Dementia Gateway: Eating well for people with dementia

Case study: Food choices: can reminiscence help?

Newly arrived resident Annie is having difficulty making it clear what she would like to eat, and care staff are worried because she's losing weight.

Background

Good nutritional care for a person with dementia depends on knowing some basic information: what the person likes to eat and drink, what they don't like, and what they find difficult to eat too. But sometimes, when a person moves to a care setting, care staff find it hard to get this information, perhaps because the person has difficulty communicating in words (because of the dementia). Quite often too, the person does not have friends or family who can provide this sort of information.

This case study explores how reminiscence was used as way of finding out more about newly arrived care home resident Annie, and her preferences for eating and drinking.

Learning just one small piece of information about Annie's life had an enormous impact on her nutritional care.

Read the full case study:

Understanding the situation - 1. The story so far Open

Annie had been living alone in a sheltered housing scheme. She had a diagnosis of Alzheimer's disease, and was struggling to cope in her own home despite an extensive care package. Annie moved to live in a nearby care home to ensure she had 24-hour care and support. Her family lived several hundred miles away and didn't visit much. She had few close friends.

When Annie moved to the care home, it was clear to the staff team that she must have been having problems eating and drinking at home: she was undernourished and frail, and her clothes and rings were loose. Care staff were keen to address this and find strategies to encourage Annie to eat and drink.

Unfortunately the team had little information about Annie at all to go on, in particular around her food preferences and mealtime patterns. Annie's ability to communicate was limited, and her relatives couldn't help. The social worker and the home care staff also seemed unable to provide this sort of information.
Understanding the situation - 2. Research and development findings Open

The book, 'Memories are made of this: Reminiscence activities for person centred care', by Julie Heathcote (Alzheimer's Society 2007), is a vital resource for any care staff wanting to do reminiscence work, as described in this case study.
Understanding the situation - 3. Views collected from key people Open

The care staff were concerned that they could not support Annie effectively at mealtimes as they were at a loss to know the food and drinks she liked. The caterers were also unsure as to what to prepare for Annie. Early on, it was clear to staff that the standard menu options didn't appeal to Annie.

The staff tried a number of things: showing her the options of the food available to Annie at mealtimes, and putting a variety of food on her plate. Even so, Annie's appetite remained poor and she did not appear to enjoy mealtimes. Care staff were concerned that Annie would continue to lose weight and this would affect her health and wellbeing.
Actions Open
In the first instance, the care team decided to do some practical things:
- record Annie's food intake and drinks daily
- observe and record Annie's responses at mealtimes (her facial expressions and body language)
- record Annie's weight weekly
With the guidance and support of the activities coordinator, care staff tried a one-to-one reminiscence activity with Annie. This was originally intended as a way of improving communication with Annie by connecting with her through life story work and past memories (see the feature on 'Getting to know me' in the section 'Getting to know the person with dementia'). Annie also joined in group-based reminiscence activities, sometimes actively, other times by just observing the sessions.

From a one-off visit from a distant relative, staff learnt that Annie had been a member of the Women's Land Army in the second world war. Prompted by this, the activities coordinator decided to run some group reminiscence sessions on the Women's Land Army. She showed the group pictures in books and old photos, including images of the Land Army. Annie seemed to respond well and was happy to take part in this activity.

At a later session, the activities coordinator showed the group ration books and a wartime recipe book. A care assistant spent time with Annie looking through the recipe book. She noticed that Annie was pointing to certain pictures of food and recipes and smiling. The care assistant took a note of which foods Annie seemed to be responding positively to. She immediately shared this information with the catering staff who were able to provide Annie with the food she liked for her teatime meal that evening. From this simple activity, care staff were able to work out that Annie's favourite foods were mackerel, grated cheese and buttered bread.
Results Open

The activities coordinator encouraged care staff to continue this activity with Annie on a regular basis, one-to-one, to help build up a profile of her favourite foods and recipes. It seemed Annie got more from the one-to-one sessions than group sessions.

The care staff and caterers were surprised that such a simple approach had brought to light information about Annie's food preferences – this had not been an intended outcome when Annie was initially invited to be involved in the reminiscence activities. But learning just one small piece of information about Annie's life – her involvement in the Women's Land Army – had an enormous impact on her nutritional care. It provided a way for Annie to communicate her food preferences with staff, which otherwise may not have happened so quickly or easily. It also showed the importance of team work and how vital it is for care staff to share information they have about residents with the caterers.

The staff team noted an improvement in Annie's appetite and the variety of foods she ate. Despite eating small portions she appeared happier at mealtimes and enjoyed the food that was offered. Overall Annie appeared more content and settled, as though she was adapting to her new home and was becoming more at ease with other residents, particularly those who were involved in the reminiscence activities.
Advice for others Open

Often it takes trial and error to find out a person's food and drink preferences. The most important thing is to identify some good communication strategies to connect with a person with dementia.

Reminiscence based activities, if approached sensitively and skilfully, can be one such strategy. They can help us connect and communicate with a person with dementia who is struggling to find the words and language to do this verbally. Images, pictures and photographs are a great way of prompting a person to recall memories and, in Annie's case, express food preferences. All care providers should consider using reminiscence-based approaches to engage with and communicate with residents, with or without dementia (for more on reminiscence, see the feature on 'Activity resources and approaches' in the 'Keeping active and occupied' section).

In this situation it was vital that the activities coordinator was experienced in and confident about leading reminiscence work. She was able to support the wider staff team to use this approach skilfully. The caterers could also have been involved in the reminiscence – it is a great way for them to promote conversation and communicate with residents and an invaluable way of learning about a person likes and dislikes.

Not all reminiscence-based activities are appropriate for everyone, and a sensitive approach is needed. Use the expertise of a trained activities coordinator, and refer to a resource such as Memories are made of this: Reminiscence activities for person centred care by Julie Heathcote (Alzheimer's Society 2007).
Financial implications Open

This sort of activity doesn't necessarily have to be part of a structured lengthy – and therefore costly – event, but can be incorporated as part of day-to-day support that care staff give to residents. In this case study, because the activity was initiated and supported by the activities coordinator, care staff and caterers as part of their person-centred approach to care, there were no cost implications from this piece of work.