This month I visited a care home to observe residents over lunchtime to see if I could offer any advice to improve the overall dining experience and encourage those with mid to late stage dementia to eat more. Care staff were concerned that some residents were losing weight despite all their best efforts to encourage them to eat. Sadly, it is all too common for people with dementia to lose an unhealthy amount of weight, particularly in the later stages.
The ability to feed ourselves is one of the first things we master as babies and is often the last daily living skill to deteriorate in dementia. Babies instinctively put things in their mouth and start to chew and yet some of the behaviours we may see in people with dementia include turning the head away from food, keeping mouths closed or pushing food away.
There could be many reasons for this and it’s important to rule out physical causes first. People with later stage dementia may have difficulty communicating pain or discomfort. Medication may cause drowsiness, nausea and loss of appetite. Damage to specific parts of the brain or a loss of taste and smell may mean that some people start to dislike food that they used to love and prefer something they never liked before. Often people may start to prefer sweeter food and although we always strive to provide a balanced diet, if adding a bit of honey or sugar to meat or vegetables encourages them to eat it then it is worth a try.
Mealtimes are a very important time of day and should not be rushed. Think of it as an activity and an opportunity to encourage social interaction and reminiscence. Food often triggers childhood memories. Residents who have co-ordination difficulties may benefit from being with others who manage well as they may copy their behaviour and start tucking in without prompting.
The environment is important too, so set the tables attractively and change the background music just before lunchtime to something gentle. Residents may then start to associate the change in music to mealtimes which puts them in a good frame of mind to focus on eating.
Giving residents a choice is important but when communication and understanding is impaired someone might tell you they would like sausage and chips but what they really mean is jelly and ice cream… another reason it might get pushed away. How disappointing it must be to be given shepherd’s pie when all you wanted was a Magnum! Showing a small portion of what’s on offer works well, much better than just asking them or showing a picture. Be aware that large portions may over-face some people. Small portions are better unless you know that someone has a hearty appetite. You can always offer more if needed.
There is little point trying to get someone to eat if they are agitated or drowsy. Imagine what it must feel like to have food pushed to your lips when you are perhaps feeling nauseous due to medication or you hate fish pie (even though it used to be your favourite).
As care-givers we have a basic instinct to nurture and providing food is a big part of that. It makes us feel sad and inadequate if we can’t meet this basic need. Unfortunately, there is no one size fits all answer for the eating behaviours we may see in dementia care, but we must continue to be creative in thinking of solutions and make mealtimes a more positive experience for everyone concerned.
For further information the Alzheimer’s Society have a useful factsheet.