Colored Plates: What do Fiestaware and Dementia Have in Common?

Got Fiestaware?  My mom does…she has a whole set of plates and bowls in lots of vibrant, beautiful colors.  Having a meal on a colored plate just seems to make mealtime more fun!

I recently read a great post from The Alzheimer’s Reading Room discussing the use of colored plates in Alzheimer’s patients.  (FYI: The Alzheimer’s Reading Room is a great resource for those with or caregiving for someone with Alzheimer’s.  They have great resources and an active community for you to connect with.  I highly recommend them!!)

The post mentions that colored plates help Alzheimer’s patients see their food more clearly, which as you can imagine, seems to help with intake.   This isn’t a new phenomenom but one we’ve been using in the practice of dietetics for some time.  Colored plates help those with visual impairment see contrast and therefore enhance intake.  Our brains also seem to pick up on the colors and may influence us to eat differently.  In particularly, red plates do seem to increase intake.

So to answer the original question…what do Fiestaware and dementia have in common?  That colorful Fiestaware (or a colored disposable plate) could be an easy trick to helping your loved one with or without dementia eat more!

Have a great weekend!  Sunday is Grandparent’s Day…be sure to honor and/or remember your grandparents!!

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Resources:

1.  The Alzheimer’s Reading Room:  http://www.alzheimersreadingroom.com/2011/11/thanksgiving-postscript-wont-eat-didnt.html#more

2.  Photo:  Kenan Crawford Hill

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Adding calories and protein: Oral Supplements or Food First?

I’ve finally decided it is time for me to speak out about the use of oral supplements (Ensure, Boost, etc.).   Oral supplements have been used for decades as a quick solution to adding calories and nutrients to the diet of older adults.  They are easy to consume and aren’t labor intensive.  They have many benefits and when folks are tired and aren’t meeting their calorie needs, many medical professionals jump to recommend them to their patients.

However, over the past few years I’ve begun to question why, during hospital care, we recommend these so quickly.  Why not recommend food first?  Would you rather drink an Ensure or have a fresh fruit and ice cream based milkshake?  How about cheese and crackers?  Or fresh fruit with yogurt?

Too many of us jump to oral supplements as a first line of defense when someone isn’t eating. There are several reasons for this:

  1. Cost.   The typical hospital will pay approximately 30-40 cents per can.  You can’t make a real ice cream based milk shake for that little.  So while your in the hospital, it makes sense that this will be given to you as a choice.  The cost on the “outside” isn’t so cheap.  Most consumers will pay $2.00 per 8 fluid ounces.
  2. Shelf Stable:  Oral supplements can sit on the shelf of a storeroom and won’t go bad like real food.
  3. Disbursement:  It is easier to leave a couple cans of a shelf-stable product next to your bed than it is to leave something that is ice cold that will begin to melt
  4. Standardization:  We know exactly what is in every can and we can count those calories and grams of protein so we know exactly what you are consuming.

Of course, all of these make sense and are good reasons….but I’d like to challenge our profession to go back to food first. Would we better serve our patients if we went back to the basics and thought about whole food calorie enhancements (like peanut butter, dried fruits, ice cream, cheese, nuts, fresh fruit, creamed vegetables, etc.)?  Could we save our patient’s money on the “outside” and help them enjoy food again?  Are we missing the social aspects of eating by recommending oral supplements first?  Could we achieve the same goals by discussing meal frequency?  Is this what you would want served to you?  Three times a day?

So, in the meantime, here are some quick, Boost High Protein (240kcals and 15grams of protein) equivalents in “real food.”  Enjoy!

