Dementia Action Week:
catering for residents with dementia
Overview
As part of Dementia Action Week, Alzheimer’s Society is promoting their work to raise awareness of the importance of an early diagnosis for people affected by dementia. Why is it so important? There are currently estimated to be 982,000 people with dementia in the UK, but more than a third of people with the condition do not have a diagnosis. The number is expected to rise to 1.4 million by 2040.
Dementia is a general term for symptoms that can affect memory, thinking and behaviour. There are many different causes and types of dementia, the most common type being Alzheimer’s disease. This progressive condition is most common in people over 65, with 70% of residents in care homes estimated to have dementia or severe memory problems.
allmanhall’s expert team are award-winning when it comes to our work in Care, having recently been crowned Best in Catering & Nutrition at the Care Sector Supplier Awards.
As part of that award-winning care support team, Tess Warnes, Registered Dietitian, works closely with all of our care clients to manage the challenges presented by those residents living with dementia.
Here, Tess explains why good nutrition is imperative when catering for dementia and how care homes can help create inspiring mealtimes for residents.
Why is good nutrition so important for residents with dementia?
Symptoms of dementia include changes in personality or mood and problems with memory, communication, understanding, movement and performing familiar tasks.
Eating and drinking may also be affected, for example, people with dementia may:
- Have a poor appetite
- Not recognise signals of hunger and thirst
- Forget to or refuse to eat
- Not recognise certain foods
- Experience a change in food preferences and eating habits
- Face issues using cutlery
- Have difficulties with swallowing (dysphagia)
- Move less, which can decrease appetite and energy requirements
- Pace or fidget, which can increase appetite and energy requirements
- Have a strong preference for sweeter foods and carbohydrate over protein and fat.
Tess highlights that “Symptoms of dementia commonly mean that individuals are at risk of weight loss and malnutrition. Malnutrition is a serious condition which can have a significant impact on quality of life, clinical outcomes, morbidity (the rate of disease) and mortality (the rate of death). For this reason, it’s crucial that care homes support residents with dementia to eat well and meet their nutrition and hydration needs.
Tess offers solutions for the most common challenges when feeding residents with dementia…
Make mealtimes easier for people with dementia
A large meal could be overwhelming for a person with dementia, so offer smaller, regular meals and snacks when catering for dementia. This ‘little and often’ technique also gives residents the best chance of enjoying hot food while it is still warm.
It is also important to experiment and be flexible with meal timings. For example, offering a snack before a meal may help stimulate appetite, or offering breakfast in stages may help residents who forget that they have already eaten.
Finally, ensure mealtimes are well planned and not during medication rounds, when there is significant noise or distraction or when you know a resident will be tired.
Important nutritional considerations when catering for dementia
Fortification:
- Fortification means enhancing the nutritional content of a dish without increasing the volume. This is important for residents who have a poor appetite and struggle to get the nutrients they need.
- Add nutrient-dense foods such as cheese, nuts (ground or nut butter), skimmed milk powder, Greek yoghurt and eggs to your recipes. An easy way to identify if a food is nutrient dense is whether it is something designed by nature to support a new life
e.g. an egg (which could potentially ‘grow’ a baby bird), whole seeds or nuts (from which a new plant could potentially grow) or milk (which would potentially ‘grow’ a baby animal). If the answer is yes, then this is likely to be a nutrient-dense ingredient. - Fortify full fat milk by adding four tablespoons of milk power to one pint and use as normal on cereal and in drinks.
- However, remember that not all residents will need to eat fortified meals – make it bespoke to individual
Dysphagia:
- As dementia progresses, residents may experience difficulties with swallowing (also known as dysphagia). If the person is drowsy or not sitting upright, they may struggle to swallow safely, which may cause them to choke. Many individuals with dysphagia are at risk of malnutrition due to poor nutritional intake. For more information on this condition, read our blog.
- Food needs to be moistened, mashed or pureed to make it safer for an individual to eat; fluids may also need to be thickened. A great example recipe for this would be roasted pumpkin soup.
- Food needs to be moistened, mashed or pureed to make it safer for an individual to eat; fluids may also need to be thickened. A great example recipe for this would be roasted pumpkin soup.
