Ensuring a nutritious diet for elderly and people living with dementia is actually the least we can do. The importance of healthy eating for our older generation resonated when I accepted an invitation to attend a National Association of Care Catering meeting. My host, a community meals provider chatted his way through the two hour journey to York, expressing his company’s commitment to providing nutritious food, an extensive menu choice and meal delivery within a specific time frame. Finishing with their ‘safe and well’ procedure, the narrative was a wonderful insight into a service which tickled my taste buds and warmed my heart by the dedicated high level of care behind my friend and colleague’s services.
Having spent many hours discussing meal-time approaches with residential home managers, day centre providers, meal delivery services and frontline carers, the most talked about issue after nutrition, was the difficulty in encouraging people to eat.
Dementia can affect a person's relationship to food, impacting on their eating habits, meal-times and food choices. Finding their way to the dining room, managing cutlery or swallowing can become difficult for some people.
Enriched social care can play a big part in enhancing a person’s well-being. At Happy Days Dementia Workshop, we believe that ‘You can’t care for a person until you care about them - and to care about them, you must know who they are.’ Finding out about and really getting to know your resident is crucial to their well-being and happiness.
Many residential care home managers are keen to show me their ‘One-Person-Plan’ which often doesn’t include meal-time favourites or absolute dislikes. Serving food to a person which the person doesn’t enjoy eating may cause unease. Repetition of this meal service, albeit thoroughly well-meant, could lead to unrest or even agitation and eventually refusal to eat the meal presented. [Imagine being invited for dinner at a friend’s house and being offered sprouts, prawns or meat if you are a vegetarian. Imagine being invited again the following week - What would you be thinking about?]
As we are aware, there are over one hundred types of dementia. Every person’s type and stage of dementia is different but we must remember that people living with dementia can still have feelings and continue to sense when something feels right or wrong - they may just not be able to express the situation easily. So it’s important to know as early as possible, which meals, snacks and drinks each resident enjoys the most. Ask relatives and friends to help collate foodie favourites for your resident.
Now, to contradict myself completely, some people living with dementia change preferences away from their known favourites. Some people may not recognise favourites but having the favourite foods list or likes and dislikes information can help carers identify when changes have occurred. Sharing information with team members can ease carer routines and enrich resident comfort.
This is why we’ve created Happy Days Memory Joggers, colourful resources with response areas to collate and edit food favourites - handy for residents, carers and families to share information.
Meal-times are not only about the delivery of nutritious food, they are about encouraging someone to want to eat and ensuring that they do. If a resident suddenly shows an aversion to eating, we know to check denture fit, medication, illness, signs of anxiety or depression - but it may just be that a person has forgotten about eating or not recognise the food on their plate. Prompting experiences around eating and drinking may also help.
As I mentioned earlier, people with dementia still have feelings and may respond to visual images linked to the senses; a freshly cut loaf may signify the smell of newly baked bread and prompt taste buds, preparing the person to eat. Taste, textures and conversational prompts around the subject of food, eating and food favourites can also help to encourage eating. Happy Days nostalgic food corridors, creative food-related dining room images, nostalgic displays and handy wipe-clean memory, conversation prompts and pointer cards have been designed to help interaction, encourage peoples’ appetites and eating habits for healthy living.
Encouraging able people to integrate with daily activities is another way to promote the idea of meal-times and eating: Laying the tables / Clearing the tables
Sharing out cards with food choice images to residents [before people go into the dining room] Placing daily menu images at the entrance to the dining area
Develop Happy Days nostalgic food corridor, dresser or wall display
Use dining, food and drink images in dining areas
Reminder signs for rehydration - Drinking / Water images
Use coloured crockery to ensure the food on the plate is easily visible
Imagine being at a special celebration or party. The host is serving inviting canapés or finger food on an interesting tray. She [or he] is wandering around with an assortment of food. You can either smell how tasty it might be - or you can see how interesting it is. You can’t resist selecting something off the tray to eat. Might this be one way to encourage your residents to eat. Turn teatime into a social time. Offer canapés or finger food, fruit cocktails or strawberry milk-shakes. And so, to get back to my car journey conversation on the way to York: I was really pleased to hear about the ‘Safe and Well’ checks provided by my friend’s community meal service team when delivering meals. Eating alone can be a lonely experience and one which could be postponed if not prompted or motivated. Linking up with volunteer visiting and befriending organisations may be another way forward in ensuring that people living alone eat well. Sometimes, just the company of another person is all that is needed to encourage eating. Initiating conversations around food: ‘I used to love/hate school dinners’, ‘My favourite pudding is …’, ‘Can you remember the smell of …’’ To help conversations around food and eating, Happy Days ‘Dinner’s Ready’ is full of nostalgic food and drink prompts, memorabilia and famous fifties brands postcards to generate thoughts around lunch, dinner and hydration.
By making a few creative refinements, we might, if you’ll pardon the pun, ‘ginger up’ mealtimes and make them as enjoyable and stress free as possible for everyone.
People may not always remember what you said - but they will always remember how you made them feel.
Gillian Hesketh MA
Happy Days Dementia Workshop & Nostalgic Design 2016©