Nursing Assistant Resources On The Web

“I Haven’t Had a Thing to Eat All Day…”
Nutrition for the Dementia Resident
by Becky Dorner, RD, LD

Anna was a delightful lady that everyone quickly fell in love with, myself included. She would spend her days
wandering around the facility, visiting everyone, charming them with warm smiles and conversation, and her joy
of life. Because she was walking constantly, Anna was always hungry. She’d come to me and say, “I haven’t
had a thing to eat all day” even though I knew she always ate well. Somehow Anna knew I would provide her
with compassion, care, and best of all, with food.

Residents with dementia frequently have nutritional problems which can lead to unintentional weight loss and
malnutrition. Here are a few tips to assure proper nutrition and hydration for residents with dementia.
Implement Proper Systems

1. Assure adequate staffing at mealtime to assist residents to the dining area, serve the food, and
verbally/physically cue or assist those who need help.

Trained and dedicated staff alert to warning signs are the key to success in preventing malnutrition and dehydration. Warning signs include: leave >25% of food uneaten, difficulty chewing/swallowing, refuse substitutions; hide food instead of eating it; and/or wander away before they finish the meal.

2. Adequately assess needs for proper diet and cater to individual preferences as much as possible.
Nutrition screening and thorough assessment are needed. Set up automatic referral to the dietetics
professional for high risk residents.

3. Have good preventive systems in place for nutritional care to prevent problems such as weight loss,
malnutrition, pressure ulcers, infection and poor wound healing. Early identification of problems allows
effective interventions for each individual.

Creative Solutions for Specific Problems

Dining Distractions and dining atmosphere can have a major impact on how well a resident with dementia
eats. Keep distractions to a minimum: A low noise level with calming classical music, soft colors and few
interruptions. Appropriate and strategic seating: Family style seating may be good for one resident, but
another may benefit from being in a smaller dining area with fewer people, or even one-on-one dining with staff.

Individualize seating to meet each resident’s needs. Provide a regular routine: Present meals at the same
time and in the same place each day, with a variety of favorite foods presented nicely. Allow adequate time to
eat.

“Sundowner Syndrome” occurs when a resident is more disoriented and distracted after the sun goes down.
This may interfere with food intake at dinnertime and bedtime snack. The Alzheimer’s Association makes these
suggestions for residents with Sundowner Syndrome:
• Decrease caffeine (coffee, tea, chocolate, colas, etc.) or restrict to early morning hours to decrease
agitation and sleeplessness.
• Offer an early dinner or a late afternoon snack to encourage better food intake.
Eating assistance is frequently needed for those who lose the ability to use utensils for eating, become
distracted and have difficulty focusing on eating.
• Promote independence. Encourage independence with eating through use of adaptive feeding devices,
finger foods, verbal or physical cueing, hand-over-hand assistance, and proper positioning for eating.
• Promote dignity and self-esteem. Residents may stop eating halfway through the meal or may
rearrange food on the plate without actually eating it. Supervise, monitor and redirect as needed,
providing gentle reminders to eat.

Weight Loss and Malnutrition: Studies indicate that residents with Alzheimer’s disease are more likely to lose
weight compared to control groups. This may be due in part to increased energy requirements as a result of
increased activity (walking, pacing or agitation). Couple this with forgetting to eat, forgetting how to eat or being
distracted from eating, and this is a dangerous combination for health.

• Offer foods that are high in calories and protein, so that every bite packs a punch. Enhanced foods
are often better accepted than high calorie/high protein supplements alone.
• Have healthy snacks available at all times. Offer snacks when a resident is willing to eat. (But try not to
ruin their appetite for the regular meal).
• Be very attentive at mealtime. Encourage eating, redirect, remind or assist as needed, and address any
mealtime concerns.
• Keep diets as liberal as possible while still maintaining good health. Overly restrictive diets reduce the
palatability of foods and contribute to poor food intake. A therapeutic diet is not effective if it is not
consumed.
• Fortified foods and supplements may be needed, but try other interventions first (assistance at
mealtime, address cognitive and behavioral issues including possible depression, provide favorite foods,
etc.). High calorie/protein, nutrient dense foods such as fortified cereal, potatoes, soups and sauces can
boost calories and protein in the foods already being served.

Dehydration is a concern due to altered thirst sensation, fear of incontinence, inability to request adequate
fluids and medication side effects. Encourage at least six to eight 8-ounce glasses of fluid each day.
• Offer fluids multiple times throughout the day (upon every contact).
• Offer a variety of fluids, being sure to offer favorite beverages. Or try popsicles, sherbet, jello, fruit
slushes, or other forms of fluid.

Caring Intervention
Residents with dementia depend on us for their care and well-being. Adequate assistance, preventative
screening, and intervention for nutritional problems will help to assure the nutritional health of these residents
and prevent further health complications later. So the next time a resident tells you, ”I haven’t had a thing to eat
all day” you’ll know how to intervene with compassion, care, and best of all with food.

2003 Becky Dorner & Associates
Becky Dorner, RD, LD is a speaker and author who provides publications, presentations, and consulting
services to enhance the quality of care for our nation’s older adults. Visit www.BeckyDorner.com for free
articles, newsletters, and information.