1. Minimising undernutrition in older adults with dementia Jennie Jackson, Jayne Brown, Yvonne Robb, Kay Currie and Cheryl Graham Glasgow Caledonian University

2. Background to our review Dementia – a collective term for a number of conditions – progressive decline in an individual’s functioning Demographic ageing – by 2025 one million people in the UK will have dementia (Alzheimer’s Society, 2007) People with dementia often experience difficulty eating and may have poor intake

3. Reasons for poor intake

4. Nutritional Requirements May be increased energy requirements due to pacing, wandering and increased activity Older adults have similar or increased requirements for vitamins and minerals but generally smaller appetite –Nutrient-dense diet required –Appealing and enjoyable food

5. Effects of undernutrition Unintentional weight loss Dehydration Pressure sores Increased susceptibility to infections Poor wound healing

6. Meaning and Importance of Food Mealtimes should be enjoyable Social interaction Promoting autonomy Involvement in preparation of food

7. Interventions to minimise undernutrition in older adults with cognitive impairment There are numerous possible interventions ranging from dietary advice to assistance with feeding to percutaneous endoscopic gastronomy (PEG) feeding

8. Objective of the review This review seeks to establish what is best practice in preventing under- nutrition in older adults with dementia –The review will focus on older adults who are not living independently –It will not include studies of the effect of particular nutrients on cognitive function –It will not include enteral tube feeding

9. Criteria for selecting studies for this review To investigate the effectiveness of interventions to improve nutritional intake: –RCTs –Quasi-experimental studies –Cohort studies –Case control studies –Observational studies without control group –Qualitative studies

10. Types of participants Adults over the age of sixty Exclusions –People with alcohol-related dementia –People with dementia living independently

11. Types of interventions Nursing practices Educational interventions for healthcare staff Medical practices Food service practices Dietetic practices Dietician assistant practices Occupational therapy practices

12. Types of interventions contd. Inclusion or exclusion of family carers Speech therapy practices Volunteer practices

13. Types of outcome measures Dietary intake Anthropometry eg weight, BMI, mid-arm muscle circumference Biochemical indicators Clinical outcomes: length of hospital stay, mortality, prevalence, and incidence of malnutrition

14. What do we hope to achieve? Use review to inform best practice Identify under-researched areas for future research projects Promote multi-professional/ multidisciplinary care Put into practice our systematic review training

15. Food provision for older adults with dementia at Marcus Humphrey Residential Home and Daycare Centre, Bridge of Weir