Good nutrition is essential for health and wellbeing.
For people living with dementia, getting the correct nutrition through food can sometimes be difficult.
It is important to remember that dementia can affect each person differently. As dementia progresses, changes may develop that can impact eating and drinking. This can lead to under-eating resulting in weight loss, or over-eating, causing weight gain.
It can be upsetting to see someone we care about struggle with eating and drinking and to see weight loss or weight gain. Good practical nutritional advice can help people with dementia manage these challenges and remain strong, healthy and independent for as long as possible.
It is important to:
- Eat a balanced diet
- Eat regularly
- Include healthy snacks during the day
- Keep hydrated by drinking water and fruit juice as part of your daily routine
- Talk to your doctor, especially if you are taking medication, about particular food and drinks that you should take or avoid.
Some suggestions for a balanced diet include:
- Eat Fish, especially oily fish such as salmon, trout, mackerel, and sardines twice a week. It can be fresh, tinned or frozen.
- Eat Fruit and Vegetables– Aim for 5 servings a day that can include tinned and frozen, as well as fresh fruit and vegetables. Enjoy a variety of colours and limit fruit juice to unsweetened, just once a day.
- Eat Wholemeal, grain cereals – at least 3 servings per day. 1 serving is a slice of wholegrain bread, half cup brown rice or a cup of wholegrain cereal. Where possible, choose wholegrain versions as they are also a good source of fibre.
- Try to include high protein foods at two main meals each day, as well as with snacks. Good sources of protein include meat, chicken, fish, dairy products, eggs, beans and lentils. Try a wholegrain cracker with cheese mid-morning in place of a sweet biscuit.
- Consume milk and dairy products such as cheese, yoghurt and custard. Try to choose lower fat options unless advised to follow a high energy diet
Sleep is one of the most essential components of our well-being. If you and the person with dementia are to lead a healthy life, it is of vital importance that you both receive adequate sleep and rest.
Problems with sleeping and changes in the sleep-wake cycle are a common occurrence with dementia. Some people sleep during the day and are awake and restless at night. Some are no longer able to distinguish between night and day, while others are simply not as active as they used to be and thus need less sleep. Trying to recognise the cause of the sleeping problems will help you decide how best to deal with them. Below are some possible causes of changes in sleeping patterns:
Physiological or medical causes
- Pain e.g. arthritis
- Urinary tract infections which cause frequent need to urinate
- ‘Restless legs’ or leg cramps which can indicate a metabolic problem
- Depression which can cause early morning wakening and inability to get back to sleep
- Side effects of medication such as diuretics
- Sleep apnoea and snoring
- Too hot or too cold
- Poor lighting with the effect that darkness causes the person to become disorientated
- Changes in environment such as moving to a new home or having to be hospitalised which may cause disorientation and confusion.
Other possible causes
- Going to bed too early
- Sleeping too much during the day
- Over-tiredness causing tenseness and difficulty in falling asleep
- Insufficient exercise so that the person does not feel tired
- Too much caffeine or alcohol
The following are some helpful hints which you as a carer may find useful to enable you both to have a restful night.
- It is important to encourage the person with dementia to be as active as possible during the day. It really does not matter what the activity entails so long as they do not spend long spells sitting down. Activity provides stimulation for the senses, mobility for the joints, and exercise for the lungs and assistance for the circulation of blood through the body.
- It is also advisable for the person with dementia to keep to a routine of getting up at a regular time. This also applies to retiring at night-time. Routine is highly recommended for those who are confused or who have memory defects.
- Coffee and tea should not be given before going to bed. These are stimulants and should be avoided as they contain caffeine which can cause restlessness. A glass of hot milk may help to get the person to sleep. Lavender oil is also useful. A few drops on the pillow may aid sleep.
- If possible, a night light should be left on, especially in the bathroom and landing or hallway. In the interest of safety, it may be necessary for the person to sleep alone in a ground-floor room. This arrangement may be essential in the advanced stages of the condition.
- Before retiring to bed, it is important for you as carer to create an environment which will be conducive towards a restful night. This might include a certain degree of quietness and relaxation by, for example, playing gentle music. Avoid violent TV shows which can provoke nightmares.
- Most important of all, try to get some sleep and rest yourself. Perhaps you have had a difficult day and, in the interest of your own health, you need your sleep. You, as carer, have the person’s best interest and welfare at heart. You need your health.
For further information:
Bathing and washing
For most adults, washing is a personal and private activity. As the illness progresses the person with dementia may need reminders or help to wash. Sometimes they may be very reluctant and you will need to find ways to encourage them which do not cause distress. It is important to respect the person’s dignity at all times.
If you are finding it difficult to persuade the person to wash or if they need more assistance than you can give, contact the public health nurse, who may be able to advise or to arrange help. You can contact the public health nurse through your local health centre.
Here are some suggestions:
- Encourage the person to wash themselves for as long as possible.
- Continue with familiar washing routines established before they developed dementia e.g. a morning shower or a weekly bath with a stand up wash on days in between
- Try reminding them of the next step, tactfully indicating the part to be washed or they might like to have some assistance from you like handing them the soap or towel.
- Check that the bathroom floor is not slippery.
- Make sure that the room is warm before they undress. Older people are more sensitive to heat and cold.
- Check the water temperature of the bath or shower as it should not be too hot or cold.
- Remove locks from the bathroom door or replace them with those that can be opened from the outside. The person may lock themselves in and become panicky or even go into the bathroom to wash and forget why they are there.
