People with dementia can often experience problems relating to eating and drinking including poor appetite; communication problems; difficulties coordinating their movements to enable them to eat independently and even the ability to see foods on their plate.
These problems can have an effect on a person’s health and on some of the symptoms of their dementia, which can result in weight loss and worsen confusion.
This is coupled with the wider picture that malnutrition continues to be a major cause and consequence of poor health with older people being particularly vulnerable. 33% of people over 65 years old are currently malnourished or at risk of malnutrition on admission to hospital1.
At East Kent Hospitals University NHS Foundation Trust (EKHUFT), the Trust, together with their food and catering service provider Serco, have been working hard to improve the services offered to support patients, with National Dementia Week (20-25 May 2013) seeing the launch of a number of initiatives which have been specifically developed for those patients suffering from dementia.
Finger Food Menus
Patients with advancing dementia can find it difficult to coordinate fine movements and thus use cutlery. The Trust is currently trialling finger food menus, which promotes intake and independence with eating. Foods that can be picked up with the fingers are often easier to eat when coordination becomes difficult. This is less frustrating for patients, so encourages patients to eat more, often in a calmer manner.
Another problem for patients with advanced dementia is the difficulty to differentiate shades of colour. Common food items such as mashed potato on a white plate, or tomato based meals being served on a red plate can make these foods difficult to see. The Trust are therefore piloting the use of blue plates for those patients who have advanced dementia. If patients can see their food more clearly, they are more likely to be stimulated to eat it.
Picture menus are being developed to help patients with communication difficulties make menu choices themselves. At EKHUFT, there are 24 choices every lunch time. It is difficult for a patient with communication difficulties, such as those with dementia, to read a list of words and make a choice. Picture menus have been developed so that patients can look through the pictures and point to those meals they like to eat. To remember the word ‘lasagne’ for instance can be a challenge, this is made easier if all they need to do is point to the colour picture of it on the menu.
Following the trial period, the picture menu initiative will have a full consultation amongst hospital inpatients, dementia groups and learning difficulty groups before being finalised and printed for use throughout the Trust.
Wendy-Ling Relph, Matron for Nutrition at EKHUFT and member of BAPEN’s Executive team commented: “Supporting patients with dementia at mealtimes is crucial and we are very excited about these initiatives which will promote independence with eating and drinking, enjoyment of food and general wellbeing and improve nutritional intake for this vulnerable group of patients. Ensuring patients have enough time and support to eat is a priority and underpins all of these new initiatives. Patients need to be in a comfortable position, sitting upright whenever possible to ensure they are in an ideal position for chewing and swallowing their food.”
BAPEN Chairman, Dr Tim Bowling added “Simple but effective initiatives such as those being rolled out at EKHUFT are exactly what is needed within our hospitals. As highlighted in two key reports published this year - The Francis Report (2013) and the Care Quality Commission (CQC) Dignity and Nutrition Inspections - it has been shown that whilst many hospitals have good practice in the provision of nutritional care, there are many that do not deliver this adequately. Older people are especially risk of malnutrition, especially those with dementia, so it is essential that all hospitals look carefully at how they provide food, drink and nutrition support in an effective manner. Examples of good practice, such as these being trialled in EKHUFT, together with guidelines, tools and resources, such as the Hospital Guide2 recently published by BAPEN and the Malnutrition Task Force, can help us consistently deliver high quality care to each and every patient.”
For more information, interviews and comment:
- Calculation based on BAPEN national screening weeks 200711
- Preventing Malnutrition in Later Life: Best Practice Principles & Implementation Guide – Hospitals, May 2013 http://www.malnutritiontaskforce.org.uk/resources.html
Further information about National Dementia Week and access to a wide range of resources can be found at www.alzheimers.org.uk