Nutrition

Question 1

What nutritional issues are there in dementia?

Answer 1

As dementia progresses eating problems tend to increase. Weight loss is common, and the hospital environment does not help with many patient being in a recumbent positions, constipated, not getting adequate help to eat where patients don’t know how to eat or what food is anymore and suboptimal mouthcare and a lack of routine also influence this.

Question 2

What medical recommendations are there for helping dementia patients to eat?

Answer 2

1. Good oral hygiene and mouthcare – dentures, oral candidiasis, ulcers etc.
2. Bowels – constipation makes people uncomfortable when eating, nauseous and delirium can also occur as a result which does not help eating
3. Make sure glasses, hearing aids and dentures are appropriate

Question 3

What general recommendations can be made to help dementia patients eat?

Answer 3

1. Finger food is often a better option for those with dementia
2. Try different food as tastes change
3. Chop up food into small bitesize amounts
4. Prompting and assisting with meals makes a big difference
5. Do not withhold dessert/worry about unusual food – any calories are good

Question 4

What general recommendations can be made to help dementia patients drink?

Answer 4

1. Often may not be aware when they are thirsty so regular recommendations to drink are important – little and often
2. Use a clear glass or brightly coloured cup
3. Place a cup within hands reach
4. Milk based drinks are a good way to add in calories
5. Fortisips can be prescribed (can also get fortijuices if people do not like milk)

Question 5

Why does swallowing become difficult in dementia and what should you, as a doctor, do about it?

Answer 5

Become common as dementia progresses. Memory declines and behaviour changes result in continuous chewing, forgetting to swallow and holding food in the mouth. SALT team should assess and may advise a modified diet.

Question 6

Why is artificial feeding not always good for the patient and when is it indicated?

Answer 6

This will not stop aspiration from gastric contents or saliva. It is an invasive procedure and often patients attempt to remove it. It will take away the enjoyment of eating, does not increase life expectancy and may actually decrease it.

Artificial feeding is only recommended where swallowing difficulties are reversible.

Question 7

What is at risk feeding?

Answer 7

Continue to allow a patient to eat and drink despite the known risk of aspiration and consequent pneumonia. SALT will advise the safest consistency to reduce the chance of aspiration. Regular mouth care should be encouraged, assistance when eating and drinking, sit upright and do not rush them.

Question 8

What is the MUST scoring system?

Answer 8

The MUST score (Malnutrition Universal Screening Tool)
MUST Score (each step scores out of 2)
Step 1: BMI – 18.5-20 = 1, <18.5 = 2
Step 2: Unplanned weight loss – 5-10% = 1, >10% = 2
Step 3: Acute illness and decreased intake for 5 days = 2

Question 9

How is the MUST score interpreted?

Answer 9

Score 0 = low risk: repeat weekly in hospital, monthly in care homes, yearly in community for at risk groups (including the over 75s)
Score 1 = medium risk: food chart for 3 days – if intake adequate then monitor with screening as above (except in community do 2-3 monthly), if intake inadequate – formulate plan for increased intake
Score 2 or more = refer to dietician, set goals to improve nutritional intake, monitor regularly weekly, monthly, monthly.