Dementia And Weight Loss Essay

Dementia And Weight Loss Essay

Dementia is a chronic and long standing condition that affects more than 4 million elderly people. At times, it can be quite an energy-consuming as well as mentally challenging. One of the most common factor which can be intimidating for many, is the weight loss associated with this condition.

What is weight loss?

Weight loss is considered when a patient fulfills any of the following criteria

• Weight loss of up to 5% of total body weight
• An unexpected decrease in weight for three months consecutively

There can be many reasons for this loss or decrease in weight. Some seem very obvious while some are quite unheard of. The main goal here is to make sure that you stay healthy and be able to fight off any sort of disease with having adequate weight.

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Causes of weight loss in dementia:

• Eating less: One of the most common causes of weight loss is eating less than required. According to research, around 76% of dementia patients need to be fed as they are unable to do so on their own. This leads them to be more dependent and eventually decreasing the food intake further. The eventual result is the weight drastically going down.
• Medical problems causing weight loss: If you have any other disease, together with dementia, weight loss may only worsen. Diseases like hyperthyroidism and diabetes can act as a catalyst for weight loss due to dementia
• Use of Medications: If you are using any medications, for any diseases, it can also be the causative factor for weight loss. In the case of comorbid conditions, these medications decrease either appetite or body mass while treating the primary disease, hence adding to the weight loss
• Psychological Cause: Dementia is already a cause of stress for an individual. Dementia And Weight Loss Essay.An additional weight loss will only increase the psychological stress which will further lead to a decrease in appetite and a vicious cycle of weight loss ensues.
• Physical pains: You can experience pain in different parts of the body associated with dementia. These pains will cause either a decrease in appetite or the usage of medications for pain, which eventually will lead to weight loss in the long term.
• Decreased fluid intake: Not drinking enough fluids is yet another established cause of weight loss. Our body mostly consists of water which is needed for all the bodily functions. If you decrease the water intake, the basic body functioning is altered, resulting in further weight loss
• Special diets: If you are very particular about eating only a specific food item, then you may have to revise your diet chart. Eating a diet that contains only a specific group of nutrients causes weight loss to worsen e.g. If you have diet lacking cholesterol or good fats, your body will be deprived of the essentials for the tissue regeneration even though you are eating a lot.
• Chronic Infections: If you have an added chronic infection, in addition to dementia then weight loss is not something out of question to happen. Chronic infections attack the body’s immune system so much that it can go beyond the point of repair and nobody mass is formed eventually.
• Cachexia: One of the most serious complications you may experience due to chronic weight loss in advanced dementia, is a condition called cachexia. This condition occurs as a result of chronic weight loss and the body comes to a point where no nutrients are absorbed. At this point, even if you eat or drink adequately, the body won’t be able to absorb any of the nutrients.
• Being Judgmental: If you are a carer for dementia patient make sure that nobody judges them for any point they make. Most of the patients get defensive and it leads to further psychological stress. Furthermore, they would stop expressing themselves which can make the weight loss even worse.
• Loss of general sensation: You may experience loss of general sensation which is usually associated with dementia. This can lead to a decrease in appetite and eventually loss of weight.
• Dementia stage: Different stages of dementia cause a diversifying degree of weight loss. The mild form of dementia will cause weight loss to be insignificant as compared to the advanced stage.

Although the causes might look a bit disturbing but the solutions are quite simple in most of the cases. You can find what suits you from the following list and incorporate it into your lifestyle to address the weight loss problem.