  1. 3 whole eggs, hard boiled (232 kcals and 19 grams of protein)
  2.  4 Tablespoons of creamy peanut butter and ½ cup of frozen blueberries (228 kcals and 16g of protein)
  3. 6 oz of greek yogurt and 1 fresh peach (283 kcals and 12 grams of protein)
  4. 2 cups frozen fruit, 1 cup of milk and 3 tablespoons of peanut butter (blended), (524kcals and 28 grams of protein)
  5. 1 cup of dry milk (prepared with water) , (240kcals and 24grams of protein)

Increasing Appetite: New Ideas

Many of us working in older adult nutrition often work with clients who complain of poor appetite.  This isn’t surprising since we now know that as we age our hormonal regulation of appetite is altered.  Hormonal changes coupled with changes in the GI tract (early satiety, constipation and  changes in smell and taste, etc.) can make feeding drive reduced.

Dietitians have tackled this issue creatively.  We’ve worked with clients on meal timing, food texture, meal preparation, the food environment and if required, used appetite stimulants.  Many of us have found that having appealing food smells wafting through the air can be just as successful as some appetite stimulants.  For example, baking bread prior to meal time seems to increase appetite when the meal is served.

I was so pleased to see this idea translated into practice during the UK’s Design Council Challenge.  If you haven’t heard, the UK Design Council partnered with the Department of Health to fund five innovative new design solutions to improve the quality of life for people living with dementia.

The design solutions are brilliant!! My favorite, the group focused on weight loss and poor appetite. Their solution, ODE, a small, discreet device that reminds people to eat and stimulates appetite by releasing pleasant food odors into the home. Magnificent!!

Here is the video that explains the device:

 

I’m so glad to see the UK taking a lead on thinking “outside the box” on issues around aging and dementia and for remembering that malnutrition and aging is just as important as obesity management.  Well done!

Music…Appetite’s Dinner Guest

Music…Appetite’s Dinner Guest

Many factors of aging (physiological, socioeconomic, and psychological) contribute to a decreased food intake once we pass into our 80s.  These might be as simple as decreased energy to prepare meals.  Losing weight at this age means losing precious muscle.  Muscle is associated with increased insulin sensitivity, better balance, and increased resistance to immunity—to name just a few of its advantages!

Factors that Increase Risk of Poor Intake by Older Adults

  • Cognitive decline
  • Dental Health: Dentures, Loose teeth, Few teeth
  • Dysphagia
  • Loss of taste and smell

Nutritional interventions to increase calories consumed vary widely.  However, for the older adults who eat less because of cognitive rather than functional or physiological decline, recommendations may be harder to implement (given that their independence is impaired).  Music is a passive, non-invasive approach to improving intake.

What we know

Taste is multisensory; our experience of food is affected by all of our senses.1 It has been shown that music preference and tempo both have an impact on meal duration with music preference being the more significant predictor.3 In addition, the higher the tempo of the music, the more bites per minute!2 A study with 12 nursing home residents with Alzheimer’s saw about 20% more calories eaten and an increase in the time spent eating when familiar background music was played (as compared to none).4 The additional calories were primarily from carbohydrates.4

Bring Music to the Table

More research is needed on the effect of music on food consumption to further explore how location, age, and type of music may take part in the results seen.  It seems that background music may increase the duration of a meal.  Longer time ‘at the table’ often means that more calories are eaten through beverages and carbohydrates.

It is important older adults choose foods rich with nutrients.  In the presence of music, the ‘extra’ calories available should be chosen wisely.  Have carrots and hummus or a whole-grain bread as an appetizer or side, for example, rather than refined bread.  Keep milk at the table in place of soft drinks or other high-calorie, low-nutrient foods.  If an older adult chooses to eat a little more, they may be more likely to snack on healthy alternatives.

