1. Nutrition & Dementia No One Should Go Hungry John Hilton Southwest Regional Chair

2. No One Should Go Hungry Eating well means the person has the amount of energy (calories) and nutrients ( protein etc.) that they need to maintain their body processes and to protect them from illness. Evidence indicates poor diet is related to illness, premature death and health conditions that affect the quality of life In order to eat well people need a variety of foods.. This is where our challenge begins.

3. Risk of under nutrition Identified by Nutritional Assessment Those at greatest risk –Have lost weight recently –Started to leave food on the plate –Lost their independence in eating

4. How to address this … Its easy to focus on the facts and reasons why it’s a problem but how to address this is more proactive

5. PLEASE P – Presentation – Colourful and appetising meals, small and frequent portions required. L – Liquids and Hydration – Offer regularly, not enough leads to dehydration which can add to the confusion. E – Environment – A pleasant atmosphere, minimal distractions A – Assistance – Specific to the resident, aids and adaptations, allow time to finish the meal, verbal prompting and reminders. S – Senses – Meal times should stimulate all of the senses. E – Eating Skills – Promote independence. Ability to eat a wide range of foods.

6. Senses Meal times should stimulate all the senses Hearing – music, radio could be played. Smell – Smell of the dinner Taste – Taste of the dinner Touch – Encourage users to maybe butter their own bread if possible. Sight – We eat with our eyes “Care homes should have a bread maker – the smell is very popular and stimulates the senses”

7. Protected Dining should be a protected experience. Principles behind Protected Meal Times include: Staff focus their attention on making mealtimes a success. Anything that supports and assists people to eat is encouraged. Anything that interferes with the meal time, and reduces the amount eaten is discouraged. There should be no doctors and no drugs trolleys being wheeled around. The more residents feel at home, the more likely they are to enjoy mealtimes. Often older people can have previously experienced a very planned eating pattern this should be considered and protected.

8. Case Study A care home in Leeds decided to look at their lunch time experience as both service users and staff were finding it a difficult, stressful experience. They decided to split the lunch. The first half have their lunch at 12.00, and the second at 12.30pm, they found making this change took a little while for the users to get used to, but found everyone was much more relaxed during and after their lunches. As they have the room, if users want to stay and drink tea whilst the others have their lunch they are able to.

9. Remember Forgetting what foods are… A fairly simple solution is to create picture menu cards showing the day’s meal choices, as it is helpful to see what food looks like. People will choose what they think looks good. The words ‘shepherd’s pie’ may not mean anything to a person with dementia, until they see and recognise exactly how this appears.

10. Support Staff guide and encourage older people to choose a balanced diet Staff join service users at the table, to help encourage people to eat, help people to copy their actions if they’ve forgotten. Main objective still giving people choice, and independence.

11. Dining Experience Slow eaters table, service users are leaving their meal if someone has already finished. Sit the service user with other people who eat at a similar speed. Encourage family meals, if room, have a small dining room where the family can sit and eat together.

12. Why & How Dementia - It is thought that around 25% of the costs of caring for this group may be attributable to the time carers spend helping with eating and drinking. Encourage participation in the social and practical activities surrounding preparing and serving meals. If you have to assist a person to eat and drink, talk about what you are offering them to help remind them of tastes and flavours. Ensure that food is available for the person, which is easy to see, both within eyesight and in clear contrast with the plate.

13. Time has not allowed us to mention Texture modification of foods Food fortification Finger foods Feeding and drinking aids Specific nutritional care staff training These requirements all need to be considered as part of the assessment of a persons needs

14. Further Supporting Materials Eating Well : Supporting older people & older people with dementia ; Practical Guide –Caroline Walker Trust How to comply with CQC’s Outcome 5 : Meeting Nutritional Needs –NACC Menu Planning & Special Diets for Care Homes Manual –NACC

15. Thank you Karen Oliver National Chair NACC www.thenacc.co.uk