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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Nutrition in Mental Health

Focus on Seniors

Erica Messing, RDN

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.29-30

Older adults are sensitive to nutritional deficiencies and imbalances. Although they have at least the same needs for vitamins, minerals and other nutrients as younger people, they need fewer calories. In other words, seniors require less food but more nutrients. Ideally, seniors could solve this problem by eating more “nutrient-dense” foods such as whole grains, whole fruits and vegetables, low-fat dairy (or alternatives), and low-fat meat and alternatives. However, this often does not occur in healthy seniors, never mind seniors with mental illnesses. A person with a mental illness experiences the “nutrient/energy paradox,” as well as their own unique problems that makes him or her very susceptible to nutritional compromise.

Seniors Who Have Long-Term Mental Illnesses

As people with mental illnesses age, the potential for nutritional compromise increases. Chronic use of psychotropic medications, chronic concurrent disorders and symptoms of the illness itself all contribute to the increased nutrition risk as people age.

Medications

Many psychotropic medications have nutritional side effects. People using lithium, for example, must maintain a consistent level of hydration in order to avoid lithium toxicity. Antipsychotics often cause weight gain, carbohydrate cravings and dry mouth. Antidepressants may help to alleviate the appetite (and weight) loss associated with depression, and some may force the patient to restrict their tyramine [an enzyme occurring in commonly eaten foods like cheese] intake to avoid hypertensive crises. Mood stabilizers such as anticonvulsants can cause secondary folate, B12, B6 and vitamin D deficiencies if they are used for long periods of time, especially in combination with certain other medications. Finally, all medications can cause weight loss, gastrointestinal upset, and constipation or diarrhea. With such diverse reactions, people taking these medications often undergo changes in eating habits.

Chronic Co-occurring Disorders

Substance abuse and dependence is widespread in people with mental illnesses. Alcohol is a common choice among older adults. Chronic alcohol abuse has many nutritional side effects, both in the short and long-term. In the short-term, people abusing alcohol may find that they lose their appetite, and thus stop eating, which in turn leads to malnutrition.

The long-term effects of alcohol abuse become evident as people age. Chronic alcohol use impairs the ability of the gut to absorb nutrients. The result is diarrhea from malabsorption. Chronic alcohol abuse also makes it difficult for the liver to process nutrients once they are absorbed. This can result in secondary vitamin and mineral deficiencies, such as scurvy (vitamin C deficiency), osteopenia, osteomalacia, and osteoporosis (calcium, magnesium, and vitamin D deficiencies), clotting disorders (vitamin K deficiency), and a whole host of symptoms from B vitamin deficiencies. Thiamin and magnesium deficiencies are dangerous complications that can have devastating side effects if a person goes through withdrawal without medical supervision. During withdrawal, supplemental thiamin and magnesium are needed to prevent permanent brain damage from Wernicke-Korsakoff ’s syndrome [a condition associated with memory loss and other symptoms]. If a person has abused alcohol to the point of alcoholic hepatitis and cirrhosis [diseases of the liver], there are many more nutrition complications.

Mental Illness Symptoms

Symptoms of mental illnesses can sometimes interfere with an individual’s ability to maintain good nutrition. For example, people with chronic eating disorders are almost always malnourished. People with delusional systems around food and eating are at risk for malnutrition, overnutrition, or oversupplementation [overnutrition results from eating too much, eating too many of the wrong things or not exercising enough. Oversupplementation is a specific form of overnutrition resulting from taking too many vitamins or other dietary replacements]. People in manic phases of illness often stop eating, as do people in depressed phases of illness.

Seniors Developing Mental Illness As They Age

Mental illness can develop at any age. Illnesses such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and multi-infarct disease [a condition resulting from stroke or heart attack] can have a profound effect on people’s dietary intakes. This in turn affects people’s nutritional status.

As these illnesses progress towards dementia, some people experience an increased sweet tooth. Research is being conducted into why this occurs; there is some speculation that the carbohydrate craving may be secondary to one or more B-vitamin deficiencies. Other people begin to “wander,” expending large amounts of energy. At the same time, they may lose recognition of food, or be unable to stay still long enough to eat or drink anything substantial. These behaviours can result in profound weight loss, coupled with malnutrition. Finally, many diseases that result in mental illness also result in dysphagia, or compromised ability to swallow safely and effectively. This may also lead to poor nutrition intake and malnutrition. If a person experiences dysphagia but is no longer able to explain his or her symptoms, it can be difficult for clinicians to understand why the patient has suddenly stopped eating or drinking.

What Can Be Done?

Regardless of the cause of the nutrition compromise, the solutions are the same.

Encourage the person with the illness to eat as wide a variety of foods as is tolerable to them. Dietitians are available to provide help, advice and advocacy in hospitals, facilities and the community. For people who have developed a nutritional side effect of a medication, co-occurring disorder, or mental illness, a referral to a dietitian is a good idea.

In the meantime, liquid nutrition supplements (commercial or homemade) are often indispensable in hydration, protein supplementation, and in helping maintain adequate nutrition if the person has trouble tolerating eating, chewing or swallowing. They can be used to satisfy the sweet tooth of the person who is developing dementia while at the same time providing some of the potentially-lacking nutrients. These can be used for short or long durations. People who do not wish to have liquid supplements may find it more difficult to obtain adequate nutrition, especially in hospitals and facilities. “Wanderers” should be tried with foods that they can take with them, such as finger foods or a nutrition “tool belt,” fitted with munchies to help them achieve their energy and nutrient needs.

Food textures and fluid consistencies must strike the balance between safety and pleasure for the person with dysphagia.

Finally, it’s a good idea for most seniors with mental illnesses to take a multivitamin and mineral supplement daily, if they can afford it. Further supplementation should only be done at the advice of a dietitian and physician

 
About the author
Erica is a Registered Dietitian in Mental Health for the Vancouver Island Health Authority.

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