Aged Care Insite Issue 92 | December 2015 - January 2016 | Page 24

clinical focus

encourage collaboration, with the following four aspects in mind.
They are all interdependent and should not be viewed in isolation.

THE PERSON
The needs of the person with dementia will change continually
as the disease progresses and cognitive capacity continues to
decline. Strategies need to be reviewed regularly to make sure they
are still effective. Careful observation of the person at mealtimes
will give clues about whether a different strategy should be tried.
As dementia progresses, an individual’s ability to recognise a need
for food and fluids diminishes. Often it is necessary to change the
texture of foods and fluids because of dysphagia that reduces the
range of foods and drinks that can be offered. Care staff need to
describe the foods they offer and prompting the person through
each step of the eating process may be necessary.

THE CARE STAFF

Four-course meal
This quartet of interdependent
factors makes an impact
on appropriate nutrition for
those living with dementia
in residential care.
By Caitlin Silvester

B

y the time a person with dementia is placed in residential
care, the psychological and behavioural symptoms of
dementia are often well established. The person, their
caregiver and extended family need much support to understand
what is to come and be prepared for the terminal stage. Providing
adequate food and fluids may already be a challenge when a
person joins residential care if:
• the carer is not accustomed to cooking daily meals
• the person with dementia keeps forgetting they have eaten
• there is food refusal
• the person with dementia is no longer able to recognise food or
has paranoia about it, such as believing it is poisoned.
It is also possible that the person with dementia, on being
admitted to a care facility, is already malnourished. Unless
they have entered the terminal phase, it is important to aim for
adequate nutrition and hydration to improve their wellbeing
and minimise other clinical problems. However, providing
adequate nutrition and hydration is not just about the food. The
environment in which the food is offered, and the approach by the
care staff and the person with dementia all influence the success
of obtaining enough food and fluids.
Dietitians value the skill of observation and clear documentation
by care staff of what factors are interfering with oral intake. If
staff discuss their observations, then the problem and possible
solutions become more clear. Nursing unit managers should

24 agedcareinsite.com.au

Interactions between care staff and the person are critical for good
nutrition/hydration. The manner of staff, and the capacity to build
rapport and respect can affect the person’s willingness to eat and
drink. Care staff should be encouraged to sit face to face, at eye
level when giving assistance for eating and drinking, and also allow
ample time. Engaging the person in simple conversation and not
ignoring them by talking only to others is also important. Wherever
possible, be flexible with timing of meals and snacks and give plenty
of opportunities to drink fluids. Unfortunately, dehydration in older
people is common and occurs quickly. It is a factor in urinary tract
infections, constipation and poorer cognition.

THE ENVIRONMENT
This includes the general amenity of a dining room or eating
area, including noise levels, how busy it is, and the immediate
environment for the person with dementia. Noise in dining rooms is
distressing and staff should ensure they are not the cause of it. Meals
should be served on plain-coloured plates, not patterned, of a colour
that contrasts with the food to improve recognition. Tablecloths and
napkins are better plain as well. Only one meal at a time should be
presented to the person to minimise confusion. The person may fare
better eating and drinking in a quiet space, or may do well eating in a
small group, where the action of eating is modelled.

THE FOOD
Small meals, mid-meal snacks, finger foods (if dysphagia