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Dementia – tips to help care for loved ones at home

Dementia – tips to help care for loved ones at home

Guide to help loved ones with dementia to eat well  (download PDF here  Guide to help loved ones with dementia to eat well  Guide to help loved ones with dementia to eat well )

Having trained in public health I take a particular interest in dementia care and have worked closely with the NHS and care home groups delivering expert advice on how to help older people with dementia to eat well.   I hope to share a little insight and a few tips to keep your loved ones with dementia properly nourished.

 

What is dementia?

Dementia is a word used to describe a group of symptoms that occur when brain cells stop working properly.  This happens to specific areas of the brain, which affect how you think, remember and communicate.

The condition has a huge impact on the lives of someone with the condition and those around them.  Dementia is now the biggest killer of women and third biggest killer of men in the UK.

 

Dementia statistics  

  • 850K people living with dementia in the UK and is expected to increase to over 1 million by 2025
  • 24% of males and 35% of females born in 2015 will develop dementia in their lifetime
  • A person’s risk of developing dementia increases from one in 14 over the age of 65 and to one in six over the age of 80
  • Over 42K people under 65 years old have dementia in the UK

 

Why do older people with dementia need to eat well?

The purpose of a good diet is that someone receives the right amount of energy and nutrients they need to maintain bodily processes and protect against ill health.  There is plenty of evidence to support the fact that a poor diet will increase the chances of illness and many other health conditions as well as lowering someone’s quality of life.  Eating a wide variety of foods regularly will ensure someone’s dietary needs are met although in the case if dementia there are often many challenges that must be overcome to achieve this.

 

How the ageing body changes

Ageing can render the immune system less efficient, which makes older people with dementia more vulnerable to illness and infection.  A slower digestive system make constipation more common and a loss of muscle and bone strength increases the risk of falls and fractures.  Understanding thirst can also occur as less efficient kidneys make urine less concentrated and this can make dehydration more common.

 

Why are older people more likely to become malnourished?

A good diet is important for everyone but even more so for people with dementia who are at greater risk of becoming malnourished.   Not eating an adequate diet can lead to someone becoming under-nourished and this will impact on the greater chance of getting ill, skin problems, muscle weakness, tiredness, confusion and irritability.  There are many reasons why this this may be more common in older people with dementia: 

  • Smaller appetites and eating too little food
  • Chronic disease
  • Increased need for energy and nutrients due to illness or wound healing
  • Chewing and swallowing problems impact no food choices
  • Medicines may contribute to change in appetite, abnormal eating or eating disorders
  • Changes to the senses of sight, hearing, taste and smell make meals less enjoyable
  • Reduced communication skills make it difficult to explain your food preferences or that the temperature of your food is too hot or cold or that you may still be hungry

 

Informal dementia carers in the UK

There are currently 700K informal carers for the 850K people living with dementia in the UK.  Looking after someone with dementia is challenging and often impacts on family relationships and physical and psychological health but at the same time it can be rewarding and strengthen family bonds through the intimate relationship.  Caring for someone at home can allow loved ones to catch glimpses of past personality such as the occasional smile, laugh or a few words that allow an emotional connection to stay alive and that may be missed in residential care.

Whether you’re a sibling, child or family friend, the effects of possible sleep deprivation and carrying out all the household chores, extra cleaning and laundry as well as moving and lifting their loved one can be exhausting and this is even more relevant as 44% of carers have a long-standing illness or disability according to research carried out by NHS digital.

Providing adequate food can be a challenge for home carers.  Budget constraints, lack of food knowledge or cooking skills, managing difficult eating behaviours anda exhaustion means that cooking home-prepared meals from scratch three times a day is often not a reality.  Understanding how to make mealtimes more manageable and quick healthy food fixes can lessen the burden whilst keeping your loved ones with dementia healthy.

 

A few tips to help people with dementia to eat well

Dementia is a fluid condition and every case is different but I hope these tips can offer a little insight and advice to help manage mealtimes.

 

Stimulate the appetite!

