title: Meal delivery practices do not meet needs of Alzheimer patients with increased cognitive and behavioral difficulties in a long-term care facility.
abstract: BACKGROUND
  Alterations in circadian rhythms and behavioral difficulties likely impact meal consumption patterns in elderly individuals with probable Alzheimer's disease (AD). Despite these known changes, the profile of meals provided in the institution parallels the needs of younger, free-living, healthy populations. This investigation examined the impact of food delivery patterns on achieved intakes in elderly individuals with probable AD in a long-term care facility and how this relationship changes depending on time of day, body weight status, behavioral function, and cognitive ability.
  
  
  METHODS
  Twenty-one consecutive days of investigator-weighed food intake and delivery collections were conducted on 25 elderly individuals with probable AD who maintained the ability to self-feed.
  
  
  RESULTS
  Energy consumed was positively associated with energy delivered for the majority of subjects, although the strength of this relationship varied across subjects and throughout the day. Energy delivered had the greatest impact on energy consumed at breakfast and the least impact at dinner in those with the greatest behavioral difficulties and cognitive impairment. Although those with low body mass indexes (BMIs) were likely to be delivered more energy, the impact of delivery on intakes decreased as energy delivered increased.
  
  
  CONCLUSIONS
  Delivering excess energy to patients with poor BMIs likely does not result in increased energy consumption. Behavioral and cognitive deterioration leads to a shift in the time of day that energy delivered has an impact on energy consumption, with the most progressed individuals being most impacted by foods delivered in the morning, suggesting that traditional meal practices are inappropriate for elderly individuals with AD.
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada. karen.young@utoronto.ca
authors.forename: K W
authors.initials: KW
authors.lastname: Young
authors.forename: M A
authors.initials: MA
authors.lastname: Binns
authors.forename: C E
authors.initials: CE
authors.lastname: Greenwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000628:therapy*; D002170:Canada; D003072:Cognition Disorders / Q000175:diagnosis; D003625:Data Collection; D005247:Feeding Behavior; D005260:Female; D005522:Food Services / Q000592:standards* / Q000639:trends; D006301:Health Services Needs and Demand; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000458:organization & administration*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D009751:Nutritional Requirements; D009752:Nutritional Status; D012044:Regression Analysis; D012720:Severity of Illness Index