09th September 2016

Roast Beef and Custard – Patient-Centred Care

Yellow sauce

An article published in Care Home   Catering, reporting on the presentations given at their latest Forum event focussing on patient-centred care, makes entertaining reading – not least because the somewhat frequent mention of humble custard.

We need a more personcentred approach to nutrition

Custard first crops up in a presentation highlighting the importance of staff supporting patient-led catering. Phil Shelley, Chair of Hospitals Caterers Association, recounted the story of a gentleman who put a blob of custard on every single meal he gave his wife because she loved the colour yellow – she didn’t actually eat it but it enhanced her enjoyment and intake of the meal. Leaving his wife in the care of staff concerned the gentleman because he felt she wouldn’t receive this personalised touch, so important to him. And so Phil reassured the gentleman that they would give his wife what she wanted – including a blob of custard on her roast. Interestingly the hardest job was ensuring the staff did this as it was so out of the ordinary. So staff need to think more flexibly to give people what they want.

This anecdote emphasises the importance of individuality, and in the case of the blob of custard how simple (and cheap) it was to improve nutrition intake. It reminds us that we should not make assumptions about people’s preferences.

Focus on talking to not talking about older people

Another speaker at the Forum, Dr Lisa Wilson, highlighted that we should be talking about prevention of malnutrition rather than focussing purely on treatment, and we should stop talking ‘about’ older people and rather talk ‘to them.’ This will facilitate exploring what they are experiencing and what they need – and if for a person with dementia that is roast beef and custard, it may well be exactly what they want.

Included at the end of the article would you believe was another roast beef and custard anecdote – a carer had taken her husband with dementia to a self-service café where they picked roast beef as a main and apple pie and custard as dessert. He promptly put the apple pie and custard on top of the beef. Despite her embarrassment, the wife relayed that it had all been eaten and thoroughly enjoyed. The wife’s embarrassment may signify something of our in depth beliefs about what and how we should eat. Staff caring for service users need to change from a judgemental response to embracing personal differences. A person-centred approach means recognising we are all individuals.

The report makes a further poignant point that we should remember – that if service users have lost much of their independence when they come into a residential home, giving them a choice of what to eat is core.

*All information is correct at the time of publishing

Ayela Spiro

Nutrition Science Manager, British Nutrition Foundation

Ayela is a nutrition scientist at the British Nutrition Foundation, where her role involves providing expert advice on nutrition and health issues to a number of key audiences including consumers, health professionals, charities, the media and the food industry. At the heart of her work is the communication of nutrition science that promotes understanding of nutrition and health and contributes to the improved wellbeing of all.

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