Issue 136 food based activity and dementia practice

PAEDIATRIC COMMUNITY

FOOD-BASED ACTIVITY AND DEMENTIA IN PRACTICE Gill Hooper RNutr Freelance Registered Nutritionist, GH Nutrition Gill runs an independent food and nutrition consultancy and her main area of interest is nutrition and dementia.

She is currently working on a research project with Bournemouth University looking at the impact of improving the delivery of nutritional care for people with dementia living in care homes.

REFERENCES For full article references please CLICK HERE . . .

Choosing and preparing food, eating and drinking are activities we can all enjoy. They form part of our everyday lives and are important for everyone, not least for people living with dementia. Food-based activity can play a huge part in person-centred care for older people in care homes.

In a previous NHD article on foodbased activity and person-centred care for older people in care homes, I explored how ‘food-based activity can help stimulate an interest in food, enhance health and wellbeing and help prevent malnutrition’.1 In this article, I hope to demonstrate with real examples the importance of food-based activity for people living with dementia.

CHALLENGES

It is important to remember that every person with dementia is unique and not everyone will experience the same changes and challenges. However, as dementia progresses, eating and drinking can become more difficult for a number of reasons. Confusion, or a lack of recognition or judgment, means someone may not recognise hunger or thirst and they may not recognise foods, or recognise when food is unsafe to eat.

Poor communication skills can make it more difficult to make choices or communicate hunger and thirst, or a change in food preference, which is common with dementia. A lack of coordination can lead to a loss of independence as someone may no longer be able to feed themselves. Other difficulties include loss of appetite, changes in sense of taste or smell, depression, mouth discomfort and difficulty chewing and swallowing.

UNDERNUTRITION

The consequence of these challenges is poor nutrition or undernutrition, resulting in weight loss, tiredness, lack of energy and 38

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muscle weakness. This in turn can cause a more rapid progression of dementia, as well as increasing the risk of other complications such as reduced physical performance, pressure sores, infections, falls and fractures. Interventions which can help create an interest in food and drink, are essential and activity around food can help meet a physical need at the same time as providing social interaction and mental stimulation.

PRACTICAL COOKING

A dementia café is a fantastic place for carers and people living with dementia to meet with others, socialise, share experiences and take part in different activities (www.altzheimercafe.co.uk). As a volunteer at a local dementia café, I’ve been able to offer practical cooking as an activity. Recently, with three willing cooks, we made a smoked mackerel paté. The recipe required only a few ingredients (mackerel fillets, cream cheese, horseradish sauce, lemon and dill) which were easy to mix, so no difficult recipe to follow and no need for accurate weighing, yet it was incredible the difference such a simple activity made.

First was the opportunity to talk about the health benefits of oily fish while everyone had a go at mixing the ingredients together. The ingredients themselves provided a sensory experience and a topic of conversation.

Our senses deteriorate as we age and this can be intensified as dementia progresses. Food is perfect to evoke the senses through smell, taste and sight.

Mackerel, lemon, dill and horseradish

Mealtimes can give structure to the day . . . . . . activity and activities around food can help maintain independence and aid reminiscence.

all have distinctive aromas and the smell of fish led to many reminiscences. One gentleman recalled stories of fishing trips when his children were younger, he described catching mackerel then scaling and gutting them on the beach before going back to the campsite to cook them over a fire. Wonderful memories! This led to further stories of fishing trips and favourite fish dishes, including of course, fish and chips.

The finished paté was spread onto slices of bread and served with great pride to other members of the group, but not before it had been tasted and enjoyed by those who had made it.

It was clear to see their satisfaction and sense of achievement in helping to make their own food. The granddaughter of one lady said it was something she would do again with her Gran.

MEANINGFUL ACTIVITY

Mealtimes can give structure to the day. Tasks such as laying the table or clearing dishes provide the opportunity for meaningful activity and activities around food can help maintain independence and aid reminiscence. One lady described how her family always gathered for Sunday lunch and her mother-in-law would cook the roast each week. However, as her dementia

progressed she was no longer able to do this, but could be involved with meal preparation by laying the table. This became her ‘job’ until she was no longer able to live alone and moved into a residential care home; it gave her a feeling of purpose and value within her family.