Aids and equipment
Some aids and equipment may help to make washing easier and enable the person with dementia to feel safer and more in control. An occupational therapist or public health nurse will be able to advise what aids and equipment may be required. You can contact an occupational therapist or public health nurse through your local health centre.
Depending on individual circumstances, aids and equipment might include:
- grab rails for getting in and out of the bath
- hand rails by the shower, washbasin or toilet
- non-slip bath or shower mats
- raised toilet seats
- a bath seat or shower stool
General tips for carers:
- Make sure everything is in place before you start.
- Use the opportunity to communicate and, if necessary, to explain what you are doing.
- When they are undressed, check for any red or sore areas of skin or skin rashes. These should be discussed with the GP or public health nurse.
- Use a mild soap and make sure all traces are rinsed off.
- Make sure the person is thoroughly dried, especially in the skin folds, otherwise skin may become chaffed and sore.
- Take the opportunity to apply moisturiser all over the skin because as we get older our skin becomes
Dressing is a private activity for most of us and one where we are used to making our own decisions about what to wear. If people with dementia need assistance with dressing, it should be offered in a tactful and sensitive way to enable them to maintain their dignity and make their own choices for as long as they can.
It is important to allow plenty of time if you are helping someone to dress so that neither of you feels rushed. Try to use the opportunity to communicate about what you are doing step by step.. If you can make it an enjoyable activity the person with dementia is more likely to feel relaxed and confident.
It is important to always give the person independence and choice when it comes to getting dressed. Ways you can do this include:
- Laying out clothes in the order the person will put them on.
- Give clear instructions and remind them which garment goes on next or handing them the appropriate clothes.
- If the person with dementia lives on their own, steps such as labelling drawers with their content or putting whole outfits together for a particular day may be helpful.
- Ask the person what they would like to put on wherever possible. People with dementia need the dignity of having some choice in what they wear.
- Try not to give too many options as it can be confusing. It may be better to make suggestions one at a time.
- If you are buying clothes for the person with dementia, take them with you, wherever possible, so that they can choose the style and colours they prefer.
- Check their size. They may have lost or put on weight without you realising it.
General tips for a carer:
- Make sure the room is warm.
- Try to encourage the person to use the toilet before getting dressed.
- Try to follow the routine they are used to. They may prefer to put on all their underwear first or completely dress their top and then their bottom half.
- If they resist your efforts to help, it may be better to leave them for a little while rather than cause distress. They may be more amenable if you try again a little later.
- The person may not be able to tell you whether they are hot or cold. Several layers of thin clothing may be better than one thick layer. You can then suggest removing one layer if it gets too warm.
Incontinence occurs when someone loses control of their bladder (urinary incontinence) or their bowels (faecal incontinence).
Among the conditions which may cause urinary incontinence are:
- a urinary tract infection which usually responds well to medication
- enlarged prostate gland in men can cause an urgency to urinate suddenly.
- the side-effects of drugs however the GP may change the drugs or alter the dose
- severe constipation which causes incontinence as a result of pressure on the bladder. To prevent this it is important to eat foods rich in fibre and drinking plenty of liquid to help to deal with the constipation. Exercise may also help.
You can discuss this with your Public Health Nurse, GP or Practice Nurse. Some areas in Ireland may have a Continence Advisor, who acts as a specialist resource on the promotion of continence and management of incontinence for people living in the community. Referrals can be made to the Continence Advisor by your GP, Practice Nurse, Public Health Nurse or other Health Care Professionals.
Strategies for carers:
- Remind the person to go to the toilet or taking them at regular intervals. Faecal incontinence can sometimes be managed by taking the person at a set time, if their habits are regular.
- Being aware of signs such as fidgeting, getting up and down or pulling at clothes that may indicate that the person needs to go to the toilet.
- Making sure that the toilet is easy to use. An occupational therapist can advise on aids such as handrails.
- Making sure that the person has clothes that can be quickly removed or unfastened. Velcro fastenings rather than zips or buttons may be simpler if the person has difficulty in managing clothes.
- Avoiding drinks for several hours before the person goes to bed if the person is incontinent at night. However, you should make sure that they drink plenty during the day.
- Making sure that they remember where the toilet is. A sign on the door may help or they may need reminding.
- If it is too difficult for the person to get to the toilet, a toilet aid such as a commode may be useful. A public health nurse or occupational therapist can advise.
A pressure sore is a damaged area of skin which occurs when pressure reduces or cuts off the blood supply to a part of the body over a period of time. If you notice any red patches on the person’s skin which do not disappear after a few hours, these may well be pressure sores.
Whenever you help the person to wash or dress or if they seem to be in discomfort, be alert to the possibility of pressure sores. Older people who are not very mobile are particularly vulnerable. Pressure sores are usually easy to treat at an early stage. However, if left untreated, they will get worse and can be dangerous. You should contact your local public health nurse for further support and information.
Tips for the carer:
- Try to make sure the person has a good, balanced diet. Good nutrition means the skin will be healthier and more resistant to sores developing.
- Help the person exercise regularly. Exercise improves the circulation and helps relieve any pressure which has built up.
- Make sure the person does not remain in wet clothes or a wet bed if they are incontinent. If urine remains in contact with the skin for any length of time, it will make it spongy and less resistant to sores.
- Avoid tight clothing or tight bedding, especially over the feet.
- Excessive heat and moisture can also contribute to pressure sores, so try to prevent the person becoming hot and sweaty.
- Make sure the person is thoroughly dry after a bath or wash, particularly in the skin folds. Pat rather than rub dry.
- Never rub or massage any places where the skin has reddened as this could cause further damage.Encourage the person or help them to move their position when they are lying or sitting for any length of time.