Dementia Gateway: Eating well for people with dementia

Eating well at home

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

Explore the links below now to read more about this topic:

• 1. Introduction: the importance of good nutrition for people with dementia living at home Open

  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 well develop problems with chewing and swallowing also.

  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. For more on this, see the feature in this section, 'Why nutrition is important for people with dementia'.

  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.

• 2. Where to start? Helping the person to choose foods they enjoy Open

  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 cereals 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. 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.

• 3. Systems for getting food into the house Open

  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 shop? 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 which is then sent to social services to order. Depending on the locality and care package in place this system may vary.

• 4. Involving a person with dementia in food preparation Open

  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 or just watching the cooking process are all good ways of involving the person.

• 5. It takes time: supporting a person with dementia at mealtimes Open

  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.

• 6. Ideas for keeping up intake of fluids Open

  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, can increase the risk of urinary tract infections, exacerbate the risk of constipation or increase 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 'Extra reading' below).

  Some practical suggestions for keeping up liquid intake are:

  • Leave drinks in a place where the person can both reach and see them, such as on a coffee table in the living area.
  • Put coloured drinks such as juice, milk or milkshakes in a clear glass – this makes it easier to see the drink.
  • Offer the person prompts and encouragement to drink.
  • Describe the type of drink you have poured (for example, 'This looks like a lovely cold drink for a hot day').
  • Place the glass or cup in the person's hands and guide it to their mouth to help start the process off if a person needs help to initiate the sequence of drinking.

• 7. Cut out the cutlery: simple meals and finger foods Open

  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'. For more ideas on finger foods for people with dementia, see the Alzheimer's Society leaflet (2010) on this topic (see 'Extra reading' below).

• 8. Snacks available throughout the day Open

  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.

• 9. Do written reminders help? Open

  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.

• 10. Chewing problems: causes and ideas to help Open

  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.

  Any item of food that can be mashed easily with a fork is likely to be easy to chew and eat. The person themselves will guide you as to their response to the food served. Meat that is tender, cut into small pieces or minced can be easier to chew. Serve with gravy or in a sauce.

  Make sure that fish is free of bones and flaked, and again if this is served in a sauce it can help with chewing. Frozen and tinned varieties of vegetables will cook more quickly and develop a softer texture. Instant mash potato can be a great help if time is limited. Make it with milk and butter for extra nourishment.

  Soft bread can be dipped into soup. Fruit that is ripe can be blended into a smoothie – this is easier to take in as a drink rather than biting into pieces of whole fruit.

  For more on this, see the feature in this section, 'Chewing and swallowing problems'.

• 11. Swallowing difficulties Open

  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.

  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, but availability varies regionally. Their advice should be available in writing and be shared with the whole care team and any family.

  For more on this, see the feature in this section, 'Chewing and swallowing problems'.

• 12. Issues to be aware of if blending food is recommended Open

  If you are advised and given guidelines to provide a modified texture diet – for example, blending food to produce a soft puree consistency – each item of food should be prepared separately before placing on a plate (and ideally preheat the plate). Blended food can be bland so ensure seasoning is added to enhance the flavour. This will vary according to the preference of the person. Adding butter or cream to some blended foods can add calories and flavour. Blending meat with gravy adds flavour. Describe the food so the person has the opportunity to recognise it.

  People who have difficulty swallowing are at a higher risk of malnutrition than those without. Having the right equipment available to blend food is also important as the end texture can vary according to the foods and equipment used. Support from a dietitian to advise and provide information 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 GP.

  Pre-prepared modified textured meals may be available under the community meal scheme provided by the local authority or for direct private purchase. These may be soft or pureed textured food that is remoulded back into the shape of the food it was before being blended. The aim of pre-made modified texture diets is to ensure that the food looks good, tastes good and is nutritionally balanced.

  For more on this, see the feature in this section, 'Chewing and swallowing problems'.

• 13. Other ways of supporting a person to access good meals Open

  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.

  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.

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