Transcript
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[Title card: Dementia Australia]
[Title card: Dietetics and the benefits of nutrition in dementia – Charmini Athukorala]
Charmini: Hello, and welcome everyone to Dementia Australia's expert webinar on dietetics and the benefits of nutrition in dementia. I would like to acknowledge the traditional custodians of the land on which we are meeting today, and pay my respect to Elders past, present, and emerging. My name is Charmini, and I'm an accredited practising dietitian, as well as an accredited nutritionist, and I'm also a dementia support specialist working at Dementia Australia.
In today's session, we'll be talking about several topics. First of all, we will be having a look at what is dementia? What is the importance of nutrition in dementia? How can a person living with dementia get the most out of their diet? What is a balanced diet? And what services and resources are available to you, as a carer, or as a person living with dementia?
So what exactly is dementia? Dementia is an umbrella term that describes a collection of symptoms caused by disorders affecting the brain. Dementia affects a person's thinking. It affects a person's behaviour, and ability to perform everyday tasks such as eating and drinking. People living with dementia have some unique nutrition concerns and challenges, and the role of nutrition is very important. As dementia progresses, changes in the brain can impact the person's physical capacity to swallow. The person may have difficulty knowing the sequence of eating. The person may not recognise eating utensils or remember how to use those utensils, for instance, to properly cut food into bite size pieces, or they may not know how to put the food in their mouth. The person may also have deterioration in their ability to chew and swallow food, which is also known as dysphagia. Changes in the brain can also affect the person's memory of what food is, their food preferences, as well as the ability to recognise food. And people may also eat non-food items or substances, which could be dangerous.
The person may forget more specific details related to eating, such as when they ate, or how much they ate, or what they ate. And hence, some may eat foods multiple times throughout the day, or there's a possibility that they may overeat at meals, and as a result, may start gaining weight and become overweight or obese. For others, poor food intake and unintended weight loss can increase their risk of malnutrition. The consequences of malnutrition can be very serious, and that can include loss of muscle mass, which can then further lead to increased loss of functional ability, including reduced mobility, impaired posture, decreased strength, and increased false risk. And then, that can further lead to greater dependence or assistance from carers and others for daily activities and tasks.
Other serious consequences of malnutrition may include things like impaired immune function and increased risk of infection, depression, and it can also affect the person's cognitive ability further. In addition to eating issues, dementia can also cause a person living with dementia to drink less fluid, and in turn, the person living with dementia is more prone to dehydration and other more significant consequences, including rapid heart rate, confusion, delirium, urinary tract infections, which may then result in the person needing further medical intervention or even hospitalisation. Therefore, when food and fluid intake begins to decrease, it is important that this is identified early and strategies are implemented to improve intake and maintain nutritional status and prevent further malnutrition.
As you can see, maintaining adequate food and fluid intake is vitally important to help reduce further cognitive decline, as well as to maintain the person's overall health, wellbeing, independence, and quality of life. So, how can a person living with dementia get the most out of their diet? First, it is important to maintain a routine and offer meals at regular times each day. Make sure that meal times are simple, relaxed, and calm. Limit unnecessary noises and distractions. Be sure to allow enough time for a meal and avoid rushing as the person living with dementia may need a little bit longer to finish a meal. Remind the individual to chew well and when to swallow if necessary.
As most people living with dementia tend to eat smaller amounts of food, it is important to pack in as much nutrition into each mouthful by fortifying food and drinks that are on offer. Tap into all the food memories and offer familiar foods. Find a way to facilitate food intake by offering finger foods so that the person living with dementia doesn't have to use utensils. Ensure foods that are served are often appropriate temperature and texture for the individual. If needed, may be moistened food with gravy and sauces, and modify food texture to aid with swallowing and chewing. When preparing texture-modified food, also ensure it is attractive to the person and that it smells good and tastes good. Providing nourishing high energy, high protein, mid-meal snacks might be beneficial to make up for reduced intake during main meals.
