Swedish researchers have found a way to increase the weight of people with Alzheimer's, by improving communication and patient involvement, altering meal routines and providing a more homely eating environment. Patients who gained weight also displayed improved intellectual abilities.
During the three-month study, published in the May issue of Journal of Clinical Nursing, 13 of the 18 patients in the intervention group put on weight, compared with just two of the 15 patients in the control group.
"Weight loss is a common issue among people with dementia and in particular Alzheimer's" explains lead researcher Anna-Greta Mamhidir from the Karolinska Institutet in Stockholm, Sweden.
"Meal environment, communication difficulties, loss of independence and confusion are just some of the factors that appear to contribute to this problem.
"Malnutrition can also lead to other serious issues, such as increased infection rates, delayed wound healing and increased risk of hip fractures."
The aim of the study was to measure weight changes in patients with moderate and severe dementia and analyse whether providing staff training and a more supportive environment could lead to weight gain.
Two nursing home wards with similar staffing profiles and numbers of patients were selected. Both received meals from the same central kitchen.
The medical profiles of the two groups of patients were similar and drug regimes were unaltered during the study. Most of the patients had communication problems and memory loss and were physically dependent on staff.
Patients in the intervention group weighed between 31.5kg and 76kg at the start of the study, with an average weight of 55.9kg. By the end of the study this average had risen to 56.4kg.
When the team looked at individual patients they found that the largest weight gain in the intervention group was 7kg (15.4 pounds) and the smallest was 0.6kg (1.3 pounds).
Patients in the control group weighed between 45kg and 76.3kg at the start of the study, with an average weight of 62.5kg. This average fell to 58.4kg over course of the study.
Staff in the intervention group attended a one-week training course run by a psychologist and professor of nursing science. It comprised 20 hours of lectures and 18 hours of group discussion covering three key themes: delivering care in a way that promotes the patient's integrity, how to communicate more effectively with patients with dementia and how to create a calmer and more homely environment.
During the study, the staff who had received training were asked to keep diary notes of any changes and they effect they had on patients. They also received support and encouragement from a research assistant, who spent most days on the ward, and a nurse researcher who visited the ward three to four times a week.
"We felt that this level of involvement in the project would make it easier for staff to accept and implement these new ideas" says Anna-Greta Mamhidir.
New pictures were placed on the dining room walls and staff worked with patients to print new patterns on curtains and tablecloths.
Patients' rooms were given name plates, they were encouraged to have more private items in their rooms and staff wore brightly coloured clothes.
The prepared trays sent by the kitchen were replaced with serving bowls and patients were encouraged to help themselves.
No changes were made to the control ward.
Staff on the intervention ward noted in their diaries that the changes increased the contact between patients and staff and created a more pleasant atmosphere.
"Patients took part in activities, sat at the table together during mealtimes and served themselves food from bowls, encouraging them to be more independent and interact more with other patients" says Anna-Greta Mamhidir.
"The initiative was so successful that staff on the control ward were given the same training at the end of the study so that they could make the same improvements on their ward."
Roger Watson, editor of Journal of Clinical Nursing, says that the research carried out by Mamhidir and colleagues makes a significant contribution to the field of food and dementia and has congratulated them for delving into what is a complex and difficult area.
"Societies are ageing and debates about food and old people and food and dementia – which are regular topics in the Journal – can only increase" he says.
"The current study shows a marked difference in weight change between the intervention and control groups and a strong link between weight gain and improved intellectual ability.
"I hope that it will stimulate further lines of enquiry as there is a vital need to improve nutrition among elderly patients, particularly those with Alzheimer's and other forms of dementia."
Weight increase in patients with dementia and alteration in meal routines and meal environment after integrity promoting care. Mamhidir et al. Journal of Clinical Nursing.16, 987-996.