Poor Appetite in Your Alzheimer’s Patients?

Poor appetite and weight loss are not uncommon in Alzheimer’s disease and other dementias. Alzheimer’s can amplify some of the common nutritional concerns of aging individuals, which include trouble chewing or swallowing, decline in senses of taste and smell, constipation, and decline in thirst. The risks of malnutrition and dehydration run high.

Malnutrition among Alzheimer’s patients

“Nutritional problems are associated with adverse outcomes, such as rapid cognitive decline,” explain Kimura and colleagues. Appetite changes, weight loss, and sarcopenia (loss of muscle mass) can begin even with mild cognitive impairment and early-stage Alzheimer’s. Their analysis shows that 54% of patients are at risk of malnutrition in the early stage of Alzheimer’s, and another 8% are already malnourished. Those same patients show a higher rate of behavioral symptoms, such as aggressive behavior, emotional disinhibition, and apathy.

They also cite research indicating that some neuropsychiatric symptoms, such as hallucinations and nighttime disturbances, are more severe in the presence of malnutrition.

Nutritional status is important to quality of living and progression of the illness, according to Kimura et al. “Nutritional problems appear to be important, albeit modifiable, factors that may affect the prognosis of dementia,” they note. Even in early stages, they say, some research indicates that low body mass index (BMI) “predicts progression of MCI to dementia.”

Reasons for reduced food intake

Swallowing problems can affect 13-57% of dementia patients, according to Koyama and colleagues. The specific dementia diagnosis and levels of neurological impairment can affect both ability to eat and swallow.

Cognitive factors play an important role in eating as well. A patient with Alzheimer’s or other dementia may not be aware of the need to eat or may not recognize food. Behavioral disturbances may also interfere with ordinary meal routines.

Researchers at Boston University identified the important role of visual-cognitive impairments in declining food intake. Patients with Alzheimer’s “cannot process visual data—like contrast and depth perception—as well as other seniors,” according to Boston University researchers. A plain, bright plate can help compensate. Their famous red plate study demonstrated that patients consume 25% more food when eating from red plates.

Loss of the sense of smell and taste are characteristic in Alzheimer’s disease. These factors reduce to enjoyment of food. If depression is present, this too can reduce interest in eating. Medications can also affect appetite and alter the taste of foods.

The Alzheimer’s Association points out that ill-fitting dentures may be causing pain, and a patient with dementia may not communicate this.

Any limitations in motor skills can make self-feeding more difficult.

How to improve food intake

The Arizona Center on Aging and the Alzheimer’s Association offer tips for helping to sustain food intake:

• Manage the environment; aim for quiet surroundings without television, loud noises, or excess activity.
• Make sure dentures, hearing aids, and glasses (if used) are in place.
• Keep the table setting simple, avoiding unneeded accessories and patterned plates or tablecloths. Include only the utensils that are necessary.
• Set plates on a skid-free surface.
• Distinguish food from the plate to accommodate changes in visual or spatial abilities.
• Give cues, such as “Pick up your spoon.”
• Ensure that food is at a safe and comfortable temperature, because “a person living with dementia might not be able to tell if something is too hot to eat or drink,” according to the Alzheimer’s Association.
• Offer one food at a time.
• Continue to respect food preferences, and understand they may change.
• Set up meals for easy clean-up and do not worry about messiness.

To help a patient maintain independence, memory care staff often provide finger foods, which are bite-sized foods that are easy to pick up. Examples: small sandwiches, chunks of fruit, steamed broccoli pieces, chicken nuggets.

Caregivers can also demonstrate eating behavior, says the Alzheimer’s association, by “putting a utensil in the person’s hand, placing your hand around theirs, and lifting both of your hands to the person’s mouth for a bite.”

For anyone with difficulty chewing or swallowing, be sure to offer mechanically soft foods. If there is a swallowing problem, a speech pathologist can evaluate and recommend specific dietary modifications on the IDDSI Framework to optimize safe swallowing.

Along with food, caregiving staff can encourage hydration all day long. Reminders or cues to drink are important. Using a brightly colored cup or glass helps patients notice it.

Along with strategies for success, patience, understanding, and flexibility can go a long way in helping a patient maintain nutritional well-being. In turn, this daily support contributes to creating the best possible outcomes and quality of living. Attention to nutritional needs and the meal experience are important tools for promoting the safety, functionality, and dignity of your patients with Alzheimer’s or other dementias.