- Again, meals should be fortified with nutrient-dense foods by adding ingredients such as smooth nut butters, cheese and skimmed milk powder to increase the energy content of their meals (remember that adding these may affect the overall texture of the food).
Hydration:
- Ensure a variety of hot and cold drinks are available throughout the day
- Offer drinking aids and assistance where appropriate
- Encourage milky drinks such as coffees, hot chocolates and malted drinks made with whole milk, or fruit smoothies and milkshakes in warmer weather
- Incorporate foods with a higher water content onto menus such as watermelon, cucumber, jelly, custard, and soup (depending on the nutrient density)
- For more information on effective hydration, read our blog.
Finger foods can help
Some residents with dementia may struggle to eat using conventional cutlery. Serving food that can be picked up and eaten on the go with fingers can help improve food uptakes during meal and snack times.
Finger food options include sandwich fingers with high protein fillings such as egg mayonnaise, slices of pizza, vegetable sticks, spring rolls and fruit segments. Ensure that your offering is carefully planned to ensure there is adequate energy and nutrients for residents. The Care Home Digest includes extensive examples of appropriate finger foods.
Finger food options should be as similar to the regular meal as possible, so residents don’t miss out on nutrients. For example, on Sundays, fill mini Yorkshire puddings with mashed potato and roast meat or vegetables, with a pot of gravy to dip.
Other considerations for the best experience
Finger food options should be as similar to the regular meal as possible, so residents don’t miss out on nutrients. For example, on Sundays, fill mini Yorkshire puddings with mashed potato and roast meat or vegetables, with a pot of gravy to dip.
Preparation:
- Involve residents with dementia in the decision of what to eat, taking their personal dietary or cultural requirements and preferences into consideration
- Focus on what your residents can do rather than what they can’t
- Use visual menus with photos of the meals as well as written descriptions
- Ask if they would like to help prepare food or set the table, to promote interest in mealtimes
Presentation:
- Ensure meals are visually appealing and appetising, regardless of the format in which they are served
- Some residents may struggle to distinguish their food from the plate, or the plate from the placemat or tablecloth. Avoid busy crockery patterns but do use contrasting plain colours to help residents see their food properly. e.g. a plain brightly coloured plate (stay away from red) on a contrasting colour tablecloth.
- For residents with dysphagia as well as dementia, make any modified food look as much as regular food as possible.
- For residents who are struggling to eat enough but are put off by large portions, serve a normal portion on a larger plate. The space around the food acts as a visual trick and will encourage them to eat more
Environment:
- Ensure that the environment in which residents are served food is well lit, calm and comfortable, without distractions such as a loud TV or radio
- Replicate a homely mealtime experience with simple table settings to recreate the family or social experience that your residents can remember
Experience:
- Enhance the dining experience by offering foods with different smells, colours and tastes, to stimulate residents’ appetite and senses. For savoury food, add herbs and spices, garlic, mustard, ketchup and other condiments. For sweet food, add honey, maple syrup, jam or vanilla
- Always check the temperature of residents’ food and drink to ensure it is not too hot – they may not be able to do this themselves.
- Allow plenty of time to eat
- Finally, make eating a sociable occasion by encouraging staff, family and friends to eat with residents. However, it is important to be mindful that preferences will differ from person to person and some residents may feel self-conscious of eating in front of other people.
It is important to remember that, whilst meeting nutritional needs is important, residents’ preferences take priority, especially if a resident is malnourished. More flexibility may be required, as getting someone to eat is the most important consideration, whether that be breakfast in the evening, two puddings, or a meal at 2am.
Tess concludes that “Eating and drinking should be a pleasure. People living with dementia may develop eating and drinking difficulties, thereby increasing malnutrition risk, but when you understand the requirements of each resident, and implement a few simple tweaks to your care provision, caterers can ensure that the food you provide is always appealing, accessible and nutritious.”
As well as providing award winning nutritional support, allmanhall are helping our care clients’ catering teams with everything from meeting the requirements of the new legislative food waste reforms to creating a more sustainable, plant-based menu for residents to meet Government net-zero goals by 2030, from mitigating the effects of volatile food pricing to improving the heart health of residents.