It is also important to encourage the person to feed him or herself for as long as possible to maintain the person's independence, strength, and memory. Providing special cutlery, cups, plates, non-slip place mats will enable the person living with dementia to maintain a level of independence. If necessary, maybe provide physical assistance by placing the utensil in their hand, and then giving a verbal cue, such as it is time to eat. Enjoy meal times by sitting and eating together as a family. This gives the person living with dementia the opportunity to observe and mimic others that are seated around the table. There are many more ways in which you can aid food and fluid intake. Seeking tailored advice from a dietitian will assist to further improve the nutritional status of the person living with dementia.
Eating a well-balanced nutritious diet is also beneficial for the person living with dementia. The diet of someone with dementia will be similar to that of someone of their age, unless they have any other medical conditions that require specific modified diet. However, it's also important, as a carer, to think about your food and fluid intake. Carers often put their food and help needs last. The nature of their role puts them at risk of having poor eating habits and nutrition themselves. As a carer, eating a balanced diet is essential to provide your body with all the nutrients that it needs. A balanced diet will also help your body become a lot stronger and give you enough energy to provide the best care for the person that you're caring for as well as for yourself.
The Australian Guide of Healthy Eating recommends that you enjoy a wide variety of nutritious foods from each of the following five food groups, and to drink plenty of water every day. As you can see, the green portion of the plate is the largest and shows the importance of consuming plenty of vegetables and fruits of different types and colours. As the foods in this particular food group tend to be high antioxidants, such as vitamin C, vitamin E, flavonoids, and many other essential vitamins and minerals. The yellow portion of the plate recommends including high fibre varieties of grain cereal foods, as per the blue portion of the plate, including moderate amounts of lean meats, poultry, fish high in omega-3, eggs, tofu, nuts, seeds, and legumes will help meet your protein, iron, zinc, and B group vitamin requirements.
The purple segment of the plate are foods that are rich in calcium, and these include foods such as milk, yoghurt, cheese, and/or their alternatives in their diet is beneficial for your maintenance of your bone health. Limiting your intake of foods high in saturated fat, high in salt, added sugars, and alcohol will help maintain your brain health as well as your heart health. Keeping physically active is also very, very important because it can help maintain your muscle strength, and also help you achieve and maintain a healthy weight.
There is growing evidence that a certain aspect of a diet can influence cognitive health and progression of dementia. Always consult a general practitioner or an accredited practicing dietitian before beginning a certain diet or taking any nutritional, herbal, or homoeopathic supplements. Accredited practicing dietitians are professionals with qualifications and skills to provide expert nutrition and dietary advice. They are trained in medical nutrition therapy, which means that they're qualified to treat a range of medical conditions with nutrition and diet. During your consultation with a dietitian, the dietitian will initially complete a comprehensive nutrition assessment. Then, they will develop a personalised eating plan that considers your medical conditions as well as your personal circumstances. Afterwards, they will provide you with nutrition, counselling, and support.
A general practitioner or a consultant can refer a person living with dementia, a carer, or any other person to a dietitian if they are concerned about their nutritional health. To find an accredited practising dietitian in your area, you can use the Dietitian Australia, "Find a dietitian" tool bar. Other allied help, such as a speech and language pathologist may also play an important role in assessing and addressing swallowing difficulties that the person living with dementia may have. For further information and advice on dementia, please contact the Dementia Australia National Dementia Helpline on 1800 100 500.
These are some links to resources that might be of interest to you. The first resource is a nutrition and dementia report compiled by the Alzheimer's Disease International. It investigates how right nutrients can help make life better for people living with dementia. The second resource provides further information about the Australian guide to healthy eating, and it also details recommended number of serves, and serves per day for individuals, especially for adults. The third resource is a practical guide compiled by Helen Crowley and Erica Hocking from the Caroline Walker Trust to support elderly and people living with dementia to eat well.
The fourth resource was developed by the Ageing and Dementia Research Centre at the Bournemouth University. It is a free toolkit that consists of a film, workbook guide, and leaflet. It is targeted for family carers, as well as paid carers to deliver person-centred nutrition care for people living with dementia. The final resource is a link to all the help sheets that are developed by Dementia Australia, and it provides advice, common sense approaches, and practical strategies on the issues most commonly raised about dementia. This is the National Dementia Helpline that I referred to earlier, and thank you for your attention.
[Title card: Together we can reshape the impact of dementia]
[Title card: Dementia Australia. 1800 100 500. Dementia.org.au]
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