Under Nutrition and Dementia: England is not beyond the wall

Longevity is one of the greatest achievements of the modern era in residents of high-, middle-, and low-income countries and people are likely to live 65 years of age and beyond (Barratt 2017). According to data from World Population Prospects: the 2015 Revision (United Nations 2015), the number of older persons—those aged 60 years or over—has increased substantially in recent years in most countries and regions, and that growth is projected to accelerate in the coming decade(World Health Organization 2015). However, older persons are particularly vulnerable to malnutrition and suffer from chronic diseases like cardiovascular disease, Stork, Cancer, Dementia and so on (Skarnulis 2006). While considering dementia, this number is alarming. It is estimated that 44 million people worldwide live with dementia in 2013, with numbers doubling every 20 years, to reach 135 million by 2050(Alzheimer’s Disease International 2014).

People with dementia rarely maintain a stable body weight and often incur numerous feeding-related challenges that contribute to the risk of malnutrition. (Jansen et al. 2014). Undernutrition is particularly common among people with dementia in all world regions. It tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace across the disease course Weight loss may be part of the clinical expression of dementia, worsens the clinical course of dementia, leads to greater functional impairment and dependence, and increases the risk of morbidity, hospitalization, institutionalization, and ultimately mortality (Alzheimer’s Disease International 2014).

There are estimated to be around 800,000 people with dementia in the UK. This includes 676,000 people with dementia in England (Parkin et al. 2016) Research conducted for Dementia UK: second edition shows that, in 2013, there were 815,827 people with dementia in the UK and 773,502 of these people with dementia were aged 65 years or over (Alzheimer’s Society 2014). If it is narrowed down to the west midlands, their proportion are relatively high and highest prevalence exists in Birmingham South and Central with 100.6 %( West midlands clinical networks 2016). With these huge proportions of dementia patients, it is crucial to initiate intervention for hindering the undernutrition problem as weight loss is associated with increased morbidity and mortality, and it also worsens the prognosis for several chronic diseases (Alzheimer’s disease International 2014). The increasing prevalence of dementia and the nutritional complications associated with dementia suggest an increasing need for health care that focuses on nutrition and dietetic support and to improve it locally, a local under nutrition control among aged over 65 years Dementia patient plan is the single most powerful tool to improve dementia care and support.

In considering strategies to improve the nutrition of people living with dementia it is important to consider care homes and hospitals, as well as the home setting (Alzheimer’s disease International 2014). The way dementia influences a person’s life is different for each individual. This is also true for eating and drinking; not everyone will experience the same changes as individual need is different. Under nutrition can be avoided by healthcare professionals doing simple things such as monitoring weight and health status, whether patients have eating disorder or not, recommended diet by professional and so on. Right nutrition and specific guidelines can hinder the under nutrition problem which will, at least, help those people to feel healthy

Care homes in UK are taking special care for the people with dementia, but matter of regret that, even though lots of care homes are providing assistance to the dementia patients and nearly a third of people with dementia suffer from malnutrition in care homes (Mirror 2014). To reduce this burden, suitable program ought to be initiated and stakeholders should come forward. following initiatives can be taken into consideration for developing an appropriate strategy for the care homes to provide adequate care to the patients.

1.     Early health assessment: The health assessment should be focused to gather the information which will help to provide appropriate health service to maintain and improve the nutritional status. Following steps should follow at the time of patient’s admission.

·       Information collection, including taking a patient’s previous chronic diseases history, anthropometric measures such as body mass index(BMI),

·       Measurement of the patient’s blood pressure, pulse rate and rhythm;

·       An assessment of the patient’s physical function ability

·       Take into consider whether any need for the patient may require for having meals or not.

2.     Diet along with supplementation: Individual diet chart should be made by the certified dietitian based on patient’s health status and if it is required, oral supplementation need to be given with the help of professional.

3.     Monthly Health assessment: Routine examination need to be done monthly to see the improvements and make the changes where needed.

4.     Special assistance for the patient with physical limitations: Aging is clearly associated with a decline in most physiological systems that culminate to limit physical capacity. People with dementia can often experience problems relating to eating and drinking including poor appetite; communication problems; difficulties coordinating their movements to enable them to eat independently and even the ability to see foods on their plate. If the patient is unable to feed by himself, special attention ought to be provided.

5.     Preferential meal arrangement: Meal can be made according to preference of individual patient. Picture of meals should be provided to the patients where needed, to help them making their choice. The meal must be convenient for individual patient so that everyone can feel comfortable about his or her meal. Favorable meal will encourage the patient to have their food. Thus, healthy eating will be ensured.

6.     Education and training session: Education and training interventions will be targeted the caregivers in order to make this program more realistic. Even though care givers are experienced, but this training will provide more information about the co relation between under nutrition and dementia.

A healthy diet and nutrition is fundamental to wellbeing at any stage of life and It helps to combat other life-threatening diseases. Older people are more vulnerable to the diseases. While a healthy, balanced diet is important, in the later stages of dementia the most important thing is making sure the person with dementia takes on nutrition, and a higher-calorie diet may be appropriate. Care for under nourished people with dementia is an emergency. It can only be erased by the special attention and appropriate program.

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