Nutrition

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Nutritional issues for peopie with dementia
T
here are many nutritional i.ssues faced by people diagnosed with dementia and lor health care staff caritig for these [x-ople. lTiese issues can include trying to ensure an I iptimum diet containing the cortiect vitamins atid mitierals to iry to help .sk)w the progression of the disease. As Is more commonly the case, however, issues can I K as basic as liiiding pr;u tical ways to encourage someone with dementia to consume enough calorics to prevent weight loss. 1 he prevalence of malnutrition in the eklcrly in hospitals and care homes has featured ill the press on a regular hasis in recent years (IJBC News. 2007). it has been re(X)rted that appaiximately 16% of people in care homes, and as tiiany as 40% of people admitted lo luvspital from home are malnourished. Malnutrition in those aged 65 years antl over |irobably costs ;t2—4 billicwi more than cahng for an equal numlx;r of well-nourished individuals. This was highlighted in the Mahmlrilio}! Universal Serening 7oo/ Rejx}rt (Ktia, 2(H(3). This is tioc lost on tiiany of those caring Ibr individuals with dcmc-ntia: these p;iiirtus often have low biKiy weight, refuse m cat or ttrink, or have iK'haviouml or [ihysical problems which may make mealtimes ilifTicult at iK'st. Tliis tan contribute to the helplessness that may Ix- felt by staff caring for these individuals. Tliis article will dist u.ss the problems assoi iatcti with liementia and nutrition, what can lie done to overcome these problems, and whether it is ;iossible for those with dementia to avoid tnalnutrition.

Ensuring those with dementia meet their nutritional needs can be challenging and frustrating for staff. Tara Hargreaves presents practical advice for staff to help promote better nutrition in older adults with dementia. year>;, and one in five over 80 years. It is predmotiinatley a disease of ageing, atid i.s on the rise. It is estimated that by 2021 there will be 940000 people with dementia in tbe UK, with predictions that it will iturcuse by iS% in the nexi 15 years. It is further estimated that those aged 65 years and over living in Ekierly Mentally Infirm (EMI) hotnes is 79.95%, nursing homes 66,9% and t^sidential care homes 52.2% (Alzheimer's Society. 2007). It costs .il7.O3 billion to care for people with dementia. This includes formal care agencies and the fitiancijil vjilue of unpaid informal care provided by family and fiiends. The cost of caring for one person with dementia in a care home is i31 296 [KT year (Alzheimer's S(x:iety, 2007). While there Is research investigating the role thai vitarnins and minerals may have in preventing dementia, the most ctimtnon nutritional issues linked to dementia arc related to the difficulty that this clietit gn)up can have with eating and drinking, and the consequential malnutrition. There are reports in the UK and elsewhere suggesting a frequent failure to recognize tnalnutrition in a tiumher of care settings and it has |-)een suggested chat this may he up to 10096 in some nui-sing homes (Eliit, 2003). It is well documented that those with dementia often have a low body weight (Benati et al, 199H). It is important to question if this L a process of the disease itself, S

or as result of reiluced intake resulting frotn tiiany of the [>t-actical i.ssue-s surroutiiling the disease. Ilicre is some reseaix'h to show that weight loss may be part of the ageing [irocess (Morley and Thomas, 1999), or that it may be a physiological response to dementia (Barrett-Connor et al, 1996). Research al.so demonstrates, however, that patients wiih dementia can ^ n weight (Barratt, 2004). In the author's experience, ihc largest contributing factor lu tbe weight loss of people with dementia is a reduced calorie intake, and possibly increased enei'gy expenditure uwitig to the matiy symptoms of tietiieniia.

Tablo 1 .
METHODS OF OVERCOMING FEEDING PROBLEMS

Background
Ihea- aiL- currently around 690 000 people with dementia in...
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