Pharmacology Book

Nutrition

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Nutrition in Advanced DementiaAka: Dementia Related Malnutrition

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  1. See Also
    1. Dementia
    2. PEG Tube
    3. Dysphagia Evaluation
    4. Dysphagia Diet
    5. Unintentional Weight Loss
    6. Cachexia in Cancer
  2. Enteral Feeding tube use is not recommended
    1. No support for continued use in the literature
    2. Conscientious hand feeding is preferred alternative
    3. Previously used for nutrition in advanced Dementia
      1. Aspiration Pneumonia prophylaxis (unproven)
      2. Malnutrition (unproven)
      3. Pressure Ulcer reduction (unproven)
      4. Improved survival and function (unproven)
  3. General measures to improve food intake
    1. See Dysphagia Diet for possible limitations
    2. Strong flavors should be used
      1. Serve foods either hot or cold (not tepid)
      2. Enhance flavor with spice, gravy, juice, cream
    3. Offer preferred foods without restriction
      1. Ice cream
      2. Miniature chocolate bars
    4. Consider liquid supplements (e.g. Ensure, Boost)
      1. Avoid near meal time (avoid within 2 hours of meal)
      2. Consider alternatives to commercial supplements
        1. Milkshakes
        2. Blended food (e.g. cereal in eggnog)
    5. Patient should have easy access to food
      1. Mealtime duration may need to be lengthened
      2. Place finger foods, candy bars, liquids at bedside
    6. Create No-fail Environment in Dementia
      1. Provide meals at midday at maximal cognitive function
      2. Reduce agitation in patients
        1. Hold hands or gently touch
        2. Talk about pleasant topics or sing softly
  4. References
    1. Finucane (1999) JAMA 282:1368
    2. Li (2002) Am Fam Physician 65(8):1605

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