People with dementia are no different from people without; like most people they will retain their usual eating habits, tastes and preferences of a lifetime. However, dementia can greatly affect a person’s relationship with food and eating. As dementia progresses eating and drinking can become difficult for some people. Eating and drinking involve the co-ordination of complex physical and mental activities. These activities are often affected by the progressive impairment of memory, thinking, planning, perception, organisation, communication and skilled movement that are associated with dementia. Consequently, eating and drinking may also be affected by environmental issues, lack of person-centred care planning, physical problems, such as pain or swallowing difficulties, poor concentration, food refusal and side effects of medication. Some people with dementia forget that they have eaten and end up eaten twice as much as they should.
Poor nutrition worsens the symptoms of dementia like restlessness, agitation, aggression and challenging behaviours. It can also increase the risk of dementia patient needing to be hospitalised due to lack of fluid intake leading to urine infection, low immune system; Constipation can also contribute to a patient’s decreased appetite and reluctance to eat. However they may not be able to communicate these problems to you due to their cognitive impairment.
An individual with dementia may become depressed. This can cause a decrease in appetite and lack of interest in food. Dementia can also cause a person to forget that they haven’t eaten or vice versa. Visual reminders i.e. snacks placed around the home may prompt them to eat. Another issue that may arise is a person with dementia that also has diabetes. The individual may forget that they have this condition and continue to eat high sugar foods as they would have many years ago. This should be monitored very
carefully due to the effects diabetes can have on the body.
Although a person may have dementia, this does not mean that we should ignore their personal and cultural preferences. For instance, if a person states that they do not like vegetables, then we should respect this and not put them onto their plate because they have forgotten. We also need to take into account a person’s cultural beliefs when it comes to food and drink. Individuals from India do not eat beef as they see the cow as a sacred animal. However we must not assume that all Indians have this belief and must find out more about the individual on admission by talking directly to them or their family members.
It is important to include a variety of food and drink in the diet of a person with dementia so that they are eating a healthy, balanced diet. Having a balanced diet is of course good for your general health, but also can have a great effect on how you feel. Individuals with dementia may involuntarily change their eating habits and only want to eat very sweet items which will cause them gain excessive amounts of weight, especially if they are not mobile. Placing healthy snacks at close reach i.e. chopped fruit, will act as a visual aid. They may not normally choose this as a snack, but seeing it will prompt them to eating it. This method can also be used on an individual who is suffering from weight loss. But using higher calorie snack as a visual aid.
Mealtime cultures such as having strict meal times and meal sizes, certain number of courses and in certain orders such as starter, main, dessert etc. may not adhere to the needs of a person with dementia. Their tastes may have changed and may not wish to eat the meals set out for them in a particular ‘traditional order’. They may not wish to eat at the same time as everybody else or may wish to eat small amounts more often. By trying to stick to normal meal time cultures, this can be a barrier to the nutritional needs of the individual. The care they receive should be person centred and to fit in with what the individual needs, this should also be true with the meals the person receives.
Environmental factors such as being around lots of other diners, loud noises, music or bustling restaurants etc. are not ideal for a dementia patient as they can become easily distracted and overwhelmed by too much information being processed at once. This can be a barrier to them being able to focus on their food.
Mealtime cultures and environments can greatly affect the way an individual eats at mealtimes. We need to adapt to a person centred approach. One individual may have been very regimental about mealtimes, and had their meals at set times of the day, where as another may have only eaten once a day and snacked in-between. We must not institutionalise people who are living within a care setting. We must remember that they are an individual. We must also take into consideration that dementia progresses differently from person to person. One individual may still have the ability to recognise foods and use cutlery etc. but another may not have the ability to carry out these tasks and may need assistance with eating. Assisting the individual must always be dignified and they must always be offered choices in a way that they are able to respond to.
Mealtimes and offering choice can often be difficult if an individual is unable to communicate their wants and needs. Showing pictures, or having the meal choices available to see can often be of assistance. There has been research done that suggests individuals with dementia eat much better if the food is served on a dark blue plate. We must also gain background information on the individual with regards to mealtime’s and eating habits. Family members are the best people to talk to should the individual be unable to communicate. This should then be documented in the persons care plan which all staff should be able to view.
A person centred approach should be adopted in all aspects of care, especially dementia. Having information from the individual and their family members will help you to care for this person much better. As the individuals needs change and dementia progresses, it is important that we adapt to the persons needs and remember that no two people with dementia are the same. Dementia can cause you to forget to eat, drink, and how to use cutlery. In the later stages it can also cause you to forget to chew and swallow. Using the person centred approach can help the individual to have their nutritional needs met as they will feel more comfortable knowing that you know what their needs are. Care plans should be kept up to date, and staff made aware of any changes. As needs change, it is advisable to contact their GP for advise and possible dietician referral.