The importance of pre-meal cues

A friend of mine was leaving the UK for a while on business this morning, and so last night we decided to have a nice meal together. We had both had busy days and neither wanted to cook, so we went together to peruse the ‘ready meals’ aisle at the local super market. We stood debating whether you could have a chick pea Indian curry alongside crispy sea weed, egg fried rice and Chinese chicken curry. One of us believed you could mix Indian style food with Chinese style food, one of us did not – the debate went on a while and we laughed and joked about foods that ‘do’ and foods that ‘don’t’ go together. We ended up getting all the aforementioned, along with a bottle of Rioja and two magnum ice-creams – one white chocolate, and one milk chocolate.

Now, having read that, I am sure that at least one item I have mentioned, if not more, has started your mouth watering and you are imagining the meal! An hour later, it goes without saying we devoured the meal, the ice cream and the Rioja. I can assure you we had no problems in swallowing any of the meal!

Often, people with dementia can simply forget to chew and swallow and, in my experience, this becomes worse when people aren’t given those pre-meal cues that my friend and I had of chatting, looking and thinking about the food. Without these pre-meal cues, they are less likely to produce extra saliva – our mouths don’t just water to tell us we are hungry. They water to give us the saliva which has special enzymes in it to break down chewy foods and to help us to swallow. It also activates the centres in the brain involved in swallowing to tell us what to do. For many people, the opportunity to be involved in preparing what they eat all but vanishes. Preparing what you eat can also improve levels of wellness and impacts on quality of life, not just from a nutritional perspective. It really is a great social opportunity for people. I could easily have picked up a takeaway on my own, but this would have taken something away from the evening.

When caring for others we sometimes inadvertently take away people’s independence, but involving a person in meal preparation helps to restore that. It can also have a significant impact on improving a person’s appetite. With involvement in cooking and meal preparation producing such positive outcomes, every opportunity to encourage it should be seized.

There are many ways people can get involved and many of the barriers to cooking with a person with dementia are perceived, not actual. We should strive to involve the person in every aspect of planning and preparing a meal, from creating a shopping list, selecting the produce off the shelves, to the final serving of the meal. This will often mean thinking creatively , it may not always be about preparing a main meal but it may be providing the opportunity to prepare the vegetables – washing potatoes, peeling carrots or shelling peas. Maybe laying the table. It may be looking at pictures of food, or smelling the spices before they are added, and so on. It requires us to focus on abilities, not frailties. If we do this the impact can be fantastic.

My frailty had been my preconceived idea that you couldn’t mix Indian chick pea curry with a Chinese style dish. I think that quite possibly I am now a bit more open in my approach to what I might like, with just maybe more adaptability to break from the norm! It was delicious!

 

Sue Jones

Dementia Carers Services Lead