Dietary Issues in the Care of the Mentally Disabled

General information:

The target group of people with mental disabilities is very heterogenous. It includes all ages. The degree of mental disability varies from subnormal to very severly mentally disabled. In addition, there are associated problems in motor function, sensory function, communicaton, behavior and medication use. The dietary problems are determined on an individual basis and vary widely. The level of functioning, environment and ability to communicate are limiting factors and make the dietetic treatment complex, especially due to a lack of frames of reference and serviceable tables for screening and determining nutritional status. In view of this complexity, referral to a dietician specializing in care of the mentally disabled is preferred. In the Netherlands, such dieticians are members of the network called “Diëtetiek Verstandelijk Gehandicaptenzorg (DVG)” and have specialized expertise.

Best time to refer to the dietician:

• when there are neurological/movement disorders (epilepsy, spasticity, tetraplegia, scoliosis), in some cases combined with the following:

• problems chewing and swallowing
• aspiration (pneumonia)
• undernourishment
• pressure ulcers
• (initiation of) enteral nutrition
• gastrointestinal disorders (celiac disease, chronic constipation, GOR, PDS)
• fear, pain and food aversion
• syndromes (Angelman, Cornelia de Lange, Down, Prader Willi)
• disorders in the brain’s satiation center
• behavioral problems (i.e. in autism and autism-related disorders)
• inexplicable food refusal, regurgitation, limited dietary pattern
• appetite suppression or stimulation, influencing absorption and metabolism of nutrients
• chronic diseases (cancers, ulcerative colitus, COPD, diabetes mellitus, cardiovascular diseases, Crohn disease, Parkinson disease)
• aging and pathological aging (Alzheimer disease)
• problems chewing and swallowing, aspiration (pneumonia), malnutrition, pressure ulcers, enteral nutrition, oral taste sensation.

• if an inpatient in an institution: screening of nutritional status
• new living situation or residence (independent or assisted living): menu planning, purchasing, pantry/supply management, hygiene and food preparation.

Relevant information for the dietician:

• Diagnosis: cause and extent of mental disability and/or syndrome, any comorbidity, medical history
• Laboratory tests: if applicable
• Medication: antiepileptics, antidepressants, antipsychotics, laxatives, proton pump inhibitors, psychopharmaceuticals, thyrometics
• Other: height, (changes in) weight, degree of mobility, chewing and swallowing function, defecation, other care providers (physician, doctor for the mentally disabled [Arts Verstandelijk Gehandicaptenzorg (AVG),] occupational therapist, physical therapist, speech therapist, oral hygienist, (remedial) educators, level of functioning, communication (limitations), educational and psychological aspects.

Aims of the diet:

• to prevent, eliminate, reduce and/or compensate for symptoms and conditions related to nutrition, in order to contribute to the recovery, preservation or improvement of the client’s state of health and/or well-being
• advise, supervise and treat the client and his living environment (total client system)

Treatment time:

• Care level 4, see “Dietician’s working methods.”

Specific remarks:

• The complex care issues demand a multidisciplinary approach to treatment and interdisciplinary cooperation
• The dietary treatment should be part of the total treatment plan. It is included as a goal in the individual care/support plan.
• Arrangements regarding risks (as in the case of swallowing problems) and arrangements regarding methods and measures (such as forced administration of fluids or enteral nutrition) should be taken up in the treatment/support plan.

References:

ADA Reports. Position of the American Dietetic Association: Providing Nutrition Services for Infants, Children, and Adults with Developmental Disabilities and Special Health Care Needs. Journal of the American Dietetic Association: 2004

Cassidy SB, Allanson JE. Management of Genetic Syndromes. New York: Wiley-Liss: 2004

Dosen A. Psychische stoornissen, gedragsproblemen en verstandelijke handicap. Assen: Koninklijke van Gorcum BV: 2005

Rooymans PG. Informatorium voor voeding en diëtetiek, (2005). Voedingsaspecten bij gehandicapten, Hoofdstuk XVI. Voeding bij mensen met een verstandelijke beperking. Houten: Bohn Stafleu van Loghum

Veugelers R, Calis EAC et al. Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Journal of Intellectual Disability Research: 2006

Dietary Issues in the Care of the Mentally Disabled was updated by Marije van Enckevort-Willems, dietician at Prisma and Neeltje, dietician at ’s Heeren Loo Midden Nederland, writing also on behalf of the network Diëtetiek Verstandelijk Gehandicaptenzorg (DVG).