Cooking, eating and drinking
By Sue Hinds, Head of Services
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 supermarket. We stood debating whether you could have a chickpea Indian curry alongside crispy seaweed, 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, the saliva also 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 with dementia, 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, and this is 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 yet involving a person in meal preparation helps to restore that and can also have a significant impact on improving appetite. As cooking and meal preparation produces 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 one type of food with another but who created that rule?! 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!
Common challenges in eating and drinking
People’s difficulties with eating and drinking can cause a challenge for maintaining nutrition and hydration. A person with dementia may experience weight loss alongside other problems including fatigue, higher risk of infection and reduced muscle strength. Some of the other challenges that people with dementia experience are:
- lack of appetite
- difficulties cooking (planning, preparation, motivation, recall etc)
- problems with recognising the feeling of hunger or being able to communicate hunger
- difficulties managing cutlery
- tiring during a meal
- losing concentration during mealtimes
- taste changes
- difficulties with chewing and swallowing
- apathy (lack of interest, enthusiasm, or concern)
It is important to realise that sometimes eating three square meals a day doesn’t have to be ‘the rule’. It is understandable for a carer to worry about whether the person has eaten enough or finished their meal. But it’s important to know that often people with dementia find it easier to eat little and often and to snack between meals. Sometimes they might prefer unusual combinations of food and it doesn’t matter what the combination is, as long as the person is enjoying it.