There are many ways to improve the voracity of the aging appetite.  Music during meals may just be the easiest!  For more information, please enjoy this handout: NUTR615_Blog handout

Guest Blogger:  Claire Newlon

 

Bibliography

  1. Massimiliano, Z., & Spence, C. (2008). Assessing the role of sound in the perception of food and drink . Chemosensory Perception, 3(1), 57-67. Retrieved from http://www.springerlink.com/content/p57703k28761m4p0/
  2. Stroebele, N., & de Castro, J. (2006). Listening to music while eating is related to increases in people’s food intake and meal duration. Appetite, 47(3), 285-289. doi:10.1016/j.appet.2006.04.001.
  3. Caldwell, C. and Hibbert, S. A. (2002), The influence of music tempo and musical preference on restaurant patrons’ behavior. Psychology and Marketing, 19: 895–917. doi: 10.1002/mar.10043
  4. Thomas, D., & Smith, M. (2009). The Effect of Music on Caloric Consumption Among Nursing Home Residents with Dementia of the Alzheimer’s Type. Activities, Adaptation & Aging, 33(1), 1-16. doi:10.1080/01924780902718566.
  5. Artist unknown for image 1 (http://www.google.com/imgres?imgurl=http://www.stpetersfairfield.co.uk/images/music.jpg&imgrefurl=http://www.stpetersfairfield.co.uk/aboutus.htm&usg=__QOECX13hiueiYBovSnU33wnK8Rg=&h=432&w=300&sz=16&hl=en&start=0&zoom=1&tbnid=mSaRPNOAsgtokM:&tbnh=144&tbnw=100&prev=/images%3Fq%3Dmusic%26hl%3Den%26sa%3DX%26biw%3D1259%26bih%3D615%26tbs%3Disch:1%26prmd%3Divb0%2C176&itbs=1&iact=hc&vpx=1046&vpy=206&dur=234&hovh=270&hovw=187&tx=160&ty=126&ei=4je-TI2oAcWBlAfSyJ3pBw&oei=yDe-TKLPFM6s8AaH__3kAg&esq=3&page=1&ndsp=18&ved=1t:429,r:17,s:0&biw=1259&bih=615)
  6. Artist unknown for image 2  (http://kankakeeorparee.wordpress.com/)

Snack Attack!

Snack Attack!

To snack or not to snack? Maybe you’re struggling to get your protein and vegetables in, or maybe you only get two meals in each day…either way, snacking may be good for you! Some experts are saying that snacking can be an effective way for older adults to meet their daily caloric and nutrient requirements. In a recent study, snackers ate about 250 more calories than non-snackers on a daily basis.1

Health problems, medications, and loss of taste sensation can cause us to eat less on a daily basis as we age. In addition, we cannot eat as much at one sitting as we could when we were younger. Nutritious snacks in between meals can boost nutrient intake.

When it comes to smart snacking, incorporating healthy snacks is easier said than done, right? It is easy to be tempted by cookies or chips. What if we incorporate the same general qualities that attract us to those nutritionally “empty” snack foods such as sweetness, saltiness, and crunchiness, into healthier alternatives? Snacking also gives us the opportunity to make up for areas in our diet in which we are lacking. For example, if you aren’t getting enough protein and fiber in your diet, a good snack could be dried fruits and nuts.

It is crucial that we make healthy snacking easy to do, which means having healthy snacks ready on-hand, or those that would be quick to make. These include snacks such as celery and peanut butter, whole grain crackers and cheese, or fruit and yogurt. If you like to bake, consider making carrot-zucchini muffins, or oatmeal raisin cookies, which are healthy alternatives to cupcakes and chocolate chip cookies. Finally, resist buying items such as soda, cookies and chips at the store so that they won’t be there to tempt you later.

In conclusion, older adults who incorporate snacking into their daily eating habits are more likely to be meeting their daily caloric requirements, so snack away! But remember to snack smartly – healthy snacks give the biggest benefits!

Helpful Handout:  Handout_Healthy Snacking for A Healthy Lifestyle

Guest Blogger:  Gentry Lasater

1. Zizza CA, Tayie FA, Lino M. Benefits of snacking in older Americans. J Am Diet Assoc. 2007;107:800–806

2.”Snacking Can Benefit Older Adults” http://www.sciencedaily.com/releases/2007/05/070502074232.htm

3. http://www.cloudninemarketing.com/healthhealersnews/?p=1242

4. http://www.thebakingbeauties.com/2008/09/gluten-free-zucchini-carrot-muffins.html