Nutrition in Severe Dementia

Abstract

An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.

Guidelines for Dementia-Related Health Advocacy for Adults With Intellectual Disability and Dementia: National Task Group on Intellectual Disabilities and Dementia Practices

“…They become more important when dementia impairs cognitive and functioning abilities related to food choice and intake and compromises nutritional status. The adverse effects of dementia on weight and nutritional status are well documented, indicating that dementia causes weight loss (Albanese & Prina, 2014;Pivi, Bertolucci, & Schultz, 2012). Weight loss, which has multifactorial etiology, occurs before the symptomatic phase of dementia; the degree of weight loss and under nutrition increases with the severity of the disease.…”

“…Aversive feeding behaviors, damage to the parts of the brain that control appetite and food intake, sensory dysfunction that reduces the sense of smell, oropharyngeal dysphagia (difficulty in transferring food from the mouth to the pharynx and esophagus) which can cause choking and food avoidance, loss of interest in eating, and poor oral and dental health that may cause pain-all these symptoms reduce food intake and contribute to weight loss (Allbanese & Prina, 2014). Dysphagia can also cause aspiration pneumonia (Pivi et al, 2012), a hypercatabolic condition that can increase energy expenditure. Weight loss and under nutrition predispose people, especially those who are immobile, to the development of pressure sores, infection, increased risk for falls, and frequency of hospitalization (Albanese & Prina, 2014;Mughal & Novak, in press).…”

“…Management of nutritional problems requires a multidisciplinary team of professionals working with the adults and their caregivers to deliver the best individualized care possible that meets the adults' health goals and preferences; in such situations, caregivers should be active participants and advocates. Given the complex feeding problems of adults with ID and dementia (i.e., difficulty in swallowing leading to choking, chewing but failing to swallow, and active resistance to hand feeding) (Pivi et al, 2012), education and training of caregivers on nutritional needs of individuals, balanced diet, ways to increase calories and protein intake, and managing aversive feeding behaviors may help delay the hazards of under nutrition (Prince et al, 2014).…”

Achieving Patient‐Centered Care in a Case of a Patient With Advanced Dementia

“…4 The surrogate decision maker was informed of the potential risks, burdens, and benefits of placement of a gastrostomy tube for feeding in patients with advanced dementia. [5][6][7] The surrogate decision maker agreed to the swallowing study. This was performed without incident and served to assess the risk of aspiration and determine the types of foods that may be less restrictive and less risky.…”

Building the evidence base for palliative care and dementia

“…6,7 Some organizations such as the American Geriatrics Society recommend against its routine use, 8 while other experts recommend an informed discussion with caregivers. 9 Two other articles in the journal point out some of the challenges in caring well for persons with dementia at the end of life. One key challenge is the reduction in burdensome transfers of care at the end of life.…”