Ask An Expert: Alzheimer's And Eating

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Ask An Expert: Alzheimer's and Eating

Question:

Do you have any suggestions on how to get a person with Alzheimer's to eat?

Answer:

Many patients with Alzheimer's disease have increased caloric needs as their activity level increases through pacing, agitation and other forms of energy expenditure. If they are not eating enough calories to meet their energy needs they will start to lose weight. The weight loss can worsen over time as the disease progresses, especially if patients lose interest in eating.

On the other hand, some patients may have ravenous appetites or don't realize what they are eating. They seem to eat continuously, which presents a whole different set of challenges.

Here are some strategies for promoting food intake to achieve optimal nutrition:

Problem: Cognitive decline decreases the ability to recognize feelings of hunger, thirst, and fullness.

Try this: Provide food and beverages for the patient at regular intervals; the person could benefit from five to six routine eating occasions and a goal of at least 6 cups of fluid per day. In addition to offering food and beverages, patients may also need encouragement through verbal cues such as "take a bite," "chew," or "swallow."

Problem: Attention span decreases and patients quickly lose interest in eating or drinking.

Try this: Minimize visual distractions and noise while eating/drinking to help them focus on what they are taking in. Sit with them for support throughout the feeding. If the patient will only eat a small amount at a time, maximize the nutritional content of each bite! Enrich foods with high-calorie additives such as canola or olive oil, protein powder, cheese, avocado, peanut butter, mayonnaise, and others as appropriate to increase the calorie-density of foods and beverages consumed. Also, small, frequent snacking can optimize total daily intake quantity when the amount eaten each time is low.

Problem: A patient is easily overwhelmed or does not seem to recognize food on the plate.

Try this: Place a small amount of one food at a time on the plate so that there is just one manageable portion in front of the patient. Some patients may lose the ability to recognize food visually and can rely more on touching or smelling it. Others may not be able to see food on a plate of the same color (e.g. chicken on a white plate) - serve it on a dish with a contrasting hue (e.g. chicken on a blue plate).

Problem: As the disease progresses, patients may be less able to self-feed or swallow.

Try this: Motor losses can decline to the point where they should only use a spoon or, if unable to use any utensils, eat mostly finger foods. Many people with Alzheimer's likely will need to be fed at some point, but it is beneficial to allow independent feeding for as long as is safely possible and provide guidance and assistance during eating. In later stages, dysphagia may develop, which means that the patients tend to choke on foods or beverages. If this is suspected, they should be seen by a speech and swallow therapist to evaluate eating safety.

Kathy McManus, M.S., R.D is the director of the department of nutrition at Brigham and Women's Hospital and an investigator on the Pounds Lost Trial, a 5 year NIH funded obesity study. She graduated with a Bachelor of Science from Simmons College, completed her Dietetic Internship at Brigham and Women Hospital, and received a Master of Science degree in nutrition from Framingham State College.

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Last updated:	January 24, 2007