Dr Vasant Hirani,
Senior Lecturer at the School of Life and Environmental Sciences, University of Sydney
While the focus of dementia research tends to centre on the prevention of degenerative ageing conditions, there is a growing interest in the way dementia is managed through food for those already coping with the condition.
We spoke to Dr Vasant Hirani, a Senior Lecturer at the School of Life and Environmental Sciences, University of Sydney. Dr Hirani is a Dietician, Nutritional Epidemiologist and Public Health Nutritionist.
In terms of how dementia is managed within aged care facilities Dr Hirani says the research indicates four key areas.
- Availability and sensation of food
- Relationship to others when eating and drinking
Maintaining a healthy weight
Dr Hirani cites weight loss as the most significant issue when dealing with dementia. Put simply, as the memory degenerates people forget when they last ate, so don’t automatically eat at regular intervals. In addition the sensation of taste begins to fade, so not only is there less memory of eating, there is less motivation to eat as food generally starts to taste quite bland. The risk of malnutrition and severe weight loss can compound as the condition advances.
Increasing protein rich foods has been found to help maintain healthy weight and a lot of research into dementia and nutrition is looking at which specific proteins and amino acids have the most effect in terms of weight gain and energy in those with dementia.
Accessibility of food
The other key factor in the well-being of dementia patients is the availability of suitable food. Dr Hirani suggests consistent snacking on smaller meals is far more effective than three meals a day with morning and afternoon tea.
By constantly offering easy to consume foods such as finger foods, smoothies, and frequent mini-meals, dementia residents are more likely to maintain a healthy weight.
In addition, a recent study done by the Faculty of Health and Social Science at Bournemouth University in the UK (based on 9 focus groups in Aged Care facilities and carers) includes several findings. The majority of these findings can easily be integrated into dementia care in Aged Care.
The study suggests that improving the motivation to eat in the first place can easily be encouraged by paying attention to people’s sense of smell, taste and sight.
- Presenting foods with contrasting colours can help stimulate interest in the food
- Increasing the flavour of food enhances the experience of eating
- Before the food arrives the aroma of cooking can activate the memory of that food (the smell of coffee or a roast chicken are good examples) and create a chain of association
Using smell is particularly effective because the part of the brain which processes smells is very closely connected to the part of the brain which processes and stores memory. Aromas are able to cut through a lot of the ‘brain noise’ and link directly with the memory of a smell.
Hydration needs to be carefully monitored as those with dementia can lose the sensation of thirst and don’t feel the need to drink. As with the consistent and frequent availability of food, drinks and foods that are very hydrating such as soups, smoothies and custards should also be easily accessible. The addition of dried milk to smoothies and custards also aids in additional protein intake.
The dining environment
The other key finding mentioned by Dr Hirani and the Bournemouth University research was concerning the social environment of where people eat.
Seating dementia patients at a shared table can make a significant difference to the intake of food. By watching others eating, those with memory loss can be reminded firstly, to eat, and also how to use knives and forks. Often it is simple things that are overlooked when trying to improve the intake of food in dementia sufferers.
Other visual reminders such as using a certain coloured tablecloth for breakfast, and a different one for lunch can also help remind people it is a mealtime. Combined with smell and visual stimulus, the right environment can motivate the desire to eat.