Supporting a person with dementia who lives at home to eat well

Over time a person with dementia is likely to develop problems preparing food, using cutlery, recognising food and drink, and remembering to eat and drink. In time, they may develop problems with chewing and swallowing also.

One of the biggest challenges for home care staff is having enough time to support a person at mealtimes.

When a person with dementia lives at home – especially if they live alone – these problems can lead to poor food and fluid intake. Malnutrition and dehydration can increase a person’s care needs, worsen the symptoms of dementia and increase the risk of delirium, an acute confusional state.

So, supporting a person with dementia who lives at home to eat and drink well is crucial. This feature looks at some of the most important things home care workers need to know to support a person with dementia who lives at home to eat and drink well.

Where to start? Helping the person to choose foods they enjoy

It’s important to try to offer a choice of foods and to show the choices to the person. For example, if you’re trying to work out a person’s food preferences, show two types of breakfast cereal or hold up two tins of soup. This will help the person to make the connection more easily between the words you are using and their memory of that food (for more on this, see the feature in this section ‘Promoting independence at mealtimes’).

If a person has difficulty expressing their preferences, they may still point or look closely at the item they prefer. Observing a person during mealtimes will also give some indication as to how well they are enjoying their food.

By reading care plans, and talking to colleagues or family members, we can get vital information about a person’s preferences. Remember that preferences can change too – for example, a person may not choose to drink coffee now despite enjoying it enormously in the past. Much of how we support a person will depend on what we know about that person, and whether we have communicated this information to others in the care team.

Systems for getting food into the house

Sometimes, the food that is available to cook with may be limited or not suit the person’s preferences and capabilities to eat. This is more likely to be the case if the person who does the food shopping is not involved in the day-to-day care of the person (perhaps another home care worker, or a family member who lives at a distance).

Whoever does the shopping needs to know up-to-date information about the person’s changing needs, preferences or routines to ensure there is always enough food in the house. Is the food being eaten? Are the person’s tastes changing? Are essential items such as milk or bread running short before the next trip to the shops? This sort of information should be recorded in the care plan on a daily basis.

Shopping via the internet could be a good solution. This may be done by the family or the care worker may sit with the person, devise the list of foods they would like, and send this to social services to order. Depending on the locality and care package in place, this system may vary.

Involving a person with dementia in food preparation

Involve the person in preparing the food, if they are able to do this. This is an opportunity to engage the person, stimulate interest and appetite, and preserve skills and self-esteem.

Each person will have their own way of participating or being involved, which most likely will depend on the role and skills the person had before developing dementia. Washing a piece of fruit, peeling vegetables, buttering toast or bread, unwrapping packaging, laying the table, stirring soup in a pan or just watching the cooking process are all good ways of involving the person.

It takes time: supporting a person with dementia at mealtimes

One of the biggest challenges for home care staff is having enough time to support a person at mealtimes. Offering this support – for example, prompting and encouraging a person to eat – takes time and patience, and is as important as the quality of the food prepared. Food and drinks that are left untouched are of no nutritional benefit.

If you are finding that you need more time to give proper support at mealtimes, report this to your line manager. Social services need to be aware of extra needs a person may have and if a reassessment of time or type of input is required.

Ideas for keeping up intake of fluids

Good hydration is vital for the body and brain to function. If a person with dementia is living alone, they may struggle to take in enough fluid. This may worsen the symptoms of their dementia, increase the risk of urinary tract infections, exacerbate the risk of constipation or increase the toxicity of medications. All of these problems can contribute to the development of a delirium (an acute confusional state). This is a serious condition that needs prompt medical attention (for more on this, see NICE, 2010).

Some practical suggestions for keeping up liquid intake are:

Cut out the cutlery: simple meals and finger foods

A person with dementia may struggle to use cutlery to eat if their coordination and sequencing skills decline. Often it is much easier to use fingers and hands to eat rather than cutlery. A spoon may be easier to use if food is cut into bite-sized pieces, avoiding the need for a knife.

Offering soup in a mug may be easier. Serving baked beans in a dish and with slices of toast can allow a person to eat with a spoon and pick up the toast with their hands.

For more on this, see the feature in this section, Promoting independence at mealtimes.

Snacks available throughout the day

A person may not want to eat the standard three meals a day, preferring to snack regularly. Make sure that snacks are easy to find throughout the day. Leave items of food in visible places around the house. Sandwiches, slices of cake, mini-muffins, pieces of flapjack, fruit cake, buttered scones and a selection of chopped fruit can be left in well-used areas – such as a living room – rather than in the kitchen. Make sure that food left out does not perish and is disposed of if uneaten.

Do written reminders help?

If food or snacks are left out of sight they are less likely to be eaten, as the person will not be prompted to eat by seeing the food. Some people may find it helpful to have a note that reminds them where the food is, for example, ‘Sandwich’ placed on the fridge door, or simple instructions left to reheat food in the microwave, such as ‘HIGH for 3 minutes’. Whether written reminders are helpful and understood can vary from one person to the next so do try this approach, but remember that it may not work for everyone and will need a review over time as abilities alter.

Chewing problems: causes and ideas to help

If a person has difficulty chewing foods due to poor dental health, loose-fitting or missing dentures or a sore mouth, it is better to try softer textured food. Dental treatment may be necessary or dentures may need to be adjusted or remade if the fit is poor. Always report such observations to your line manager so that the variety of food purchased for the person is of a suitable texture and any necessary appointments can be made. For more information and guidance on food preparation, see the feature in this section on ‘Chewing and swallowing problems’.

Swallowing difficulties

If the person you are supporting shows any sign of a swallowing difficulty, report this to your line manager. Don’t assume that blending or liquidising food is the answer – blended or liquidised diets are often bland, unappetising and nutritionally poor. Having the right equipment available to blend food is also important as the end texture can vary according to the foods and equipment used.

There are many ways to help in this situation, but the person needs to have an assessment from a speech and language therapist to determine the best strategies and most suitable textures of food. GPs can make a referral for a speech and language therapist.

People who have difficulty swallowing are at a higher risk of malnutrition than those without. Support from a dietitian and provide information and give advice on increasing calorie content of food and drinks offered, as well as providing tips and strategies to help when modifying the texture of foods is advisable. A dietitian can be accessed through a referral to a person’s GP.

For more on swallowing difficulties and food preparation, see the feature in this section, ‘Chewing and swallowing problems’.

Other ways of supporting a person to access good meals

Local day centres or lunch clubs can offer social contact and company – as well as a meal. For some people, this could be a good solution to getting access to nutritious food. Social services will be able to advise on the local availability of these sorts of services. Local charities or voluntary groups may also provide these services: The availability of meals delivered to people with care needs living in the community – usually known as ‘meals on wheels’ – also varies across regions. Social services will assess a person’s need for a delivered hot meal or a pre-prepared frozen meal which they can then reheat in a microwave. For more information on community-provided meals, visit the website of the National Association of Care Catering.

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