People with dementia often forget to eat and drink and can become disinterested in food, with the malnutrition and dehydration that ensues causing even more damage to the person’s physical and mental state.
With 80 per cent of people in care homes living with dementia, it is vital staff are aware people with dementia are often unable to recognise hunger and thirst or due to being non-verbal may be unable to ask for food and drink.
Nearly 40 per cent of people admitted into care homes have signs of malnutrition, according to the Malnutrition Task Force which is made up of an independent group of health and social care experts.
Weight loss can cause pressure sores, muscle wasting, apathy and depression and heighten the risk of falls and infection, while dehydration can cause urinary tract infections, constipation as well as liver, joint and muscle damage.
Joanne Holmes, lecturer in nutrition at Bournemouth University, spoke at the recent Future of Care conference, highlighting the prevalence of malnutrition and dehydration in residential settings.
She said: “Malnutrition costs £13bn in the UK. Yet we rarely hear about malnutrition. It isn’t being recognised and as a result it is being under treated. It is obesity that gets the most press.”
‘We need to improve mealtime experience in care homes
To tackle this, Ms Holmes believes we need to improve the mealtime experience in care homes.
She said: “We need to break down that traditional model of three meals a day. It may be better to give smaller meals such as five to six mini meals a day and finger food.
“People who are living with dementia forget what different types of food there are. So they will often choose the same food every day as they don’t know what anything else is. It will help to give them visual prompts. If you know your residents you will get to know their food preferences.”
We have a tendency as we age to prefer sweet food and this is particularly so with people with dementia, according to Ms Holmes.
She recommends if you want to offer residents cake, “give them cakes with vegetables in like beetroot cake. You can also put fruit in savoury dishes. This will make sure residents still get the nutrients they need.
“As people with dementia tend to lose their sense of smell, it may help to use herbs and spices in the food to give it a distinct smell. Also offer residents food with a strong smell such as tomato puree or cheese.”
‘Don’t get too bogged down with what is nutritious’
She advises care homes to find out what people like to eat and don’t worry about getting “too bogged down with what is nutritious”.
In some cases, people with dementia won’t recognise what a cup of tea is and don’t realise it is a drink.
When this happens, care home staff can physically show residents what to do by using the copycat method and sitting down and having a cup of tea with them so they know what they are supposed to be doing.
In term of fluids, Ms Holmes recommends sometimes thinking outside the box and getting fluids into people with ice lollies or watermelons. Residents should be getting 1,500ml of fluid a day.
She has carried out research in care homes on nutrition and hydration and has found residential settings don’t tend to like serving tea and coffee as it is a diuretic but says “some people have been drinking 10 cups of tea a day all their life, who are we to say when they are 78, you can’t have 10 cups of tea a day”.
The actual mechanics of eating and drinking can also be problematic and care homes can purchase adapted cutlery and plate guards which will reduce spillages. Finger food is another option for residents that have problems with their coordination and manual dexterity.
Guidance from Coventry and Warwickshire University Hospitals recommends boosting people’s sight and perception by using brightly coloured crockery so they can more easily distinguish the food on the plate.
Care homes should also avoid distracting items such as patterned table cloths, vases or lots of condiments.
Ms Holmes has spoken to many care home residents during her research and found “mealtimes for them are the most important time of the day”. Involving residents in making the food will make them feel part of the process and get them interesting in eating. Good activities to make them feel involved include shelling peas, picking herbs and laying the table.
Ms Holmes also recommends making mealtimes an occasion and get everyone in the care home involved, even the gardeners and the cleaners. “Food and drink is so much at the heart of what we do in life. It shouldn’t be any different for people in a care home,” she says.
For more information on supporting people with dementia to eat and drink well, go to: http://www.bournemouth.ac.uk/nutrition