Dementia Gateway: Eating well for people with dementia

Case study: Eating and drinking at home

Home care staff were having difficulty knowing what meals to prepare for Dennis, who was unable to recall what or if he had eaten.

Background

Dennis has Alzheimer's disease. He lives alone. Both of his two children live some distance from him, but visit every weekend. Dennis has three visits daily from home care staff (breakfast, lunch and teatime) and each visit is covered by a different member of staff. Dennis needs help to choose food and prepare a meal or snack.

Dennis's food preferences and dietary requirements are written in some detail in his care plan, which care staff can read, but in reality, and from day-to-day, they generally don't. A shopping service organised by the care team delivers food for Dennis.

The manager led this process, but its success depended on good communication with and among the care team.

Read the full case study:

Understanding the situation - 1. Research and development findings Open

This case study shows how we can support people with dementia to communicate their food choices by using pictures and writing information clearly. The Alzheimer's Society Food for Thought project drew together lots of knowledge and best practice in this area, and resulted in a series of publications (see Wilson 2003 in the 'Further reading' section below). The Alzheimer's Society guide 'Catering for people with dementia' (2009) also includes this sort of information.
Understanding the situation - 2. Views collected from key people Open

Care staff ask Dennis if he has eaten, but he finds it hard to remember. Dennis then gets confused and frustrated that he can't remember. He also feels that sometimes he is offered food that he is not keen on.

Although Dennis has a care plan kept safely at his house, the care staff generally don't check or update this regularly, let alone at each visit. Now, some of the staff have become concerned that Dennis is always being offered the same meals, over and over. They've also noticed that the foods delivered by the shopping service don't always seem to be what Dennis wants or needs.

Dennis is also struggling to know where the fridge is and to put the appropriate items in it. Occasionally, he puts milk in the oven and has difficulty finding the cutlery drawer. These things are meaning he is less likely to get himself a snack.
Actions Open

After meeting with Dennis and the care staff and hearing of their difficulties with meal preparation, the home care manager decided on a number of strategies. Overall, she wanted to make sure that all care staff could have up-to-date information about Dennis's food preferences and needs. She also hoped to offer more support to Dennis in recalling foods eaten, and in locating and recognising key items in his kitchen.

First, she placed a laminated list of Dennis's preferred foods in the kitchen for care staff to see easily. It could be kept clean easily and Dennis could read and comment on it too, if he wanted to. The list included a range of menu ideas, including snack foods and small meals for care staff to prepare.

Then she placed a white board on the kitchen wall so that staff could record what food they'd prepared for Dennis throughout the day. This would help Dennis recall the food he had eaten too, and also mean care staff could provide a variety of foods over the day.

Then she sent an updated shopping list to the shopping service and agreed that care staff would update the list as often as every week, if needed, if Dennis's tastes or preferences changed.

She then placed laminated signage on the fridge, crockery, cutlery and pantry areas. The signs used both words and pictures.
Results Open

The care staff were pleased to find that these simple changes made a big difference. They could see instantly the sorts of foods Dennis liked and get ideas easily about what to prepare for him at mealtimes.

The white board worked well. After a short time it was obvious that it made more sense to record two days of information, rather than one. The information was clear, easy to read, and in the right place. Because it was so useful and easy to see, the care staff kept this information up-to-date in a way that they had never been able to with the care plan. New staff found it particularly helpful.

Dennis also liked the white board – it helped remind him what foods he had eaten over the day. The only difficulty he had was if the words were not written clearly enough.

With the new signage in place, Dennis seemed more at ease and confident moving about in his kitchen. Family felt reassured by the strategies and found the white board particularly helpful too, especially as they were not present daily.
Advice for others Open

These methods were simple but effective. This is a sustainable approach, but the care team do need to regularly review a person's preferences and capabilities (for example, whether a change is needed to a soft diet).

The home care manager led this process, but its success depended on good communication with and among the care team to ensure the information was kept up-to-date and appropriate.

As Dennis's dementia progresses, he may struggle to understand words alone, and future strategies may depend more on the use of pictures beside the written word to help with recognition and understanding. Laminated pictures and images of food to put on the white board or a magnetic board could be helpful.
Financial implications Open

The process did involve some costs, but these were fairly minor: a laminator (which many offices would have already), a white board, coloured pens, and wipe clean cloth.