• Eat food of choice: Try eating food of your choice as the smell and taste of that specific food will stimulate your appetite. Also, altering food groups helps in increasing appetite as well as weight gain.
• Oral Nutritional Supplements: ONS is very helpful in increasing weight, assisted with increased nursing time and proper care. ONS includes soft pureed gratin/Reformed minced diet. Lyophilized (freeze-diet) food products have also been found effective
• Social feeding: Eating with family members helps boost appetite hence, it helps encourage you to eat. A study showed that tactile positive feedback by the carer improved feeding in dementia patients.
• Never force eat: Of all the things you can do, this should be something which should never be considered. Force-feeding can damage you psychologically and physically too, and in turn, will do more harm than benefit
• Regular follow-ups: This should be a mandatory task documented in your diary and never be missed. This will help you in understanding your current condition as well as to identify any issue, at an early stage.Dementia And Weight Loss Essay.
• Impaired autonomy: Imagine a person fully independent all his/her life, gradually hit by a debilitating disease, being unable to do simple tasks even. They would definitely be not happy depending on others. As a carer, having empathy is of paramount importance.
• Environmental changes: Changing the surrounding, the settings of the dining hall, etc. are also helpful in encouraging them to eat.
• Physical Activity: Being active is important not only for your physical wellbeing but also to improve your dietary habits. Getting yourself involved in daily activities will help you counter weight loss by keeping you physically and mentally strong.
• Setting up an eating timetable: Having a scheduled eating time is very important to boost your eating habits. In dementia, if Research shows that setting up a specific eating pattern helps in improving the appetite and increase the weight
• Assisted eating: Since most of the dementia patients require support in daily activities, assisted eating is quite helpful. This helps strengthen social contact as well as make the patient eat well while staying in the comfort zone
• Artificial feeding: If you are unable to swallow food and eat properly, this technique can be helpful for you to increase weight. It includes tube feeding whereby food is directly put in the gullet, bypassing the oral cavity. Although it seems to be the preferred choice but research discourages it due to complications it carries.

Weight loss in dementia can be treated with a multidisciplinary approach including food fortification, nursing care, nutritional supplements and above all social support. Family support and dementia support groups are quite helpful in this regard. If, even after trying above-mentioned strategies, there is no weight gain, then consult your dementia nurse, General Practitioner who can guide you further

References

• Abdelhamid A, Bunn D, Copley M, Cowap V, Dickinson A, Gray L, Howe A, Killett A, Lee J, Li F, Poland F. Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis. BMC geriatrics. 2016 Dec;16(1):26.
• Bunn DK, Abdelhamid A, Copley M, Cowap V, Dickinson A, Howe A, Killett A, Poland F, Potter JF, Richardson K, Smithard D. Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review. BMC geriatrics. 2016 Dec;16(1):89.
• Herke M, Fink A, Langer G, Wustmann T, Watzke S, Hanff AM, Burckhardt M. Environmental and behavioural modifications for improving food and fluid intake in people with dementia. Cochrane Database of Systematic Reviews. 2018(7).
• Jones S. Nutritional interventions for preventing malnutrition in people with dementia. Nursing older people. 2019 Sep 27;31(5).Dementia And Weight Loss Essay.
• Testad I, Kajander M, Froiland CT, Corbett A, Gjestsen MT, Anderson JG. Nutritional Interventions for Persons with Early-Stage Dementia or Alzheimer’s Disease: An Integrative

Factors that may contribute to altered nutrition in elderly. Introduction: Factors influencing nutritional status in elderly persons may be divided into three categories: psychological, social, and medical. For instance, psychological disorders such as depression and dementia are highly correlated with loss of body weight in nursing homes and are the major causes of weight loss in free-living elderly individuals. In addition, numerous studies have suggested that social isolation, low socioeconomic status, and poverty are also associated with reduced dietary intake and weight loss. Moreover, numerous medical factors such as the use of prescription medicines, poor dentition, institutionalization, a decrease in taste and smell sensations, and an inability to regulate food intake have all been suggested to decrease appetite and adversely affect nutritional status in older adults.

Three factors identified to contribute to altered nutrition in elderly are as:

1. Changes in the gastrointestinal tract.

2. Decreased neuromuscular coordination.

3. Personal factors e.g. fixed income, loneliness and susceptibility to health claims

Changes in the gastrointestinal tract.

Many changes occur in the gastrointestinal tract, including loss of teeth, reduced production of saliva, diminished taste and smell, and increased ability to digest foods. When these changes occur, chewing may become painful, and a diet with soft foods is preferred. Eating pleasure declines when taste and smell are impaired. Some adults prefer strongly flavored foods, while others avoid food because it does not taste good anymore. The decrease of gastric secretions may interfere with the absorption of iron and vitamin B12.Fat digestion may be impaired if the liver produces less bile or the gallbladder is non functional.

Decreased neuromuscular coordination

Neuromuscular coordination decreases with age and conditions such as arthritis may hamper food preparation and the use of eating utensils. Muscles in the lower gastrointestinal tract become weaker with advancing age and constipation is a common problem. Many nutrient absorption .Kidney repair and maintenance deteriorates with age, and renal function is impaired in some individuals. Fluid and electrolyte balance is difficult to maintain, especially during illness.

