Minimising undernutrition in older adults with dementia

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• Minimising undernutrition in older adults with
  dementia
• Jennie Jackson, Jayne Brown, Yvonne Robb, Kay
  Currie and Cheryl Graham
• Glasgow Caledonian University

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Background to our review

• Dementia
• a collective term for a number of conditions
• progressive decline in an individuals
  functioning
• Demographic ageing
• by 2025 one million people in the UK will have
  dementia (Alzheimers Society, 2007)
• People with dementia often experience difficulty
  eating and may have poor intake

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Reasons for poor intake
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Nutritional Requirements

• May be increased energy requirements due to
  pacing, wandering and increased activity
• Older adults have similar or increased
  requirements for vitamins and minerals but
  generally smaller appetite
• Nutrient-dense diet required
• Appealing and enjoyable food

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Effects of undernutrition

• Unintentional weight loss
• Dehydration
• Pressure sores
• Increased susceptibility to infections
• Poor wound healing

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Meaning and Importance of Food

• Mealtimes should be enjoyable
• Social interaction
• Promoting autonomy
• Involvement in preparation of food

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Interventions to minimise undernutrition in older
adults with cognitive impairment

• There are numerous possible interventions
  ranging from dietary advice to assistance with
  feeding to percutaneous endoscopic gastronomy
  (PEG) feeding

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Objective of the review

• This review seeks to establish what is best
  practice in preventing under-nutrition in older
  adults with dementia
• The review will focus on older adults who are not
  living independently
• It will not include studies of the effect of
  particular nutrients on cognitive function
• It will not include enteral tube feeding

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Criteria for selecting studies for this review

• To investigate the effectiveness of interventions
  to improve nutritional intake
• RCTs
• Quasi-experimental studies
• Cohort studies
• Case control studies
• Observational studies without control group
• Qualitative studies

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Types of participants

• Adults over the age of sixty
• Exclusions
• People with alcohol-related dementia
• People with dementia living independently

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Types of interventions

• Nursing practices
• Educational interventions for healthcare staff
• Medical practices
• Food service practices
• Dietetic practices
• Dietician assistant practices
• Occupational therapy practices

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Types of interventions contd.

• Inclusion or exclusion of family carers
• Speech therapy practices
• Volunteer practices

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Types of outcome measures

• Dietary intake
• Anthropometry eg weight, BMI, mid-arm muscle
  circumference
• Biochemical indicators
• Clinical outcomes length of hospital stay,
  mortality, prevalence, and incidence of
  malnutrition

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What do we hope to achieve?

• Use review to inform best practice
• Identify under-researched areas for future
  research projects
• Promote multi-professional/ multidisciplinary
  care
• Put into practice our systematic review training

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Food provision for older adults with dementia at
Marcus Humphrey Residential Home and Daycare
Centre, Bridge of Weir