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)

Amp Up the Calories and Protein in Your Diet

Yesterday I was fortunate enough to listen to a case study given by a Registered Dietitian, like me, who is passionate about older adult health and nutrition. Her case presentation was about a gentleman who had recurrent c.diff and his struggle with eating and eating enough. During her presentation, I thought back to the many older adults I’ve worked with who have also dealt with malnutrition. Malnutrition is a common and a very serious problem among older adults.1

Malnutrition can occur for a number of reasons, including lack of adequate food intake, intake that would be adequate but is not properly absorbed or metabolized due to an illness or medical treatment, or increased needs, again possibly due to an illness or medical treatment.

Malnutrition puts you at increased risk for adverse health outcomes, such as increased susceptibility to infection, delayed wound healing, and impairment of both physical and cognitive function.2 Older adults are particularly susceptible to malnutrition because as we age our appetite naturally decreases – labeled “the anorexia of ageing.”3 Given this fact, it’s especially helpful for older adults to make sure that their meals are higher in calories and protein – without necessarily being larger in volume, which may lead to discomfort.

Easy Ways to Add Calories and/or Protein to a Meal:

  • Powdered milk
    • Mix a few tablespoons into a glass of milk, pudding, mashed potatoes, soup, milkshakes, yogurt, hot cereal, and pancake batter
    • Eggs (cooked)
      • Add to casseroles, meat loaf, mashed potatoes, cooked cereal, etc.
    • Butter
      • Add to pudding, casseroles, vegetables, hot cereal, bread, and pasta
    • Cheese
      • Add to casseroles, vegetables, potatoes, soups, sandwiches, eggs, etc.
    • Mayonnaise, Salad Dressing, Oil
      • Use liberally on sandwiches, salads, and bread, or to dip raw or cooked vegetables
    • Avocado
      • Add to sandwiches, salads, and casseroles
    • Evaporated Milk
      • Use in place of whole milk in desserts, baked goods, casseroles, and hot cereal
    • Sour Cream
      • Add to casseroles, potatoes, dips, sauces, and baked goods
    • Sweetened condensed milk
      • Add to pies, puddings, milkshakes
    • Nut Butter (peanut, almond, etc.)
      • Spread on bread, crackers, bananas, apples, celery, etc.
    • Gravy
      • Use liberally on meat, mashed potatoes, noodles, rice, etc.

A special thanks goes to Anne, co-author of this blog entry. You can read her blog at http://www.fannetasticfood.com

Sources:

1) Seiler W.O. & Stahelin H.B. (1999) Malnutrition in the Elderly. Springer, New York.

2) Sullivan D.H. (1995) The role of nutrition in increased morbidity and mortality. Clinics in Geriatric Medicine 11, 661-674.

3) Morley J.E. (1997) Anorexia of aging: physiologic and pathologic. American Journal of Clinical Nutrition 66, 760-773.

Older Adults Can Win…by not losing weight.

Older Adults Can Win by Not Losing Weight

With much of America concerned about losing weight and celebrating every pound dropped, it’s easy to forget that in older adults weight loss may happen unintentionally and that’s not something cheer about.  As eating patterns, habits, tastes, and preferences change, it’s important for older adults to consume enough nourishing foods to maintain a healthy weight, strong bones and muscles, and overall good health.

In older adults, losing weight can mean “losing health”

Research has shown that unintentional weight loss and low weight in older adults can lead to poor health outcomes, including frailty and increased risk of infection and disease.  Maintaining a healthy weight can help older adults remain independent longer and can decrease the length and number of hospitalizations if illness does occur[i].

There are many things that can contribute to poor calorie intake in older adults, from medication to isolation to an underlying medical condition[ii].  Consult with your doctor and/or a registered dietician to address any concerns that may be contributing to unintentional weight loss.

Make those extra calories count

To maintain or increase weight in a healthy way, additional calories eaten should be high in nutrition, especially protein.  As the major building block in bones, muscles, hormones, and enzymes, protein plays a key role in preserving and restoring health.  Adequate amounts of high quality protein foods eaten throughout the day—at every meal—have been shown to be especially important helping in older adults maintain muscle mass, which in turn keeps bones strong and helps prevent fractures and frailty[iii].

Getting adequate protein and calories is easy—and delicious!

  • Highest quality protein comes from meat, fish, eggs, and dairy.  Carefully combining plant products such as nuts, grains and beans is another way to get protein.
  • Quick and easy meals with plenty of protein can begin with:
    • 2 eggs cooked with 2 slices of cheese
    • A medium chicken breast (about 4 oz.)
    • 1 cup of cottage cheese
    • A 6 oz. can of tuna
  • Snacks with quality calories and additional protein are:
    • Cheese sticks, cubes, or slices
    • Nuts and nut butters of any kind
    • Milkshakes, puddings and custards made with added protein powder, dry milk powder, and/or cream

Guest Blogger:  Adele Hite

[i] Martin CT, Kayser-Jones J, Stotts NA, Porter C, Froelicher ES.  Risk for low weight in community-dwelling, older adults. Clin Nurse Spec. 2007 Jul-Aug;21(4):203-11.

[ii] Bernstein M, Luggen, AS.  Nutrition for the Older Adult.  Sudbury, Mass:  Jones & Bartlett, 2010.

[iii] Layman DK.. Dietary Guidelines should reflect new understandings about adult protein needs. Nutr Metab (Lond). 2009 Mar 13;6:12

Picture credits:

Top: http://www.nia.nih.gov/NR/rdonlyres/1A8A375D-8E45-42DB-9FAA-B15707FE9321/7778/pic08.jpg

Middle: http://nutritioncaremanual.org/vault/editor/Docs/High-CalorieHigh-ProteinNutritionTherapy_FINAL1.pdf

Bottom: http://www.rosieleescafe.co.uk/img/milkshake.jpg