Practical nutritional care of elderly demented patients

Much of the research into nutrition and dementia focuses on end-of-life decisions about the ethics and efficacy of non-oral feeding. However, there are very many issues that arise long before that stage is reached. This review examines very recent papers that address the practical, day-to-day issues arising from the time that an individual with dementia needs help with eating and drinking.

Evaluations of interventions aimed at increasing body weight demonstrate that weight gain is possible in dementia. Helping people with dementia to overcome problems with eating and drinking poses ethical and emotional problems for carers, particularly in the interpretation and management of apparent food refusal. Evidence-based practice can be incorporated into routine services for people with dementia and lead to improved nutritional care. Research needs to move away from the problems of providing adequate food in hospitals and care homes, to incorporating the views of people with dementia and their carers in the design of services in non-institutional settings.

Few practical solutions to the nutritional problems of people with dementia have been presented in recent papers. Increased energy intake from food or supplements promotes weight gain, but effective interventions to overcome aversive behaviours have still not been described.