Nutrition in Advanced Dementia


Nutrition in Advanced Dementia, Dementia Related Malnutrition, Failure to Thrive in Dementia, Weight Loss in Dementia

  1. No support for Feeding Tube (e.g. PEG) use in the literature
    1. Does not improve functional status, nutritional markers or survival in Dementia patients
    2. Does not reduce the risk of Aspiration Pneumonia in Dementia patients
    3. Often requires restraints for Feeding Tube placement and maintenance
    4. Associated with adverse effects (pain, Cellulitis, Vomiting, Diarrhea, fluid imbalance)
  2. Conscientious hand feeding is preferred alternative
  3. Previously used for Nutrition in Advanced Dementia
    1. Aspiration Pneumonia prophylaxis (disproven)
    2. Malnutrition (disproven)
    3. Pressure Ulcer reduction (disproven)
    4. Improved survival and function (disproven)
  • Management
  • General measures to improve food intake
  1. See Dysphagia Diet for possible limitations
  2. Strong flavors should be used
    1. Serve foods either hot or cold (not tepid)
    2. Enhance flavor with spice, gravy, juice, cream
  3. Offer preferred foods without restriction
    1. Ice cream
    2. Miniature Chocolate bars
  4. Consider liquid supplements (e.g. Ensure, Boost)
    1. Avoid near meal time (avoid within 2 hours of meal)
    2. Consider alternatives to commercial supplements
      1. Milkshakes
      2. Blended food (e.g. cereal in eggnog)
  5. Patient should have easy access to food
    1. Mealtime duration may need to be lengthened
    2. Place finger foods, candy bars, liquids at bedside
  6. Create No-fail Environment in Dementia
    1. Provide meals at midday at maximal cognitive function
    2. Reduce Agitation in patients
      1. Hold hands or gently touch
      2. Talk about pleasant topics or sing softly