some of the declines in muscle tone associated with ageing. As a result, protein is one of the most important components of cultivating a healthy diet for the elderly and especially so for those coping with confusion and dementia
Eggs for example, are a highly versatile, rich source of protein and nutrients. They are cost effective and can be prepared in so many ways.
Researchers have confirmed the important role that fortified oral nutrient supplements (ONS) can play in providing people with dementia adequate supplies of energy and essential nutrients.
Adding extra nutrients like coconut oil (above) or the contents of a probiotic capsule will greatly enhance the overall effectiveness of the liquid supplement. Using ONS as a basis for smoothies provides the opportunity of adding in fresh fruit and fibre.
A meta-analysis by Alen et al. (2013) (8) stated that malnutrition is the most prevalent nutritional status in people diagnosed with dementia and therefore the use of ONS is encouraged in order to promote weight gain and muscle strength.
DHA (Fish Oils)
A group of oils worthy of mention in their own right. DHA from fish oil, krill oil or cod liver oil is crucial for optimal brain function. Other benefits include reducing inflammation in the body. It is becoming more widely recognised that underlying inflammation is implicated in many chronic health conditions, especially Dementia, Alzheimer’s and Diabetes.
A good quality fish oil supplement is essential as many of the cheaper poorer brands are contaminated with high levels of mercury and other toxins. Look for brands that have excellent filtration processes.
Providing clients with a wide spectrum of probiotics could have numerous benefits and related impact on their cognitive abilities
The bacteria and yeasts in the gut, known as the gut microbiome, are increasingly seen as key players in serious and chronic neurodegenerative diseases like Alzheimer’s and Parkinson’s (3).
Scientists are finding evidence that the microbiome may play a role not just in Alzheimer’s disease, but Parkinson’s disease, Depression, Schizophrenia, Autism and other conditions.
As recent studies have been revealing, these “gut bugs” do more than aid digestion. They appear to affect a range of bodily functions, from immune defence to the production of vitamins, anti-inflammatory compounds and even chemicals that relay messages among brain cells.(4)
One study demonstrates a clear relationship between the gut microbiome and dementia in Japanese patients. Further analysis of differences in the composition of the microbiome will be important to clarify the gut-brain connection. However their results are consistent with the hypothesis that gut microbes are involved in the development of Dementia.
There are many ways of adding in probiotics to the diet. Yakult is one of the easiest and also bio Yoghurts as they are readily available. However neither of these have a wide range of bacterial strains. Yeo Valley now make a Kefir (flavoured or unflavoured) in their yoghurt range which contains 14 strains of good bacteria. Probiotic capsules are easy and convenient. The contents of a capsule can be sprinkled on food. Look for ones with 14 strains or more, at least 5 billion. A very good probiotic powder, new on the market, is –
An overview of probiotics and what they do is found in this link:-
Basic list of Essential Supplements
1. Vitamin D. The natural form D3 not synthetic versions. Available in drops so can be added to food or drinks
2. Vitamin C: for its anti oxidant and anti- inflammatory properties
3. Vitamin E: powerful antioxidant. Available in drops
4. Fish oils
References and further reading
ProRisk Care Consultant