Read for the ‘solutions’ and stay for the ‘science’

20 February 2019

Dr Sarah Russell RGN is a carer and Honorary Research Fellow, University College London, Visiting Fellow, University of Southampton. Here she reviews Practical Nutrition and Hydration for Dementia Friendly Mealtimes by Lee Martin. She tweets as @learnhospice and @WeEOLC

I like this book. I like this book very much, but before I say why, let me do my disclaimer. I am a nurse, been one for 33 years, of which most of that has been in hospice and palliative care. I have also been a carer for nearly sixteen years. First at a distance and at weekends and then for many years fulltime when my mother came to live with us. Mum lives with moderate Alzheimer’s and is severely frail (Rockwood Clinical Frailty Scale 7). She moved into a local nursing home at the end of 2018 after a fractured neck of femur. So, our experience of eating and drinking has taken place at home, in hospital and nursing home.

Why am I saying this? Because that is why this book has resonance for me as a nurse, researcher, educator and carer. Wherever I picture Mum, I can see the relevance of this book for family or clinical care givers. Mum likes this book too – she says its full of useful examples that illustrate why she is put off eating and drinking. This matters. Because for her mealtimes are not only about calorific intake, they are also about retaining who she is and being able to interact with those around her.

Who should read it? I suggest anyone with an interest in dementia, nutrition and hydration will find this of value, in particular frontline staff, but also those involved in the design or management of care.

The book is an excellent illustration of how a mealtime is a complex intervention. Managers take note – this book justifies why staffing levels at mealtimes are so important not just for patients/resident’s nutritional intake but also for their health and wellbeing. Clinicians consider – this book provides a myriad of assessment, diagnosis and intervention considerations (including Dementia Mealtime Assessment Tool) which will improve the meal time experience and nutritional intake of people living with dementia.

Written by Lee Martin, a London based dietician, the book is a delight especially for those providing daily hands on care. Lee is a wordsmith and viewing nutrition and hydration through the dietician lens provides a highly person-centred narrative, evidence base (including research that I might not have come across as a nurse) and practical clinical interventions.

The book is aimed to support people living with moderate to severe dementia. Lee points out that the book does not cover end of life (pity as I would be interested to know the authors views and advice) and that the focus is on the practical applications of evidence. And the book has an abundance of practical applications with relevant research. That is one of the strengths of the book. I particularly liked the ‘use red plates’ debunking on page 72, where the author comments that the highly quoted research only included nine participants and perhaps the real point is about contrast between colour. In addition, the book makes you think about the multicomponent experience of eating, the importance of looking at people’s ability to eat and drink as well as meal behaviours (i.e. mealtime abilities). It doesn’t forget practicalities such as dental care and swallowing assessment as well as challenging the reader to consider mealtime social interactions, self-feeding ability, the dining environment and experience, attitudes, knowledge and skills of staff as well as time capacity to eat, availability of staff to assist, sensory properties and mealtime logistics.

The real strength of the book is that it is focussed on people living with dementia with practical evidence-based solutions. Whilst ideas and solutions are spread through the book, chapters 5,7,9 and 11 provide detailed advice which could be used in any setting.

So, that’s why I would advise reading it: Read it for the solutions, and stay for the science.

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