Category: Dementia – Nutrition and Hydration

Changes in eating behaviors and food preference are very frequent in patients with frontotemporal dementia. Despite a specific pattern, this behavioral change is not used as a diagnosis tool. In this study we proposed a new caregiver questionnaire named Eating Behavior Inventory (EBI). This questionnaire consisted in 30 questions investigating four domains of eating behavior (eating habits, food preference, table manners, and swallowing problems). The aim of this study was to show how this questionnaire could be used as a clinical tool allowing to distinguish frontotemporal dementia from Alzheimer’s disease. Concludes that the EBI, shown as a rapid and simple caregiver questionnaire, could be proposed as a new diagnosis tool distinguishing fv-FTD patients from AD patients.

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Patients with advanced dementia (PwAD) often have difficulty expressing their needs verbally because of cognitive impairments. PwAD thus often communicate these needs through behaviors and psychological symptoms. Understanding the behavioral characteristics of certain needs is critical for caregivers and clinicians when caring for PwAD. The purpose of this study was to develop a checklist that may be used to assess the thirst status of PwAD. Exploratory factor analysis identified seven checklist items, including repetitive movements, squirming, restlessness or anxiety, persistent or unreasonable demands, pacing back and forth, repeating a sentence or question without purpose, and slow reaction. The factor loadings of these seven items accounted for 49.3% of the total variance. The reassessed internal consistency reliability was .66. Caregivers may use this checklist as an aid to identify the thirst or fluid needs of PwAD who are unable to communicate their needs effectively.

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Patients with different types of dementia may exhibit pathological eating habits, including food fads, hyperphagia, or even ingestion of inanimate objects. Several findings reveal that such eating alterations are more common in patients with frontotemporal dementia (FTD) than other types of dementia. Moreover, eating alterations may differ between the two variants of the disease, namely the behavioral variant and semantic dementia (SD). In this review, we summarized evidences regarding four areas: eating and body weight alterations in FTD, the most common assessment methods, anatomical correlates of eating disorders, and finally, proposed underlying mechanisms. An increasing understanding of the factors that contribute to eating abnormalities may allow first, a better comprehension of the clinical features of the disease and second, shed light on the mechanism underlying eating behaviors in the normal population.

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Percutaneous endoscopic gastrostomy (PEG) tubes are commonly utilized as a method of enteral feeding in patients unable to obtain adequate oral nutrition. Although some studies have shown improved mortality in select populations, the safety and effectiveness of PEG insertion in patients with dementia compared with those with other neurological diseases or head and neck malignancy remains less well defined. OBJECTIVE: To evaluate the nutritional effectiveness, rate of rehospitalization, and risk of mortality among patients with dementia compared with patients with other neurological diseases or head and neck cancers who undergo PEG placement. CONCLUSIONS: PEG insertion in patients with dementia neither improve both short-term and long-term mortality nor rehospitalization rate as compared with patients who underwent PEG placement for alternate indications such as other neurological diseases or head and neck malignancy and even was associated with shorter time to death. Furthermore, PEG insertion in patients with dementia did not improve albumin. Therefore, careful selection of patients with dementia is warranted before PEG placement weighing the risks and benefits on a personalized basis.

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The CPD article outlined the effects dementia may have on a person’s ability to eat and drink safely. It discussed assessment tools to identify patients at risk of malnutrition and management strategies to help maintain nutritional intake.

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The aim of this systematic review was to identify the best ways of supporting people with dementia to eat. Five electronic databases were searched, with a date range from January 2004 to July 2015. Following screening of the 233 studies identified, 22 were included in the final analysis. The study interventions focused on educational programmes, environmental or routine changes, and assistance with eating, with the strongest evidence shown in the more complex educational programmes for people with dementia. The evidence suggests that staff who support people with dementia to eat should undertake face-to-face education programmes and aim to give people enough time when helping them to eat. However, cultural change may be needed to ensure individual assessments are carried out to identify those having difficulty eating, and to ensure they are afforded enough time to eat their meals.

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This toolkit has been designed for staff in care homes and carers in the community. It provides a readily accessible and practical guide to help them assist older people (including people with dementia) in their care to achieve optimum hydration.

Access the paper by clicking here TOOLKIT Improving hydration among older people in care homes and the community.

Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia).

Access the paper by clicking here Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review. (BMC Geriatrics, May 2016)

Ability to eat autonomously at mealtimes enhances social contact and interaction, supports adequate nutrition and intake, and promotes the enjoyment of food. Yet more than half of older adults with dementia living in long-term care lose the ability to get food into their mouths. Factors influencing eating performance include intrapersonal characteristics (eg cognitive impairment), interpersonal features (eg interactions with caregivers and other residents) and environmental aspects (eg physical elements such as noise or organisational elements such as staffing levels). Caregivers are in a strategic position to support eating ability with targeting each of these factors. The purpose of this study is to summarise mealtime interventions and to evaluate their effectiveness on the eating performance of older adults with dementia in long-term care.

Training programmes and mealtime assistance may improve eating performance for elderly long-term care residents with dementia. (Evidence Based Nursing, 2016, 19(1)) (Follow this link if you have an Athens password). Alternatively contact the UHSM Academy Library for a copy of the article or call 0161 291 5778)

The article describes the efforts of the County Durth and Darlington National Health Service (NHS) Foundation Trust in implementing its nutrition and hydration strategy plan. Topics discussed include the launch of a finder food menu in management of dementia among hospital patients, the afternoon tea party held at Darlington Hospital, and the trial of Simple Measures mugs.

Nutrition and Hydration Week: one trust’s recipe for success. (British Journal of Nursing, 2016, 25(5)) (Follow this link if you have an Athens password). Alternatively contact the UHSM Academy Library for a copy of the article or call 0161 291 5778)