What We Can Learn From the “Oldest Old”

OAA 2014It is finally the merry month of May and I wanted to wish y’all…a Happy Older American month! Bet you didn’t see that one coming did you? Every year, May is the time we celebrate older Americans and their contributions as well as raise awareness for issues that older folks face. If you ask me we should be doing that every day! This year’s theme for Older American month is “Safe today. Healthy tomorrow.” Basically the choices we make to stay safe (like avoid injury and preventing disease) will help us live healthier at an older age.

With this theme I’d like to bring your attention to the 90+ Study conducted by researchers from the University of California at Irvine (UCI).1 It is one of the few studies out there that focuses on the “oldest old,” what it takes to get there and what it takes to stay there. It also looks at dementia in this age group.

Celebrating your 90th birthday is a commendable feat, which is why there aren’t many people 90+ out there to study. But, it is important to understand this age group because we have a longer life expectancy and there will be more older adults who will reach the 90 year old mark and beyond. In 2010 the US Census Bureaus estimated there was 1.9 million Americans 90-and-older.2 This age group tripled in the last 30 years! Sadly, most people in their 90s had 1 or more disability and required some kind of assistance.2 A study like the 90+ Study could really help us understand how we can reach 90 but stay healthy.

The 90+ Study follows the oldest old and collects data on diet, physical activity, medical history, medications, and so forth. Then it uses this data to understand which factors are associated with living a longer and healthier life free from cognitive decline.1,3

happy 90

So far, the researchers have published several papers and have received more funding to continue this work. Here are some of their key findings:1,3

  • People who drank moderate amounts of alcohol or coffee lived longer than those who did not.
  • People who were overweight in their 70s lived longer than those who were normal weight or underweight.
  • More than 40% of people 90 and older suffer from dementia, while almost 80% are disabled. Both conditions are more common in women than men.
  • About half of those over 90 with dementia do not have sufficient Alzheimer’s-related plaque growth in their brains to explain their cognitive loss.
  • Individuals 90 and older who carry the APOE2 gene are less likely to have Alzheimer’s-like dementia but much more likely to have Alzheimer’s-related plaque growth in their brains.
  • Poor physical performance on activities such as walking is associated with increased risk of dementia

I don’t know where you’re from but in North Carolina, my home state, we are ranked #9 for people over the age of 60.4 This number continues to grow every day so I want to do my part in raising awareness for older adults. In the mean time I will continue to update y’all on trailblazing studies like this one. Comment below if any of the 90+ Study findings are intriguing to you.

Happy reading and a toast to all Older Americans out there no matter what age you’re at!

Special Thanks to Trinh Le for her assistance with this post.

Photo Credits

  1. Older American Month Logo: http://www.ncdhhs.gov/aging/images/OAM-logo2014.jpg
  2. Birthday Cake: http://4.bp.blogspot.com/_LQnvgKAniIU/S93jquxya-I/AAAAAAAAARI/IksAMHtzoL4/s1600/Black+and+white+90th.jpg


  1. http://www.mind.uci.edu/research/90plus-study/#sthash.6IPUkL5J.dpuf
  2. http://www.census.gov/prod/2011pubs/acs-17.pdf
  3. http://news.uci.edu/press-releases/national-institute-on-aging-renews-funding-for-ucis-90-study/
  4. http://www.ncdhhs.gov/aging/oamonth/

What’s anemia got to do with dementia?




A new study finds evidence that having anemia increases your risk for dementia.


As a part of healthy aging, we ought to care for our bodies as much as we care for our brain. There is a BIG connection between the two that we’re learning more about everyday.

Just this week I read some new research, which suggests that having anemia today might increase your risk for developing dementia in the future.  The study is called the Health, Aging and Body Composition study and it followed 2,552 men and women in their 70s for 11 years. Over this time, researchers found that the people who had anemia were more than 40% likely to have dementia over that 11-years compared to people who did not have anemia1.

But how do we know that anemia is directly causing the dementia? After all, dementia has many causes and risk factors like genetics, obesity, drug abuse, etc.  The truth is we don’t know for certain that anemia directly causes dementia. In the study, researchers did consider these other risk factors but still found anemia to be an “independent risk factor.” This means that even if anemia is your only risk factor for dementia you are more likely to get dementia than if you did not have anemia.

Anemia in older adults is pretty common and increases with age: someone who is 65-74 years old has an 8% of getting anemia but this quickly rises to 20% when they hit 852. Researchers acknowledge that it is not known if treating anemia will prevent dementia. But if you ask me, it certainly wouldn’t hurt!

It is safe to say that both you and I would rather not live with anemia or dementia. Just because we’re aging does not mean we should accept a lower quality of life. While some types of anemia cannot be prevented others can be.

