The third round of the National Audit of Dementia, with nutrition as a new theme, has just been published. This audit, established in 2008 to examine the quality of care delivered in hospital to people with dementia, is managed by the Royal College of Psychiatrists in partnership with organisations representing healthcare professionals, people with dementia and carers. The audit reviewed data collected between April and November 2016, including questionnaires from 14,416 staff and 199 hospitals across England and Wales.
Audit themes highly relevant to care home
Although the audit was conducted in hospitals, the nutrition aspects are particularly relevant to care homes because they look at some of the common themes in food provision for people with dementia. It is estimated that a significant proportion of people with dementia living in the community are at high risk of becoming malnourished. When people enter care settings, problems with eating and drinking may be exacerbated by illness, pain or the unfamiliarity of the setting. Food and drink presented may be unsuitable, given without adequate support, or be given at an unfamiliar time, all of which will increase difficulties with intake.
24-hour food service and finger foods should be available
Catering services in all healthcare settings should be able to provide for the needs of people with dementia who may have a disrupted sense of routine. Providing food outside of regular mealtimes is often necessary as people with dementia can forget to eat, or eat in different meal patterns. The availability of a 24-hour food service is therefore important as is the provision of finger foods meal alternatives and snacks. People with dementia may have become accustomed to their own particular times for meals, and find it easier to eat and drink then, rather than more conventional set meal times. They may also experience changes in their sleep pattern due to dementia or to the unfamiliar setting and require support not to miss meals. Finger foods can be eaten without cutlery and can allow people with dementia to maintain independence and enjoy food at their own pace.
There was an interest in specifically looking at such provision in the audit. The questionnaires used explored aspects such as whether food was available throughout the day and night (24-hour food services) and whether finger foods were available as alternatives to meals and as snacks. The audit also collected feedback from staff on how well the food services provided work for people with dementia.
Audit findings
Data was collected from an organisational checklist per hospital, and from staff/carer questionnaires.
Around 1 in 5 of the staff said that patients with dementia had nutritional needs met only some of the time, and five percent said their needs were not met.
Providing finger food
Around two-thirds of staff said that they could access finger food for people with dementia always or most of the time.
Providing 24-hour service
The majority, but not all, settings (86%,) said that they can provide some food services 24 hours each day. Of these, some could provide light meals whereas others could only provide simple foods, such as bread, cereal, yoghurt and biscuits, and some could only supply biscuits/snacks. This compared to only 75% of staff that reported they could obtain food 24/7 for their patients.
Feedback from staff provided insight
In nutrition care provision, uninterrupted and supported mealtimes should be established. In addition, ensuring that carers (like family members) who have knowledge of the person, and can provide reassurance, can visit at any time, including mealtimes to offer support/encouragement may assist in improving intake.
Staff feedback also provided useful information. It was noted that families often could bring in the snacks that were enjoyed. However for those without families, limited choice and availability made it difficult to provide suitable alternatives if the provided foods were disliked.
Some staff were concerned about a lack of availability of suitable foods for late evening or night snacks, as this is important for people who had not eaten sufficient amounts in the day. An additional concern was the lack of flexibility that came about as a result of using outside catering services. Staff also talked about mealtimes being disturbed, for example by transfers, and that this impacted the time staff could spend supporting people with dementia at mealtimes.
There was some discrepancy between the organisation reported provision and staff feedback. This may reflect that provision and/or staff awareness is not always consistent with the nutrition policies in place.
Like care homes, hospitals have made many positive changes aimed at making them more “dementia-friendly”, and again, as in care homes, there is still some room for improvement.
Services do not seem to be consistently available. Do look to your nutrition provision to make sure that you provide a good nutrition service to people with dementia, including 24-hour food availability and the provision of finger foods at meal and snack times, as well as ensuring support with food and drink is provided whenever needed.
