“A blog a day blether” for #DAW2015 Allied Health Professionals Q&A Day 2 “Ask a Dietitian”

Hello and welcome to today’s blog. The following questions were asked by people who care for someone with Dementia on the topic of nutrition. Hopefully you will find the practical advice given useful.

Blog previously published this week in LetsTalkAboutDementia Blog

Question 1

Tips on how to keep your loved one interested in food. ‘My mum’s diet is becoming more and more limited. By using dessert forks (they are light and pretty) she is continuing to feed herself.’ Catriona, carer

Try buffet style foods such as cut vegetable sticks, pork pies, quiche, pizza, cocktail sausages, fish cakes, fish or chicken goujons, bite sized pieces of meat or rolled up cold meat and cut pieces of fruit which your Mum will find easy to eat herself if she finds cutlery can be a problem.

If your Mum is only using one piece of cutlery try place this in her dominant hand as a prompt.

Use food as a conversation starter or memory jog – if your Mum used to like to go to a particular place or enjoy a particular food trying having that food and taking about times when it was enjoyed before such as on a holiday or a family event. Use a cup that your Mum is familiar with to encourage drinks.

Eat together where possible and talk about the taste and smell of the food as you are eating. Verbal prompts can help to encourage someone to eat better in a relaxed way.

Try foods which have a strong flavour such as sweet, sour or spicy foods or even foods your Mum previously didn’t include. You may find that what she enjoys has changed. As we get older we have fewer taste buds in our mouth. In addition the signals to tell us what food look, taste and smell like are not always recognised when you have Dementia. Foods to try could include curries, lasagne, chilli con carne, sweet desserts, citrus flavour or simply adding some herbs or spices to regular dishes.

Question 2:

Taking the stress out of mealtimes. ‘My mum will only eat food if plates are piping hot. As her vision is not great, I’ve been looking at tableware designed for people with dementia but it is really ugly, chunky and cannot be microwaved. Some of it is melamine so would not be suitable as it would never be hot enough. There don’t appear to be plain blue or red china plates around.’ Catriona,carer

Try ceramic plates which tend to hold more heat or use a plate warmer under regular crockery.
Encourage a relaxing environment – put on a piece of favourite music. Some people are able to concentrate better if there are no distractions, everyone is different.
Use a high contrast table mat under the plate.
Serve smaller portions at a time to keep food hot. An additional portion can be given after if desired.
Ensure good lighting where your Mum is eating.
Include bright coloured foods and foods which are high contrast to the background colour of plate e.g. dark on light or light on dark. Doing this will help to make foods clearer to see.

Question 3:

‘My husband has always eaten well, but now refuses to eat anything which isn’t on bread. Recently his iron levels were found to be very low and he’s had trouble with constipation. The doctor says he must eat more fruit and vegetables, but he just leaves them on his plate. What can I do?’ Anon.

Adopt a flexible approach – your husband’s diet can still be healthy with a few modifications.
Add a topping such as egg (poached, scrambled), cold meat – red meats such as corned beef, roast beef, ham, lean bacon, dark poultry meat, pate, mackerel/sardines, baked beans- these are all good sources of iron. Try adding salad vegetables such as cucumber, tomatoes or peppers.

Encourage a glass of orange or apple juice with the meal – vitamin C helps absorption of iron.
Some of the foods above will help to increase his fibre intake such as vegetables, baked beans but using a wholemeal bread, seeded bread or 50:50 bread would also help. You could also try crackerbreads, pitas, bagels or crispbreads for variety.
Ensure adequate fluids as being dehydrated can result in constipation.

Question 4:

‘My dad will only eat sweet foods and doesn’t like foods he previously enjoyed. How can I ensure my dad gets a balanced diet?’ Jean, daughter

You can still achieve a balanced diet with sweet foods but this can be stressful when it doesn’t look like what we typically think of as a healthy meal.
Add fruit – dried, tinned stewed or fresh to desserts or cereals to add extra sweetness but also additional vitamins, minerals and fibre.
Include dairy based desserts such as custard, rice pudding, mouse, trifle, ice-cream, yogurts, fromage frais, semolina, whipped desserts, crème caramel or crème brulee. Dairy foods are a good source of energy, protein and calcium.
Use naturally sweet foods such as baby plum tomatoes, carrots, parsnips, sweetcorn to enhance the sweet flavour of dishes and again add extra fibre, vitamins and minerals.
Try sweet sauces such as sweet chilli or sweet and sour in savoury dishes. Alternatively try adding sweet condiments to savour dishes such as apple sauce with pork dishes, cranberry with game or poultry dishes, sweet chilli dipping sauce, mango or other types of fruit chutney.
Adding a little honey, syrup or sugar to naturally savoury dishes can also help to encourage them to be enjoyed.

Question 5:

‘How strong is the anecdotal evidence that organic Coconoil can ameliorate some of the symptoms of dementia, even if only in the short term? e.g. memory loss, aggression, concentration What, if any, research is being done? And what is the incidence of dementia in countries where coconoil or coconut derivatives form a staple part of the diet?’ Kathryn,carer

Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices. There are currently a range of foods being studied to exam whether there is any benefit in prevention or treatment of dementia. There have been some reports recently in the press of improvement in symptoms for people with dementia who are using coconoil or coconut oil. However to date there is no conclusive scientific evidence to support including coconut oil or coconut derivatives as a prevention or treatment for dementia. As coconut oil is high in fat and in particular harmful saturated fat, large amounts of this in a person’s diet would not be recommended as this can increase risk of heart disease and vascular diseases such as stroke or transient ischaemic attacks (TIA’s). However as with any food, if desired coconut oil or coconut products can be included as part of a balanced, healthy diet.

The British Dietetic Association website has food factsheets on a range of nutrition topics which you can download for free at: www.bda.uk.com/foodfacts/home

As part of Dietitians week there will be an event at Scottish Parliament to highlight the role Dietitians can play in improving nutrition for people with Dementia. If you would like to know more you can follow ahpscot.wordpress.com and letstalkaboutdementia.wordpress.com throughout Dietitian’s Week (June 8-12).