Many types of nutrition-related anemias can be prevented eating a diet rich in iron, B12, folate and vitamin C. Here’s what you can add to your future shopping list3:

  • o Meats like beef, pork and chicken  (iron, B12)
  • o Beans and lentils (iron, folate)
  • o Breads and pastas (folate)
  • o Milk and cheeses (B12)
  • o Eggs (B12)
  • o Oranges, lemons, grapefruits (folate, vitamin C)
  • o Kale, collards, spinach and other dark leafy greens (folate, iron)
  • o Melons and berries (Vitamin C)

iron b12 folate foods







  1. http://www.agoritsaslaw.com/wp-content/uploads/2013/08/Anemia.jpg
  2. http://700childrens.nationwidechildrens.org/wp-content/uploads/2013/10/anemia-770×420.jpg



  1. 1.    http://www.alzinfo.org/03/articles/diagnosis-and-causes/anemia-tied-dementia-risk
  2. 2.    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572827/
  3. 3.    http://www.mayoclinic.org/diseases-conditions/anemia/basics/prevention/con-20026209

Favorite Reads for Easier Chewing and Swallowing

IMG_1495Like previous years, I’ve been on the road most of June and July visiting my students.  I’ve traveled 3200 car miles and taken 5+ plane rides.  Our students have done a 
spectacular job this summer during their clinical internships!!  Way to go Class of 2013!!

I’ve also done a lot of talking and researching about dysphagia and how to best prepare easy to chew and swallow foods.  As we learn more about this topic I realize that many foodservice operations and caregivers don’t have access to some really great resources.

If you are trying to tackle pureed foods or thickened liquids for your loved one there are two books that you must read.

1.  Soft Foods for Easier Eating by Sandra Woodruff, RD and Leah Gilbert-Henderson, PhD.  You will find techniques in meal preparation and gain access to some of the most flavorful and delicious recipes.  The authors have done an excellent job tackiling some hard to puree foods like pasta,  beef and fish.

Flavorful Fortified Foods2.  Flavorful Fortified Food by Digna Cassens MHA, RD and Linda S. Eck Mills MBA, RD, FADA.  If you have been looking for quick and easy ways to add LOTS of calories and protein this book with be your answer.  Digna and Linda have given you small portions that pack in the calories, protein and vitamins and minerals.  If the idea of an easy to prepare 8oz/1cup milkshake  made with real food that has 550kcals and 13 grams of protein sounds appealing…you will love this book!!

Happy Reading and it is good to be back!! ~Amanda

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!!



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

2.  Photo:  Kenan Crawford Hill

Creative ways to swallow crushed medications

If you are helping someone with medication management you may have encountered the need to “hide” their crushed pills in food.  Of course, we aren’t doing this to be deceitful but to help “the medicine go down”…as Mary Poppins would say.  Our goal is to use the food as the delivery method for the crushed medications.

It sounds easy until the person tires of the food or “discovers” the food is the delivery method for medications.  This may sound familiar to those of you who care for adults with dementia.

Here are some of my ideas on foods that can be used to deliver crushed meds:

-Yogurt (get the full-fat, whole milk kind: it works much better)
-pureed fruit (any kind…bananas, apricots, strawberries, mixtures)  We use the Gerber pureed fruits a lot (they are real tasty!!).
-Pimento cheese (delicious on a cracker)
-Any kind of salad (egg, tuna, etc.)
-Ice cream (just scooped)
-Grits (or Farina)
-Cheese dip (like pub cheese)
-Any kind of little debbie cake (I know, not what you thought you’d hear the dietitian say…but you can cut a swiss roll (or oatmeal cream pie, etc.) in half, put the meds in the cream and then put back together and serve with a fork). They are soft, easy to chew and have tons of flavor.
-Pudding or Mousse
-Avocados or mild guacamole
-Cottage cheese
-Cream cheese
Of course we aren’t talking a lot of volume for any of these…Enjoy!
Image Location:  nutella-spoon-2.jpg

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)

Dining With Dementia

The past few weeks have been busy around “the office.”  I’ve been driving around NC visiting students as they complete their clinical rotations.

I recently received an email from the folks at Chicagoland Methodist Senior Services (CMSS).  If you’ve never heard of  CMSS, visit here to learn more.  They are an incredible organization specializing in Chicago senior care.

Since both of us work with seniors who have dementia, we thought it would be a great idea to share practices around eating and dementia.  My post, Eating with Dementia provides five practical tips that will help mealtime be more successful.  Be sure to visit the link to learn more.

Karoline Hutson, with Chicagoland Methodist Senior Services, was nice enough to provide the below post:

Dining with Dementia:

A meal can easily turn into a stressful situation for someone with dementia – not to mention for the person providing care. In our memory support communities, we have found these tips helpful in creating a calm, pleasant dining experience for our residents:

  • Use different colored dishes. For example, use a red plate and a blue mug on a yellow placemat. This helps distinguish each item for their proper use in addition to defining the food on the plate.
  • Create a delineated space for each individual. When serving several people, use a square table rather than a round one; this can help to prevent confusion regarding which items are to be used by each person.
  • Play to the sense of smell and incorporate it into the dining experience. Using fresh herbs and spices helps to stimulate senses, memories, and conversation.
  • If there are options to choose from, do not use menus or verbal descriptions. Choices should be made after the food is seen, smelled, and perhaps even tasted.
  • If using utensils properly is an issue, serve finger foods or make the meal into a sandwich, which is easily done if you get creative. Now is not the time to worry about being neat and tidy.
  • If there is a loss of appetite that is leading to unhealthy weight loss, fortify a simple dish with extra ingredients. For example, serve a comfort food like mashed potatoes and mix in sour cream, cheese, or bacon to add some fat content.
  • Be sure that the dining environment is calm and free from distractions such as loud noises and unpleasant smells. Play soothing music and allow enough time for everyone to eat at their own pace.