For this lady and many others, preparing food, cooking and caring for other people, is part of their life story. An important part of their daily activities would have been to provide meals and care for their partner, children and grandchildren.

Drawing on someone’s past experience can help care providers to promote activities that have meaning for them. I recently visited a care home which provides opportunities for residents to be involved with their new care community and to feel at home. For health and safety reasons, they’re unable to use the main kitchen, but a small kitchen area off the dining room allows residents to wash the dishes after meals if they wish and help bake cakes and biscuits. It’s a homely, familiar looking kitchen and they can also make their own drinks and snacks whenever they want.

These are great examples of meaningful activity and ‘can promote a sense of independence and wellbeing which can consequently positively impact on appetite’.2 www.NHDmag.com July 2018 - Issue 136

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COMMUNITY ACTIVITY IS FUN

It’s important to remember that whilst activity should be meaningful, it can also be great fun.

During Nutrition and Hydration Week earlier this year, I had the pleasure of working with a group of people living with dementia and we decided to make fruit kebabs. Who would have thought that making a healthy snack option could provide so much fun! It didn’t matter that most of the fruit never actually made it on to the skewers! We had the opportunity to talk about the different fruits (and eat them), their health benefits and most of all laugh. One lady commented on how much fun she’d had and this reminded me that whilst some of them might not be able to remember the actual activity or the importance of fruit in the diet, they will remember their emotions and the feeling of fun and enjoyment they had. This makes it all worthwhile.

INTEREST IN FOOD

Making chocolate and Rice Krispie Easter nest cakes with a group of residents in a care home provided equal pleasure. The cakes were made to be served with afternoon tea in the care home (meaningful activity), but also highlighted the significance of how food-based activity can help stimulate an interest in food. One lady with a very low BMI and a generally very poor appetite managed to eat three cakes during the course of the afternoon - a great way to consume high calorie food without thinking!

When people are engaged in activity around food, conversations naturally take place about food which in turn may help develop an interest in mealtimes. We had memories of baking gingerbread, cooking for a large family and making sure the freezer was always full for when friends dropped in, as well as childhood reminiscences of Easter.

COMMUNITY ALLOTMENT

Socially Yours3 is a friendship group based in the North West of England. It was set up by a family run care company, Quality Care of Cheadle, to provide service users (mainly older people and people living with dementia) with a place to meet and take part in activities around food, exercise and craft to promote healthier living. But 40

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not everyone is comfortable with this kind of set up. As Natalie Peters, Community Development Manager, explains: “We wanted to continue the good health and wellbeing theme but reach more people that were less keen on the indoors…so the idea for a community allotment was born.

We could promote exercise purely by getting involved in gardening activities and at the same time encourage healthy eating by growing our own produce.” Exercise and physical activity may bring many benefits for people with dementia,4 including improving heart health and physical fitness which can help people maintain independence for longer.

The allotment is a community initiative and has been made accessible with some paved areas for wheelchairs and raised beds. There is a seating area for rest breaks and socialising and a polytunnel to grow crops (and shelter from inclement weather!). All produce is available for people to take home and there are plans to provide recipe sheets with different cooking ideas. Any surplus is taken to a local food bank and it is hoped this year to sell some produce at a makers’ market and bring some funds back into the project.

Natalie says, “In the winter we often make a nice hot soup to warm us up. We put the veg in the middle of the table and everyone gets involved peeling and chopping ready to drop in the pan. It’s a fabulous, cheap and easy activity that everyone gets involved with and it brings with it great conversation.” The friendship group has also hosted afternoon tea at the allotment for local schoolchildren and in Natalie’s words: “It’s fantastic to see the different generations coming together and sharing the food - smiles are huge!”

SUMMARY

The allotment and other food-based activities I have described here are fantastic opportunities to create an interest in food and drink, at the same time as providing social interaction and mental stimulation. They provide meaningful activity and can improve confidence, self-esteem and help maintain independence for people living with dementia. As eating and drinking can become more difficult as dementia progresses, food-based activities can have a very positive impact on appetite.