Protein-calorie malnutrition is frequently encountered in elderly patients in hospitals and other institutional setting as a condition secondary to the primary disease. Inadequate consumption of food frequently arises from mental decline, loss of physical dexterity, difficulty in swallowing and the need to be spoon-fed.

Consuming an adequate diet is necessary to obtain nutrients and to help individuals stay healthy. The following tips are suggestions that have worked for some Alzheimer's patients. However, each patient is different; and dietary will need to determine what may work for each individual patient.

Tips to Increase Appetite

* Have the main meal of the day at breakfast or lunch when the patient's appetite is larger, keeping the dinner meal smaller.

* Use familiar foods fixed in a familiar way.

* If the patient refuses to eat a balanced diet or is not consuming enough calories, consult with the family and physician about using vitamin and/or mineral supplements.

Tips to Overcome Mealtime Confusion

* Make mealtime a routine that occurs at the same time, in the same place and with as little confusion as possible.

* Make sure physical surroundings are pleasant and calm, avoiding unnecessary distractions.

* Set aside ample time for meals so they are not rushed.

*Serving one food at a time may result in less confusion.

Tips to Overcome Eating Problems

* When a patient clinches his/her teeth, spits out food, becomes unruly, or demonstrates other disruptive eating behaviors, try discontinuing mealtime for a few minutes.

* Have meals in complete privacy if the patient is embarrassed about his/her inability to feed himself/herself.

* A patient may not have the judgment to know what should not be eaten. This is particularly important regarding special diets or when removing nonnutritive foods such as salt, ketchup, or seasonings that should not be consumed in excess.

* When messiness or spills become a problem due to loss of coordination, here are a couple of suggestions to help alleviate these problems.

* Try using plastic tablecloths and a plastic apron for the patient; this will ease the clean-up process.

* Utensils with large built-in handles can be held more easily. Foam handles can be built so that utensils are easier to grip.

If chewing and Swallowing Become a Problem

* Be sure dentures fit properly

* Use gravy and sauces to help moisten the food.

* Provide fluids at mealtime to help with swallowing. If fluids such as water are difficult to swallow, try jello or milkshakes.

* Encourage the patient to eat slowly and to chew foods thoroughly. Verbal cues may be necessary.

* Avoid using baby foods if possible. The baby foods may unknowingly be degrading to the patient, thus making them feel like a child.

If Taste and Perception of Smell Decline

* When the taste sensation is diminished, use food that vary in texture.

* Enhancing the flavors of food with spices can increase the acceptance of foods by those patients whose taste has decreased.

* The sense of different tastes (sweet, salt, butter) are best perceived at body temperature. Patients will be more aware of different flavors if food is served at body temperature (rather than normal serving temperatures).

* Along with the decline in taste and smell, the Alzheimer's patient may not be able to determine the temperature of food or beverages. Therefore, check the temperature before serving.

@ copyright 1995