The most important thing is remain observant – most problems can be easily solved with a keen sense of awareness and a little creativity. If you have any questions or want to share tips of your own, feel free to join the conversation at our Dealing with Dementia Facebook page!


Thanks Karoline!!  Happy Eating!

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!

Coconut, Dementia and Aging: Part 2

A few weeks ago I posted about coconut oil and the aging brain. If you do decide to try this with your older adult, here are some ins and outs on the use of coconut oil.

Coconut oil can be used to replace many cooking oils and is even safe for frying and baking. It is a solid at room temperature, but melts very easily. Some people will prefer to simply use coconut oil where they are already using other cooking oils, but what about the most effective dose for dementia patients?

For that we look to Axona, the FDA-approved medical food mentioned in the March 22 post. In total, each day’s worth of Axona contains 20 grams of medium chain triglycerides (MCT). Fast-forward through the math and that translates to 7 teaspoons per day of pure coconut oil to get the same amount of MCT. As with any oil, this is going to contribute about 275 calories and 32 grams of fat to the diet. Unlike many cooking oils, most of this fat is saturated.

If this regimen helps your older adult, the first signs of improvement will take weeks to months to appear and continual use of coconut oil will be necessary to sustain the benefits. With all of this coconut oil consumption, you might need to stock up. One of my students, who is an avid fan of coconut oil, suggested Spectrum and Nutiva if you’re looking in stores and Tropical Traditions if you prefer to shop online or buy in bulk.

As always, I would encourage you to talk with your physician or your registered dietitian about this before you begin.

Guest Blogger:  Hannah Martin


Image:  http://www.google.com/imgres?q=7+teaspoons&hl=en&client=safari&rls=en&biw=1738&bih=960&tbm=isch&tbnid=-BognOIG-bjCOM:&imgrefurl=http://www.tias.com/13609/PictPage/3923875153.html&docid=Msx8qqCQuXpWjM&itg=1&imgurl=http://www.tias.com/stores/hollylane/pictures/cc8182a.jpg&w=299&h=287&ei=iVqRT_6iEo-I6AG4lI2sBA&zoom=1&iact=hc&vpx=1318&vpy=606&dur=339&hovh=220&hovw=229&tx=158&ty=126&sig=112940717231066151774&page=1&tbnh=139&tbnw=147&start=0&ndsp=43&ved=1t:429,r:32,s:0,i:139


Coconut Oil, Dementia and Aging: Part 1

Do you drink coconut water?  Do you cook with coconut oil?  What are the benefits of each? I’ve been getting a lot of questions about coconut and health.  I thought it might be time to bring it up here.

First, let’s have a quick lesson on coconut and it’s components.  Coconut oil is the oil that is withdrawn from the meat of matured coconuts.  Coconut water is the liquid inside the coconut that has a milky looking consistency.  Coconut oil is of interest to many because it holds up well at very high temperatures (especially during frying) which is due to its high saturated fat content  (something that isn’t that great for your heart).  Coconut water has peaked in popularity because it is a natural source of electrolytes, like that found in many popular sports drinks.

Recently, there has been more and more in the press about the benefits of coconut oil for patients with dementia.  I know many of you may have watched this video on YouTube:

This video has also been on Twitter and is under discussion in support groups.

The component of coconut oil that is of interest is MCT.  MCT’s or Medium Chain Triglycerides are commonly used in dietetic practice as a type of replacement fat for clients experiencing fat malabsorption or having lots of GI distress after eating fatty foods.  They are helpful because they do not require bile acids for digestion.

MCTs may also help with managing some forms of dementia.  Why is this?  Well, the brain uses two types of fuel:  1.  glucose and 2.  ketones.  Glucose, which comes from the breakdown of carbohydrates, is the brain’s preferred source of fuel or energy.  As we age and cognitive decline sets in, the brain doesn’t use glucose quite as well.  The aging, cognitively impaired brain seems to continue to use ketones well, if available.  Ketones come from the breakdown of body fat and/or from including MCTs in the diet.

The big questions is:  Does the aging brain, in someone with dementia, work better on ketones?

One of the speediest ways to get ketones to the brain is to increase the number of MCTs in your diet.  Coconut oil is made up of ~50-60% of MCTs.  Other sources of MCTs are Axona (~50% MCT), a medical food, or  straight MCT oil (100% MCT).

Some patients, with some forms of dementia, have seen mild improvements in their memory and in performing simple tasks when increasing the amount of MCT in their diet.

Is coconut oil safe? Want to know how much to add?  For how long? AND What type of coconut oil to use?  Be sure to re-visit the blog next week as our discussion continues…