Individuals with moderate to advanced Alzheimer's dementia present complex nutrition challenges to the health care team. They require careful supervision or feeding with periodic evaluation for changes in nutritional status. Nutrition and health may be compromised by weight loss, chronic urinary tract infections, aspiration pneumonia, dehydration, and skin breakdowns (1-4).
it has been estimated that as many as two out of three beds in long-term care are occupied by demented patients. Dementia may be caused by brain damage from an injury, a cerebral vascular accident, or extensive alcohol abuse. It may also result from dysfunction of the brain due to a degenerative neurological process, as is present in senile dementia of the Alzheimer's type (SDAT). The irreversible process that occurs in SDAT begins with a loss of memory, overrides the ability to think and act in established, lifelong patterns, and ends in a totally dependent state with little or no verbal communication (5-7).
Although patients with SDAT are believed to compose the greater percentage of those with dementias, accurate numbers are not available because the diagnosis may be delayed for years in some cases. A diagnostic laboratory test is not available to identify the presence of Alzheimer's disease. Early recognition of SDAT is difficult because confusion can be mistakenly attributed to a stroke or to hearing loss or can be considered a side effect of medication
(8-11). Mental status testing coupled with documentation of cognitive changes is helpful in confirming the diagnosis for those who have advanced beyond the earliest stages.
Although positive diagnosis of SDAT is often elusive, health care professionals and family can measure observed changes, using the Cognitive Function Scale (6,12). At the stage of mild confusion, changes in food behaviors such as the tendency to overeat or to leave meals unfinished are commonly reported. As confusion advances, the person becomes unable to shop or prepare food independently Meals must be provided, and supervision is required to ensure adequate intake. Unusual food behaviors may develop as the disease progresses to the stage of early dementia. Excessive eating, bizarre cravings, or eating foods in a peculiar fashion are observed
(13). When a caregiver is not available, institutional placement may be considered to provide for daily needs.
Elderly women with advanced SDAT residing in a long-term-care facility were the subjects in this study. Researchers analyzed the nutrition content of the women's diets and determined whether the Recommended Dietary Allowances
(14) were being met. Particular attention was given to factors leading to optimal intake, such as …