Parkinson’s and good eating
Loss of appetite and difficulty in swallowing are symptoms of this disease but can be handled with dietary planning. By Jamie Sheard.
Aged Care Insite -
Parkinson’s disease is becoming more common, particularly as the Australian population ages. Figures from 2011 suggest it affects about 64,000 people, with about 6600 living in aged care facilities.
The symptoms of Parkinson’s can present challenges for maintaining adequate food and fluid intake. Visible symptoms that are associated with the disease include: tremor, slowness of movement, stooped posture, poor balance and difficulties with walking.
These can be accompanied by a loss of fine motor skills and the inability to handle small objects. These symptoms degenerate as the disease progresses, making it more difficult to handle eating utensils and can extend the time required to eat.
A number of symptoms also occur that are not visible. Many of these are related to ageing, but occur with greater severity in Parkinson’s. As with ageing, the senses are affected, with loss of smell and taste commonly occurring. As a result, loss of appetite can occur and lead to a lack of interest in food.
In addition, the automatic movements of the gastrointestinal system slow down which can result in dysphagia (difficulty swallowing); feeling full quickly and gastric reflux due to slow emptying of food and fluid from the stomach; and constipation. Slow movement of the gastrointestinal muscles can be exacerbated by a lack of physical activity.
People with Parkinson’s disease may not report difficulties with swallowing but may compensate by eating smaller bites of food, avoiding some foods which are too difficult to swallow and eating more slowly. Feeling full quickly and discomfort from constipation may also result in less food being eaten. Mentally, the disease can result in dementia, increased anxiety and depression, which can result in forgotten meals/snacks and again, a lack of interest in food.
Because of these symptoms and a potential decrease in food intake and unintentional weight loss, protein-energy malnutrition can occur.
Medications, such as Levodopa
The dopaminergic cells in the brain are affected by Parkinson’s, and less dopamine is produced. Management of the disease often involves medications containing levodopa, which is converted to dopamine, or medications which assist the body to use its existing dopamine.
Levodopa is absorbed in the small bowel, and the transit of the medication through the gastrointestinal system can be slowed due to food in the stomach. This can delay the effect of the medication and therefore symptom control.
Therefore, medication containing levodopa should be taken on an empty stomach to ensure optimal effectiveness. This may cause nausea in some people, but this can be managed by taking it with a small snack that is easily digested.
What can be done?
• Ensure that Parkinson’s disease medication is taken on time and, if possible, 30 minutes to one hour before a meal. This will help to better control symptoms, particularly if the person has difficulties with tremor, co-ordination and slowness of movement. Better control of symptoms may help with self-feeding.
• Provide adaptive eating utensils, plates and cups, which can help to manage movement related symptoms, particularly for difficulties handling utensils and spilling from cups due to tremor.
• Provide assistance whenever required, particularly if slowness of movement is prominent.
• Provide a social, pleasant environment in which to eat. While the food may not hold a great amount of interest, the environment can.
• Be alert to consistent coughing or choking while eating or drinking as this can indicate difficulties with swallowing. Excessive drooling can also be a sign that the swallowing reflex is declining.
• Ensure appropriate food textures and fluid thickness if dysphagia is an issue. Consider frequent, small meals/snacks for someone who gets full easily or who suffers from gastric reflux.
• Offer nutrient- and energy-dense choices such as nutrition supplements to help ensure adequate intake in those who find it difficult to eat sufficient quantities of normal meals and snacks.
• Monitor weight. This can alert staff to unintentional weight loss, which may result in protein-energy malnutrition. A referral to an accredited practising dietitian (APD) may be appropriate.
Each person with Parkinson’s typically has a different set of symptoms so taking the time to determine which one(s) specifically are affecting each resident can be important in the appropriate management of those symptoms.
Maintaining appropriate food and fluid intake for someone with the disease is similar to that of other residents who may struggle with meals. The most important difference is following the prescribed frequency of medication for the management of the symptoms as this will ensure the resident has the best possible function and symptom control.
Jamie Sheard is an APD. Her article is written on behalf of the Dietitians Association of Australia, Rehabilitation and Aged Care Interest Group. To find an APD, visit www.daa.asn.au or call 1800 812 942.