By JUDD MATSUNAGA, Esq.
It had to be 60 years ago, but I still remember. If it were up to us kids (my older sister, younger brother and myself), we’d live on hot dogs, pizza, and spaghetti. But Mom and Dad wanted us to have a balanced, nutritional diet, e.g., vegetables and fish. So, they’d tell us that eating fish would make us smart. Dad would joke, “Why are fish so smart? Because they live in schools.”
Today, there’s a reversal of roles — it’s dear old Dad that needs the nutritional foods. At 95 years of age, Dad seems to have lost his appetite and is losing weight. When he was first diagnosed with dementia a couple of years ago, we were warned about the memory loss and irritability. But we didn’t know that dementia can also cause his appetite for food and liquids to disappear.
Loss of appetite can result from several different factors, such as difficulty swallowing, lack of exercise, seemingly tasteless food, side effects of medication, and other reasons. This ultimately leads to a major problem in the older adult population: Malnutrition. Helping a senior eat the necessary nutrition requires astute attention to detail to help solve the root of the problems.
Therefore, understanding how to prevent malnourishment among seniors with dementia is vital. To help caregivers who deal with dementia be informed and trained in how to prevent malnutrition, the following tips to increase appetite and consumption come from an AARP article titled “Meal Appeal: Help Loved Ones with Dementia Get the Nutrition They Need” (Source: www.aarp.org/caregiving, July 10, 2018).
To start, I want to share my favorite tip from the article below — start with the most nutritious food. Not to mention any names, but someone gave my dad a bag of Cheetos Flaming Hot Cheese Puffs just to see if he would eat anything. Dad neglected the tuna sandwich but started eating the Cheetos Puffs. Perhaps it was because he could taste them, i.e., “Flaming Hot.” Before he got to the sandwich, he was full and had lost his appetite.
The following is from the above-referenced AARP article. Hopefully, you’ll find one or more tips that you can use for your loved one. The article starts: “To improve the experience for both of you and maximize the nutrients your loved one consumes, start here.
1. Know what doesn’t work
● Insisting that your loved one eat is not productive.
● Nagging, pleading, frustration and “Try a bite” will not generate cooperation or hunger.
● Leaving food in front of the person in your care after it is clear that they are uninterested in eating.
2. Know what can help:
While preparing the meal:
● Bring the care recipient into the kitchen while you’re preparing a meal.
● Bump up the nutrition. Powdered protein, healthy fats, pureed vegetables can be slipped into soft foods and whole-wheat baked goods. Use nut flours for breading, baking and thickening.
● Cut out empty calories, such as sugar and processed foods.
● Add preferred spices or flavors.
● Cut chewy food into small pieces.
● Limit salt.
● Prepare nutrient-dense food.
● Switch to finger food such as fish sticks, chicken strips, burgers and green beans when you see that your loved one is becoming unable to use fork, knife or spoon.
People with dementia do not always see their surroundings or the food on the plate as others do. To make mealtime easier for your loved one to manage:
● Eat in a quiet, simple area. Busy, ornate rooms are distracting.
● Sit at a small table opposite your loved one. Even if it is not your mealtime, set a place for yourself and put a little food on the plate. Companionship improves appetite and gives you the opportunity to assist.
● Eat with minimal talking, no electronics or preventable noise. Doing more than one thing at a time can be confusing for people with dementia.
● Put food on a red plate. Boston University researchers found people with Alzheimer’s ate 25% more food when it was served on a red plate versus a white plate.
● Consider using tableware designed for dementia patients. Plastic cups with handles, curved handles on forks and knives, plates with a high lip to keep food from sliding onto the table will make it easier for your loved one to manage food.
● Avoid patterned china, which can make it harder to tell the difference between food and plate.
● Don’t use patterned tablecloths, which can make it appear that the plate and the tabletop are one. Easy fix: Put a single-color, contrasting placemat under the plate.
● Skip proper table settings. A spoon, knife, or glass that won’t be used adds to the visual clutter that makes eating harder.
● Remove centerpieces, candles, salt shakers, serving dishes.
● Use unbreakable cups, spill-proof if needed.
● Be flexible about meal times. Eating dinner at 10 p.m. is better than not eating at 6.
When serving:
● Serve the nutritious food first.
● Try small portions on a salad plate.
● If using a dinner plate, serve one or two foods at a time. More can be overwhelming.
● Turn your loved one’s plate so that the food favorite is furthest from the hand your loved uses to eat. People with dementia often eat the closer food first.
● Make sure temperature is not too hot. People with dementia are not always able to tell extreme heat or cold.
● Know that tastes can change suddenly for people with dementia. Smells and textures can also become bothersome. A favorite food may be rejected or a previously disliked food may become acceptable.
● Be aware that intense smells can be distracting.
● Flatter the food. Use short and tempting phrases. “This fish is delicious!”
At the table:
● Make eye contact. Smile and look them directly in their eyes for a minute or more. Wait for the person to smile in return. As the disease progresses, returning the behavior may not come easily or quickly, but it may register and comfort. Repeat throughout the meal (and during the rest of the day).
● Others at the table should follow the same guidelines. The more people, noise, dishes and silverware, the harder it is for someone with dementia to decipher and focus on food.
● Model the action. If the person in your care is having trouble handling food or utensils, say “watch me” and demonstrate.
● Allow lots of time to eat.
● Don’t worry yourself or your loved one over fallen food.
● Remind the person for whom you care to chew thoroughly and swallow carefully. Monitor for choking.
● If your loved one won’t eat, put the food in the fridge and try again later.
After eating:
Jot down everything your loved one ate, how much and at what time. Measure the food when you put it on the plate and estimate how much is left. This will let you make sure the daily intake is enough, make it easy to spot a pattern or change, and give you a record to share with the doctor.
Top tips
● While many people with dementia may forget to eat without reminders, others don’t recall the meal they just ate and believe it’s now time to eat. If this happens, it may help to break the meal into several small “meals,” serving as requested. Start with the most nutritious item.
● Look beyond the dementia for issues that may be affecting appetites. Among the possibilities: medication side-effects that dull hunger or leave a metallic taste, a re-occurring headache, mouth or stomach ulcers and ill-fitting dentures.
● Notice if a flavor or texture falls out of favor. Replace with an equally nutritious but much different alternative. For instance, collard greens, raspberries, sweet potatoes, okra, and tomatoes all have more than 12 mg of vitamin C.
● Accept that some days will be more successful than others.
In conclusion, we all know the importance of nutrition and that certain foods are good for your brain, e.g., green veggies; fatty fish; berries; tea and coffee; and walnuts (Harvard Medical School). So it would only follow that lack of certain foods would hurt your brain. “Nutrition, and in particular malnutrition, is an important and preventable factor related to cognitive decline and dementia.” (Source: Kings College London, “Malnutrition predicts faster functional loss in dementia patient,” Feb. 16, 2021).
Being the primary caregiver for a loved one with dementia is a daily challenge. As the disease progresses, skills are lost. Your loved one may become unable to apply logic, override inclinations, explain a sudden refusal to eat favorite meals or, as time goes on, remember the purpose of a spoon. Through it all two things remain constant: your loved one’s need for nutrients and your need to make sure they are met.
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Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.