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Don't Forget Breakfast

Late-stage Alzheimer's patients eat better in the morning

WEDNESDAY, Nov. 7, 2001 (HealthDayNews) -- Loading the breakfast table and going easy on lunch and dinner helps Alzheimer's patients eat better, says a new study. The problem: Most long-term facilities serve light breakfasts and heavier lunch and dinner meals.

People with Alzheimer's tend to eat more in the morning when they are more alert and energetic and eat less for lunch and dinner times when their mental sharpness tends to decline, the new study found. But because most nursing homes and long-term care facilities traditionally serve a light breakfast and put the emphasis on lunch and dinner, these patients may not be eating as well as they could.

A light-morning meal schedule mimics the way younger, healthier people eat -- but it's not the best for Alzheimer's patients, said Karen Young, lead author of the study and a doctoral candidate at the University of Toronto in Ontario, Canada.

"Long-term care facilities tend to give food in a traditional manner -- a smaller breakfast and heavier lunch and dinner," Young said. "That means long-term care facilities are serving the most energy- and nutrient-dense meals when elderly persons with advanced Alzheimer's disease are least likely to eat."

The study appears a recent issue of the Journal of Gerontology: Medical Sciences.

Weight loss, poor nutrition and eating difficulties are big problems among people with latter-stage Alzheimer's, the degenerative brain disorder that afflicts 4 million Americans. As their brains undergo increasing damage, people with Alzheimer's can develop difficulty chewing and swallowing and have a higher risk of choking, said Sharon Roberts, past president of the Greater Illinois Chapter of the Alzheimer's Association.

"The research is right on target," Roberts said. "[Alzheimer's] people do eat better at breakfast. They are able to cope with the environmental stimuli better, just like anyone when they're well rested."

Young and her colleagues analyzed the food served to 25 elderly Alzheimer's patients at Baycrest Centre for Geriatric Care in Toronto. They found that patients tended to eat most of the calories they consumed for the day at breakfast, while they ate very little for lunch and dinner.

There are multiple reasons why this could be the case, Young said. Previous research has shown that people with Alzheimer's tend to function better in the morning and become progressively more confused and agitated as the day progresses, she said.

"It's called sundowning," Young said. "Residents are the most alert and aware first thing in the morning and then slowly decline as the day goes on."

Secondly, foods served at breakfast tend to have more carbohydrates and therefore are sweeter than lunch and dinner foods, she said. Elderly people, and Alzheimer's patients in particular, tend to favor sweet foods as their senses of smell and taste decline. Breakfast foods like juice, fruit, pastries, cereals and jam on toast may simply appeal to them more than, say, meatloaf and peas.

A third cause could be that breakfast foods tend to have the least variety of all three meals, and people with Alzheimer's might be better off eating foods they recognize, Young said.

A fourth factor might be that breakfast foods tend to be hand-held. Patients might be more apt to eat them than something where they need to use utensils, Young said.

"We need to make changes to better meet the needs of advanced stage Alzheimer's patients," Young said.

So what should long-term care facilities do?

One obvious idea is to put more emphasis on breakfast, but this doesn't mean just piling more food on the plate, Young said. The idea would be to make breakfast more nutrient rich and higher in calories using creative means.

Roberts, a registered nurse and nursing home consultant, suggests that facilities expand the time that food is available to residents. Rather than have breakfast arrive on trays at an appointed hour, have cereal, fruit, oatmeal and other breakfast foods available throughout the morning so that if residents get up at 5 a.m. and are ready to eat, they can; or, if they prefer to sleep late, they don't miss the meal.

Some nursing homes serve a pureed diet, but Roberts said this food looks unappealing. Some food can be pureed and then re-formed so it looks like the original food, and this is done because it's easier to chew. Finger foods like French toast sticks and chicken nuggets may also enable people to eat on their own as long as possible.

What To Do

Many Alzheimer's patients have trouble eating, Young says. Here are some tips from the Alzheimer's Association for making mealtime go more smoothly:

  • Provide a calm environment. Minimize distractions and loud noise.
  • When dining out, avoid noisy or large restaurants and choose those that are small, comfortable and familiar.
  • Make mealtime a pleasant but simple event. For example, put only one item of food on the plate at a time. Don't use patterned plates, tablecloths and placements that can cause distraction or confusion.
  • Serve foods so that the person can eat as independently as possible. Try finger foods or sandwiches. Use a spoon with a large handle rather than a fork.
  • Avoid such foods as nuts, popcorn and raw carrots that can get lodged in the throat.

    For more tips, visit the Alzheimer's Association. Or see this overview of Alzheimer's from the American Psychiatric Association.

SOURCES: Interviews with Karen Young, doctoral candidate, the University of Toronto and Baycrest Centre for Geriatric Care, Ontario, Canada; Sharon Roberts, R.N., past president, Greater Illinois Chapter of the Alzheimer's Association, Skokie, Ill.; October 2001 Journal of Gerontology: Medical Sciences
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