When you think about treatments for Parkinson’s disease you probably think about physiotherapy and medications first. While both are incredibly important in managing Parkinson’s, an unexpected ally in helping fight the effects of the disease is dietetics.
People living with neurological conditions, such as Parkinson’s, can be particularly vulnerable to nutritional deficits, resulting in malnutrition, higher risks of falls, infections, and hospitalisation. Which is why dietetics and our dietitians are an integral part of treatment, supporting good nutrition in the face of reduced food intake caused by conditions like Parkinson’s and the body’s affected ability to absorb nutrition.
Malnutrition affects more than 15% of people living with Parkinson’s disease, with a further 24% being at a moderate to high risk.* This increased nutrient requirement can come from energy expenditure with tremors and altered gait, from altered consciousness or cognition that contributes to increased nutrient needs, or from reduced ability or reduced motivation to eat.
Additionally, approximately 80% of people living with Parkinson’s will develop dysphagia (pronounced dys-fay-jah)*, which is difficulty swallowing. For both our in-home and residential aged care clients, weight loss is a key indicator of disease progression. The weight loss can signify loss of fat and muscle, which contributes to negative outcomes.
How do dietitians help fight the effects of Parkinson’s?
Dietitians ensure that those living with Parkinson’s get the nutrition they need to improve their quality of life. They take into consideration behavioural and environmental factors, such as mood changes, food preferences, and social environment, when planning a meal plan. Vitamin D is one vitamin that dietitians pay attention to, to ensure the client is getting enough. Those who are vitamin D deficient and take supplements appear to have slowed progression of the disease.
Aged Care Dietitians are also heavily involved in the planning and complex requirements of tube feeding to ensure clients are receiving the precise nutrition they need to manage their condition.
And of course, quality of life and happiness for each client is a large focus of what we do. Our dietitians look for opportunities to creatively incorporate food preferences into client nutrition plans in a safe and supportive way.
How dietetics works alongside other health professionals
Nutrition has a key part to play in and alongside other allied health professionals when managing Parkinson’s disease. Offering nourishing food is one thing, but having strategies in place to actually get a person eating that food is where the magic of dietetics happens!
Some ways community health dietitians work alongside others to limit the impact of Parkinson’s disease include:
- Working with Speech Pathologists which minimise the impact of dysphagia through encouraging and monitoring food texture and fluid thickness.
- Working with Physiotherapists and Occupational Therapists to preserve muscle mass and mobility, supporting carers, and identifying the need for meal assistance and environment aids for meal times.
- Working with all health professionals to manage dehydration, impaired consciousness, fatigue, cognitive changes, wandering, and tremors.
Now that you’ve heard about all the ways dietetics can help those with Parkinson’s disease, let’s look at a real-life case in which dietetics has played a key part.
Joyce moved to residential aged care on a background of acopia with Parkinson tremors/rigidity. The tremors/rigidity and ‘off’ times continued to make eating a challenge for Joyce.
Joyce was keen to maintain her independence with food choices and eating and was keen to regain recently lost weight. Joyce was treated initially with an oral medication, and the impact of dietary protein competing with the medication needed to be considered. Our dietitian worked with Joyce to design a High Energy High Protein diet (HEHP), inclusive of nutritional supplements to assist with weight gain. However, over time Joyce’s acceptance and tolerance of her nutritional supplements waned and she agreed to change her goal of weight gain to weight maintenance. Joyce continued to make her own dietary choices from the menu, focusing on HEHP options, such as additional milk or cheese, ensuring she completed her dietary protein component of main meals and supplementing her diet with her self-purchased nuts. Joyce reduced her intake of nutritional supplements.
Over time Joyce was considered for Duopa Therapy and a Duopa pump was inserted to pump medication directly to her intestine through a tube. This new treatment regime significantly improved Joyce’s symptoms and she was able to continue to eat independently and maintain her body weight without nutritional supplements.
Recently our dietitian became reinvolved in Joyce’s care after Joyce’s weight slowly started to decrease, and was keen for further intervention. Joyce was willing to recommence nutritional supplements, acknowledging that she was unable to orally consume adequate calories and protein, while still being keen to stop her weight loss. Joyce has continued with her new oral nutritional supplement regime, she continues to be able to self assist with meals.
Our dietitian will continue to monitor Joyce’s weight and acceptance/tolerance of her nutritional supplements and work with Joyce to ensure she continues to be happy self-managing her menu choices.
As you can see, without a dietitian’s support, Joyce’s quality of life would have suffered and she would have been at risk of malnutrition. But with continued support from our dietitian, Joyce will be able to continue to enjoy the food she likes.