Best practice approaches to deliver good nutritional care for people with dementia
Jane Murphy is Professor of Nutrition, a Registered Nutritionist and Dietitian and co-leads the Ageing and Dementia Research Centre at Bournemouth University. She will be speaking at the upcoming BGS Autumn Meeting on 27 November at 14:30 (UK time). She tweets @JaneLMurphy100
Over 850,000 people in the UK have dementia, many of whom struggle with eating and drinking issues affecting nutritional status, due to changes in memory, motor skills, appetite, taste perception, dysphagia and food preferences. Unintentional weight loss and malnutrition are common in people with dementia and can occur at any stage of the condition, contributing significantly to reduced physical and cognitive status and quality of life. By the time someone with dementia moves into a care home, they may already be experiencing significant weight loss and other nutrition-related problems. This can trigger further physical and mental deterioration, which means that supporting people living with dementia to eat and drink well can be quite a challenge for busy care and nursing staff. It is important that all staff have appropriate skills and knowledge to support eating and drinking for people living with dementia, in accordance with the national Dementia Training Standards Framework (Skills for Health et al 2018).
With funding from The Burdett Trust for Nursing, our research sought to understand how to improve the delivery of nutritional care for people with dementia living in care homes (Murphy et al 2017). Themes identified from the research informed the development of a new conceptual model to guide improvements for nutritional care in care homes. Person-centred care was identified as the primary theme, alongside six other themes: availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care; and provision of information (see model left).
This research informed the development of a number of resources, as part of the award-winning Nutrition and Dementia Care Toolkit (see here). This toolkit provides freely available resources such as films, downloadable workbooks and guides to deliver person-centred nutritional care in dementia.
Professor Jane Murphy, lead investigator ‘We recognised there was a need for research in this area as there were no evidence-based approaches or training programmes to provide staff with information about good nutrition. People with dementia may need much longer to eat, due to poor co-ordination or becoming tired more easily. Others may be losing their appetites or facing difficulties with chewing and swallowing. As dementia progresses, many people become less able to sense thirst so may be unaware they are dehydrated.’
The tools help to explain the importance of good nutrition and provide staff with lots of practical tips and ideas to try out. These include:
- Keeping people interested in food by getting them involved in food preparation activities, including growing their own fruit and vegetables
- Eating meals together with carers, which allows people to copy actions if they’re struggling to remember how to eat
- Adapting the physical environment to create an improved dining experience using colours, smells and lighting used at meal times
The toolkit aims to develop knowledge and skills around nutrition and hydration to provide best-quality care. It also offers an excellent CPD opportunity, which can be completed flexibly. To date, over 1,500 known recipients of the workbook (including nurses and allied health professionals, hospital and care home staff) have reported positive benefits and said that it inspired action to reconfigure the way in which nutritional care is delivered. Our evaluation of the tools indicated changes in the knowledge and practice of care home staff, leading to improvements in the eating and drinking behaviours of people living with dementia in care homes (Murphy et al 2020). The primary reported improvements were increased appetite and fluid intake, enhanced mealtime experience and an increased participation in food-related activities.
The Nutrition and Dementia Care Toolkit is freely available from our website here.
- Murphy JL, Holmes J, Brooks C. (2017) Nutrition and dementia care: Developing an evidence-based model for nutritional care in nursing homes. BMC Geriatrics 17:55. doi: 10.1186/s12877-017-0443-2 https://bmcgeriatr.biomedcentral.com/track/pdf/10.1186/s12877-017-0443-2
- Murphy J, Aryal N. (2020) Improving the provision of nutritional care for people living with dementia in care homes. Nursing Older People. doi: 10.7748/nop.2020.e1263
- Skills for Health, Health Education England, and Skills for Care (2018) Dementia Training Standards Framework. www.skillsforhealth.org.uk/services/item/176-dementia-core-skills-educat...