Personal factors e.g. fixed income, loneliness and susceptibility to health claims

Fixed income: Often the elderly exist on a fixed income that prevents an adequate food supply. This income deficit affects housing and facilities, limiting cooking frequency and food storage. Without transportation, the elderly often purchase food from nearby store or one that will deliver groceries. Such stores usually charge more for foods. Dementia And Weight Loss Essay.

Loneliness: Social isolation affects the eating behaviors of the aged to a great extent. Elderly persons living alone lose their desire to cook or eat. Lonely people become apathetic, depressed, and fail to eat. They are more susceptible to illnesses and other stresses.

Health claims: Many of the elderly purchase foods and supplements from health food stores because of advertisements claiming that the foods have curative power and may in fact retard the aging process.

4. Emaciation

This is progressive loss of weight resulting in a low BMI of 16/m3.This involves general wasting away of the body tissue as a result of severe malnourishment.

Roles of the RN in assessing risk factor for altered Nutrition in the health care setting.

1. Perform regular assessment of nutritional status of the patients. This achieved continuous clinical observations of the patients especially with special regards to the patient’s nutritional history, medical history, growth history, physical examination and investigation of the blood count. Carrying out comprehensive nutrition assessment that involves identifying and screening patients at risk of developing protein energy malnutrition .This is done routinely in order to detect any changes in the level of nutritional risk. Dementia And Weight Loss Essay.

2. Monitor the response to nutritional intervention. This is achieved through periodic nutritional assessments, monitoring weight gain and BMI in response to therapy to determine adequate dietary intake, quality of patient’s life, functional status, and complications of nutritional support measures among others

3. Administer nursing diagnosis. This include documentation of weight, determining of body fat composition by skin fold measurements, calculation of body mass index as a ratio of height, performing nutritional assessment, exploring the importance and meaning of food with the patient, assessing knowledge regarding nutritional needs and level of activity or other factors, ability to read food labels, access to plan menu, making appropriate food selections among others.

Describe specific nursing interventions that need to be implemented to overcome the 3 problems identified.

1. Eating meals alone (social isolation): Encourage the patient to eat food in a group as this increases the ability to eat more food since eating is a social activity. Also the food can be served attractively to increase his appetite.

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2, Anorexia: The nurse intervention on overcoming the problem of anorexia includes: serving the patients with foods at the right temperatures, and with foods that are spiced or herbs added, by offering small servings of food frequently, providing an opportunity for oral hygiene before meals which stimulates salivation increasing patients appetite, catering to patients food preferences, arranging for the patient to eat in company of others which increases his ability and by ensuring that the patient takes a rest before taking of meals to increase his desire to eat.

3. Impaired swallowing: The nurse interventions that need to be implemented to overcome the problem of impaired swallowing include: keeping the client in a sitting position or semi-sitting position for at least an half before eating, encouraging the patient to use his tongue or finger to sweep retained food from the cheek and repeat the swallowing , inspecting the patients mouth after each swallowing attempts and by encouraging him to do same while by looking in the mouth with the aid of an hand-held mirror. Dementia And Weight Loss Essay.

Discharge planning and teaching that should be initiated for a client who will be discharged.

Emaciation: The client or his family is thought by the nurse on several activities to be done to assist in weight gain while discharged. These include: taking a rest after taking a meal, by disguising extra of calories meals by fortifying foods with powdered milk, gravies or sauces, eating of small amounts of food frequently, eating a variety of foods from small amounts and gradually increasing in terms of number of servings or serving sizes, eat in a company of others, garnishing food with cubed or grated cheese, diced meat, nuts or raisins and including high calorie and nutritious food such as cheese, milkshakes and nuts in his diet.

Obesity: The client prior to discharge is advised to use fats, oils and sugar sparingly. Also, to practice eating food in small amounts frequently as compared to large amounts sparingly. The client is also advised to eliminate consumption of junk foods and alcoholic beverages as well as increasing fiber in the diet from fresh fruits, vegetables and whole grains. The client is also advised to participate in regular exercises which help to raise metabolic rates while suppressing appetite.

2. Anorexia: the client and his family members are thought on how to serve the patient with foods at the right temperatures, foods that are spiced, offering food in small servings frequently, and providing an opportunity for oral hygiene before meals which serves to stimulates salivation thus increasing patient’s appetite.  Dementia And Weight Loss Essay.