How Food & Nutrition Can Improve Dementia Outcomes

An overview for aged care providers, including practical tips you can implement now.

Considering more than half of people in residential aged care in Australia live with dementia, it's essential that care providers utilise evidence-based strategies to improve the lives of people impacted by this debilitating condition.

And while managing issues around memory and behaviour often get the most attention, food and nutrition are equally important considerations in providing high-quality care for people with dementia.

In this article we'll unpack the major points about the interactions between food, nutrition and dementia. We'll also explain how, in an aged care setting, implementing creative solutions to enhance choice in meals and improve dining experience can result in better outcomes for people living with dementia.

Links between nutrition and dementia onset

Good dietary habits are important for the overall health of all people in residential aged care homes. But when it comes to dementia, there are some important links between disease onset, progression and management that must be considered.

While research is still ongoing, there is a growing body of evidence to suggest that good dietary habits can:

• Reduce overall risk of dementia
• Delay disease onset
• Support healthy cognitive ageing

We can't conclusively say yet that one specific dietary approach is superior to others. However, regarding prevention of early onset dementia, Mediterranean-type diets (in particular the Mediterranean-DASH Intervention for Neurodegenerative Delay, or MIND, diet) seem to show the most promise.

Unfortunately, just as good habits can reduce the risk of dementia, suboptimal nutritional intake can lead to worse outcomes.

Nutrition risk factors for dementia

The biggest dietary risk factor involved in dementia management is malnutrition.

Research demonstrates that malnutrition can both:

• Hasten the progression of mild cognitive impairment to dementia
• Increase the severity of behavioural and psychological symptoms of dementia

Considering the high prevalence of mild cognitive impairment and dementia in residential homes, it's clearly a priority to ensure adequate nutrition for aged care residents. Highlighting the importance of this issue, the 2021 Royal Commission into Aged Care Quality and Safety identified food and nutrition as an area requiring priority attention.

However, as any experienced care provider knows, supporting people with dementia to maintain an adequate diet isn't easy.

Challenges with dementia and food intake

From changes to food preferences to difficulty participating in meal times, dementia and cognitive impairment can result in a range of obstacles to adequate dietary intake.

When not addressed, these challenges can result in a "vicious cycle," where memory impairment impacts nutritional status, which in turn results in progressively worse cognition.

In fact, some studies have found that compared to well-nourished people with dementia, malnourished people had four times the risk of experiencing "severe dementia" and a threefold higher risk of death (mainly due to complications from frailty).

Some of the main challenges of maintaining adequate nutrition for people with dementia include:

• Loss of appetite. Factors such as reduced physical activity, forgetfulness, decreased enjoyment in food and general apathy can result in people with dementia experiencing a loss of appetite. Without input, this is an issue that usually becomes progressively worse.
• Changes in taste. People with dementia can experience substantial changes in taste. This can result in being uninterested in previous favourite meals and a change in overall food preferences. Cravings for overly sweet, sour or salty foods are quite common.
• Chewing and swallowing issues. Where cognition makes it difficult for a person to recognise mouth discomfort (whether from a dry mouth or poor dentition), they may inadvertently lose interest in food. In some cases, dementia may also impact motor functions related to eating, like chewing and swallowing.
• Difficulty with meal times. Becoming confused and overwhelmed at meal times is a common challenge for people with dementia. Some dementia sufferers may forget what cutlery and crockery are for, or find it hard to concentrate for long enough to consume an adequate meal.

Scope of the problem in Australia

Unfortunately, despite increasing knowledge about the challenges around dementia and nutrition, the prevalence of malnutrition in Australian residential aged care settings has been identified as ranging from 22% to 50%.

In recognition of the need for increased funding and support for this issue, the Albanese Government recently announced $12.9 million to establish a food unit in the Aged Care Quality and Safety Commission.

Amongst other things, this unit will administer a hotline providers can call for advice, linkage to education programs and a commitment to "engage Dementia Australia experts to promote nutrition and food enjoyment for people with dementia."

Creative strategies for care providers

While funding for residential aged care food budgets obviously still remains an issue, the spotlight on aged care food services has made it much easier to access high-quality information on improving nutrition for people with dementia.

A full overview of the topic can be found in a discussion paper on the ACQSC website. And the associated Why do meals matter? page describes proven interventions to improve the nutritional intake in aged care residents.

We have summarised some of the key points below, along with general tips for enhancing mealtime experiences for people with dementia.

Person-centred mealtime care

There are obviously limitations on just how personalised each resident's mealtimes can be. But overall, more person-centred, enabling and social approaches to mealtimes improve nutritional outcomes for people with dementia.

This might involve things like:

• Using a multidisciplinary approach to developing individual mealtime plans for at-risk residents
• Providing easy-to-use cutlery or crockery to residents who require it (along with finger food if needed)
• Catering to preferences for sweet, high-carbohydrate tastes where interest in standard meals is reduced

Improving food choice and independence

A clear pattern in the evidence is that interventions which increase choice and decision making at mealtimes improve nutritional intake.

Proven strategies include:

• Buffet style dining programs, where residents can choose their meals independently
• Providing finger foods at and between meals for people with dementia
• Facilitating food combination requests by residents, even if they might seem unusual

Enhancing the dining environment

Depending on the needs of residents, several adjustments to the dining area can enhance the experience for people with dementia.

Examples include:

• Providing better lighting and colour contrast in the dining room, so residents are better able to see and focus on their food
• Removing any clutter and unnecessary items from the dining table to minimise confusion
• A "family style" approach, where residents are given serving bowls and plates and invited to participate in mealtimes

Flexible meal delivery and availability

Providing flexible options for receiving meals and extended access to snacks can improve dietary intake.

Approaches could involve:

• Giving the option of room service for suitable residents
• Decentralised bulk portioning systems, where food is portioned at the point of service in each meal area
• 24/7 availability of snacks and fluids

One small change at a time

It's acknowledged that for many residential aged care providers, some of the changes suggested above could pose significant implementation challenges.

Whether it's budget limitations, staffing difficulties, regulatory obstacles or competing priorities, timelines for change can be impacted by a range of important factors.

However, considering the prevalence of dementia and the impact food and nutrition can have on outcomes, it's important to view this challenge through a lens of continual improvement. Adopt one small change at a time.

If you would like support with aged care food and nutrition, Embrayse provides smart catering software to empower teams to implement evidence-based nutritional strategies.