The importance of our food to our bodies in our lives has been around since the dawn of man, as indicated on cave drawings of hunts and feasts. Charles Pierre Monselet (1825-1888) once said, “Ponder well on this point: The pleasant hours of our life are all connected by a more or less tangible link, with some memory of the table.”

A person with dementia or Alzheimer’s disease presents a complex situation when it comes to maintaining nutritional status. The ability to tie memories to food diminishes. When the brain is involved, all functions that are needed to eat, such as seeing, smelling, thinking, responding, and moving, are impacted. These individuals are experiencing the common factors that affect all of us as we age, but they are magnified. Not only is there a decrease of smell, taste, chewing ability, and digestion and absorption, but the following challenges emerge:

■ Forgetting how long food has been around or out of the refrigerator, causing an increased risk of food-borne illness;

■ Increased distraction;

■ Not sitting long enough to eat;

■ Forgetting to eat;

■ Forgetting she has eaten;

■ Rejecting food;

■ Difficulty planning the movement of scooping with a utensil;

■ Inability to express needs and desires; and

■ Compromised quality of life and fear.

The key to addressing the needs of the individual with dementia was summed up nicely by Lacy and Burrows in 2004: “You need to know where I am so you can come to me.” If you are going to be effective, no matter what you do, you must get to know the individual and understand where they are at the moment and where they are in the disease process.

You need to know:

■ What time they used to eat;

■ What they used to like to eat or their favorite foods; and

■ Did they participate in cooking, setting the table at home, or did they eat out most of the time?

Depending on the type and stage of dementia or Alzheimer’s, you can get this information directly from the individual or a close family member. Then you’ll need to incorporate as many of those items into their daily routine as possible.

A research study from the Journal of Clinical Nursing (2007) demonstrated that weight gain was achieved in individuals with dementia by “adjusting the meal environment to the individual’s needs” and “ensuring good meal situations were given high priority.”

Weight loss and nutrient deficiencies, which increase the rate of mortality in the individual with dementia, are a challenge. We may not be able to stop it in the last stage of the disease. But with the use of these interventions, we can have a positive impact on nutritional status and quality of life for however long the moments last.

In the United States, we have not been a society that “eats to live” for quite some time. Let’s face it, we “live to eat,” so with these devastating diseases, it becomes our responsibility to tie living to eating in preventing poor nutritional status. 

Angela Sader, MBA, RD, LD, serves as senior director of nutrition services for Kindred Healthcare’s Nursing Center Division. Prior to joining Kindred, Sader became a leader in the profession through her experience in all levels of care and hospitality service, including working for such organizations as Golden Living. She is a graduate of Kansas State University specializing in dietetics. Sader is a contributing author in college textbooks and industry management tools. She is a member of the Academy of Nutrition and Dietetics, the Food and Culinary Professionals practice group. She serves on the Executive Committee for Dietitians in Healthcare Communities and is a member of the national RD Executive Council.