CAROLINE BARTLE discusses the importance of good nutrition for people with dementia and gives some practical advice to help make meal times easier.
Good nutrition is vital for a person with dementia. However, maintaining a healthy weight can be a challenge for many people with dementia. Difficulty with eating and drinking is more noticeable as dementia progresses, and unwanted weight loss is a common problem but not an inevitable part of the disease process.
The impact of good nutrition on the health of our brains cannot be dismissed. We know that malnutrition affects physical and mental wellbeing. Despite the research conducted on this topic, there are no conclusive guidelines on consuming actual quantities of nutrients to help to reduce the risks of developing dementia or the progression of dementia once diagnosed.
Causes of poor nutrition
Eating and drinking involves coordination of physical and mental activity. These activities are often affected by ageing as well as the progressive impairment of memory, thinking, perception, planning, organisation, and communication. For example, a person with dementia may lack the motivation to eat, or in the later stages, lose the coordination skills to feed themselves or develop problems swallowing. They may forget if they have eaten or that they need to eat at all.
A person in the early stages of dementia may lose the ability to concentrate on the activity of cooking or feeding long enough to complete it. They may experience changes in their taste sensations, sometimes preferring sweet foods to savoury or vice versa. In the case of Lewy Body dementia, a person can experience taste hallucinations that might impact on nutrition. Depression can be a common feature of dementia, which can lead to nutritional difficulties.
The physical changes in the brain can lead to poor motivation, which leads to lack of activity, which can cause other physical problems, including constipation. Quality organisations address this by taking both preventable and remedial action, including exercise and increasing fibre and fluid in the diet.
We also need to be aware that some people with dementia may experience difficulties with their sight and visual perception. They may be unable to see or recognise the cutlery, crockery, or the food in front of them. Difficulties with depth perception and colour contrast can make it difficult, for example, to identify white fish against a white plate. This may give us the impression that they are not hungry or uninterested in eating. However, this may be an incorrect assumption to make, and may be easily solved by providing a red plate to support colour contrast difficulties.
A person-centred approach
It is up to us to identify what the difficulties are and not make the assumption that they do not wish to eat. We need to understand the challenges faced by the cognitive deficits, whilst at the same time identifying how to use strengths to encourage active participation in meal times.
A person-centred approach should be taken at meal times. For example, meals should be provided in a way that is familiar to people. A person with dementia may be used to eating their main meal in the early evening by themselves, sitting in a comfortable chair, listening to the radio. If this person is suddenly offered their main meal at lunch time and expected to sit at a dining table with others, it would be no surprise if they refuse to eat the meal or leave it uneaten. This new situation may be confusing and unfamiliar to the person or they may just not be hungry at that time of the day.
The social environment plays an important part in the care of a person with dementia. As memory is contextual, changes can be made in the environment to help reinforce a person’s identity and their reality. Finding out through continuous assessment what the person’s perception is will enable you to identify what works. For example, a person might prefer a cup and saucer as opposed to a mug for tea. Supporting a person’s reality will give them a sense of well-being, and enable them to be more independent at meal times.
Food and images of food can be used as part of reminiscence activities. This can help stimulate discussion and interest in food and meal-times by helping the person to reconnect with familiar food from their past. This can be part of the assessment process or form part of a group activity process.