Just the Facts and More: Nutrition

Providing the Alzheimer patient with nutritious meals and snacks is a problem for many caregivers. Often the patient can't sense or identify hunger or fullness or she need for fluids or foods with certain vitamins and minerals.

Predictability

The person's response to food is also difficult to predict. An individual might like specific foods such as turkey or chicken and then ---without warning -- turn away from these foods.

Poor Nutrition

The result of poor nutrition among Alzheimer patients is usually weight loss or gain and a variety of other symptoms including poor-fitting dentures, listlessness, and fatigue.
  • A person who snacks regularly on such foods as candy and pastries often experiences a "sugar high" followed by complaints of being tired, depressed or hungry.
  • "Junk foods" tend to make the person more restless and disoriented and reduce the craving for regular meals and more nutritious foods.
  • The person may also experience bowel or bladder problems because of not drinking enough fluids or eating adequate fiber.

Disease Progression

As the disease progresses, providing the person with proper nutrition may become even more difficult.
  • The individual might not understand the timing of meals or the difference between breakfast, lunch, dinner and snacks.
  • In addition, you may have to offer more coaching at mealtime to help the person use utensils, for chewing, swallowing, or identifying various foods. For example, you may hand the person a spoon only to discover that (s)he can't remember how to use it.
  • In another situation, a person who feels no need for food may clench his jaw tightly and refuse to let you put a utensil near his/her mouth. This person may not understand or remember what to do with food.
Action Steps

Watch out for danger signs and take action.

Look for early behavior changes such as increased snacking, drastic shifts in food likes and dislikes, dramatic weight losses or gains, or bowel problems. Experiment with changes in the person's diet to address these problems. You may need to allow for more time and offer more assistance at mealtime.

Monitor changes.

Check the person's weight weekly and, on the advice of your doctor, have regular blood work completed, as needed. Laboratory reports will help to identify problems with cholesterol, anemia, dehydration, or constipation.

Prepare food for easier eating.

If the person has problems with chewing, swallowing, or choking, try chopping or cutting the food into bite-size pieces. Use food to trigger the patient's attention.
  • Use rough-textured foods such as toast or sandwiches made on toasted bread to stimulate the person's tongue and encourage chewing and swallowing.
  • The person with Alzheimer's sometimes has little sensation of food in the mouth. By gently moving the person's chin, you can remind him/her to chew.
  • Stimulate chewing by touching the person's tongue with a fork or spoon. By lightly stroking his/her throat, you can remind him/her to swallow.

Use soft foods to assist the person.

  • A person who has problems chewing or who has poor-fitting dentures will benefit from foods of soft textures such as a peanut butter sandwich rather than a sandwich made of sliced meat, or a mashed potato rather than a fried potato.
  • You may want to serve mashed or steamed vegetables, bite-sized pieces of cooked meat, or turkey or chicken salad instead of sliced meat.
  • If swallowing becomes a problem, put food into a food processor or blender before serving it. Also remember that soups with two consistencies may confuse the individual.

Make knife-and-fork foods into finger foods.

If the person's regular breakfast consists of scrambled eggs and bacon, cut the food into small squares. You could also combine cheese, meat and eggs into an omelet so the person can pick up the food with his fingers.

Proceed with caution in using liquid supplements.

Liquid food supplements are often costly, high in sodium, and can sometimes be prepared more economically at home. If the person is eating regular meals, use supplements as an occasional between-meal or late-night snack or when the person refuses to eat a regularly scheduled meal. When considering supplements, consult with your physician.

Work to make mealtime calm and comfortable.

  • Keep the environment quiet and free from such distractions as the television or radio.
  • Try to maintain regular meals with the family for as long as possible. Social interaction and conversation are important.
  • Feed the person at regular intervals. Many caregivers find it helpful to serve several small meals rather than three large meals.
  • Be consistent. Feed the person in the same area at every meal and at the same approximate times each day.
  • Keep the table setting simple. Avoid placing objects on the table that might distract or confuse the individual.
  • Put condiments on food before serving it to the person.
  • Set the table only with the utensils needed to eat the meal.
  • Avoid using plates or placemats with patterns that might confuse the individual.
  • Use a plate that is a different color from the placemat.
  • Offer one food item at a time. A full plate with a meat, potato, and vegetable might overwhelm and confuse the person.
  • Rely on nutritious finger foods as between meal supplements.
  • Encourage independence for as long as possible by allowing the person to use utensils and eat finger foods. Holding a cup and drinking fluids through a straw will also give the person a sense of accomplishment.
  • Serve thick fluids to prevent choking. If choking occurs, be prepared to use the abdominal thrust (also known as the Heimlich Maneuver) to dislodge food.
  • Prepare the meal ahead of time so you can stay with the person during the meal. (S)he may mimic your eating behavior.
  • Reduce between-meal snacks to ensure that the person eats at regular meals or provide the person with fruit or nutritious snacks.
Resources

One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.

The primary resource for this fact sheet was Paula Pless, COTA, Manor Oak Skilled Nursing Facility, Buffalo, New York.

Special thanks to the following Chapters of the Alzheimer's Association: Atlanta, Greater Washington, DC, Eastern Massachusetts, St. Louis, Western New York, Cleveland, Columbus (Ohio), Northern Virginia, and South Central Michigan.

Other Resources include:
  • David L. Carroll. "When Your Loved One Has Alzheimer's Disease: A Caregiver's Guide." New York: Harper and Row, 1989.
  • Donna Cohen, Ph.D., and Carol Eisdorfer, Ph.D., MD. "The Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related Disorders." New York: Norton & Company, 1986.
  • Nancy L. Mace and Peter V. Rabins, MD. "The 36-Hour Day." Baltimore: The Johns Hopkins University Press.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.