Dementia is a complex disease, chronic and progressive in nature, in which cognitive functions such as thinking, remembering, reasoning and behavioural abilities deteriorate. Due to this loss, a person’s daily life and activities are affected, and this adversely impacts not only the person, but also the caregiver, said Neha Sinha, CEO and co-founder, Epoch Elder Care and dementia specialist
“Eat well, eat right; we have all heard this so many times during our childhood, and irrespective of age, good nutrition is vital for one’s overall health. However, as dementia progresses, feeding and maintaining nutritional status becomes challenging. Patients may forget to eat, get overwhelmed with too many things on the thali or may find difficulty in verbalising dental issues or mouth ulcers. In the later stages, when chewing and swallowing becomes difficult, caregivers struggle to maintain the balance between appetite and food texture,” she added.
Maintaining good physical health and weight is a huge aspect of good stage management in dementia. The presence of multiple comorbidities, especially diabetes, where restrictions on diet or medication intake would need constant reminders and explanations makes it even more tricky. “It is important to provide a balanced diet, avoid high fat and cholesterol heavy diets, cut down on processed food as well as sugar intake. Adding green leafy vegetables and following the Mediterranean diet of fish, cereals, fruits and olive oil have also shown promising results in reducing further risk,” she told indianexpress.com.
Apart from managing nutrition, planning meals and mealtimes is also an important aspect of dementia care. Sinha said that if the elder starts resisting meals or eating poorly there may be more than one causes involved. “Start with eliminating distractions around meal times – noisy backgrounds and loud conversations can add to their confusion. Lack of physical activity, poor dentures and side effects of medication can all be contributors to reduced appetite. They may also reach a stage where they may not be able to recognise food or poor colour coding of crockery (white rice on white plate) can further perplex them,” she explained.
It is important to maintain independence in feeding for as long as possible. Though it may need a considerable amount of support and time to facilitate, it is essential for the elder’s dignity and respect. It is a good idea to pre-portion/pre-mix their meals, prepare shorter meals as per their likes and dislikes and garnish food to make it look attractive especially semi-solid food like khichdi. “Always sample their food before you serve since they may not be able to give feedback on the taste. Also, opt for more sturdy cutlery and handles which they will find easier to hold. Always keep some food handy, in case they want to eat in the middle of the day (or night) rather than convincing them they have already eaten,” she suggested.
Elders with dementia are also at an increased risk of dehydration, which leads to co-morbidities like Urinary Tract Infection, or headaches and this may result in agitated behaviour. One needs to encourage fluid intake which could be sips of plain or flavoured water throughout the day; give fruits and vegetables with high water content or simply whip up fruit smoothies or juices.
“For a family member, managing meals at a dining table with a loved one who has dementia can be demanding. Have patience and do not hurry the elderly during meals — give them all the time they need. Since the person may lack judgement, ensure that the temperature of the food or liquids such as dal, soups is moderate, not boiling hot (or ice-cold). Eating together with them will also encourage feelings of togetherness and may even act as a good appetiser!
“Involving elders (with or without dementia) in preparing goodies for festivals together is always a great idea! Simply rolling laddoos or filling the gujiya maker, can not only help bring back fond memories but also act as great motor activity,” she said.
Last but not least in the current times of pandemic, work towards building elder’s immunity with herbs and condiments such as ginger, garlic, jeera, turmeric and tulsi. Offer such things as part of a routine diligently and they may do wonders, said Sinha.