If you’re struggling to get someone to eat then try whetting their appetite.  Any increase in activity can help instigate hunger so a short walk or chair-based activity may help (this also helps relieve constipation).  Don’t fill stomachs with excess fluids before mealtimes as this will blunt the appetite. Prepare very flavoursome meals by adding spices or strong flavoured foods such as mature cheese, mustard or tomato puree.  Food should also look appealing and eye-catching with bright colours as we often, ‘eat with our eyes’. 

Try and use simple food cues to help older people with dementia orientate themselves with mealtimes.  The smell of toast or coffee in the morning, the clanking of pans or sight of someone cooking may all help someone with dementia to understand that it’s time to eat.

Mealtimes can be flexible and it may be easier to focus on the times of the day when someone usually has a bigger appetite, whether this is at breakfast, lunch or evening meal.  You should also offer small portions of food if someone has a small appetite as too much can be off-putting.

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Create a calm eating environment

  • Avoid noise from the television or radio at mealtimes
  • Make sure plates are clearly visible on the table opting for red or blue colours or ones with a coloured ring around the edge (you could also try a white plate with coloured placemat)
  • Don’t clutter the table as this can be very distracting
  • Allow plenty of time to eat
  • Eat together

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Take account of food preferences

Understanding someone’s food likes and dislikes can make a difference at mealtimes.  Be adventurous with new flavours but not to the point that someone refuses food.  Think about food occasions that the person your caring for may have been familiar with as it may even trigger a memory and connection with that particular food.  A Sunday roast, Christmas dinner, Strawberries during Wimbledon, seasonal foods, Birthday cake or hot cross buns at Easter are all good examples.

Taste and smell diminishes with age and more so with dementia so food preferences may change day-by-day.  It’s not uncommon for people with dementia to prefer sweet foods so try adding a little honey to savoury quiches, pies and omelettes or serve main meals with apple or cranberry sauce.  Fruit chutneys are also great to serve with cheese or cold meats, which also work as finger foods.  You can also add honey to roast vegetables and apples or dried fruit work well in stews, casseroles, curries and other one-pot dishes that can be cooked in batches and frozen.

Be aware that someone may not remember when they last ate and this may cause reluctance to meals.  Listen to what they are saying or trying to communicate and try and work around this with the food you offer. For example, if the person you’re caring for keeps asking about breakfast then you could consider several breakfasts across that day to encourage them to eat.

 

Maintain independence

It’s important that someone with dementia is given the opportunity to feed themselves as this helps retain a sense of independence and dignity.  Don’t worry about neatness as it’s more important that someone is eating independently. This may mean being patient and mealtimes could be lengthy and often require gentle encouragement along the way as well as appropriate supervision to reduce any risks of choking.

As dementia progresses someone may become less dexterous and lose the ability to use cutlery.  You can find specially adapted cutlery, cups with handles and non-slip placemats to make things easier.  If cutlery becomes difficult to use then provide finger foods.  A finger food diet can be just as nutritious and served hot or cold.  Pizza slices, chopped vegetables, fruit, meat pies, boiled eggs, potato wedges, sandwiches, fruit loaf are all good examples.

 

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Recognising weight loss

There are many reasons why someone with dementia may lose their appetite such as suffering with constipation, swallowing issues, depression, mouth ulcers or painful teeth.  It’s important to be aware of weight loss in people with dementia and act immediately to help regain a healthy appetite and reduce the risk of malnutrition.

  • Bones visible under the skin
  • Loose clothing
  • Loose rings
  • Loose fitting dentures
  • Leaving food on the plate

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Fortify foods 

If someone is losing weight then you may need to consider fortifying foods as it’s important to get as much nutrition as possible into a small serving of food, especially calories and protein.  Full fat milk, cream, cheese, oils, butter, mayonnaise, crème fraiche, milk powder, coconut milk, avocado, nut butters and pureed tofu are a few ideas of foods you can use. 

Nourishing smoothies can also help to top up someone’s calorie and protein intake.  There’s no end to the different combinations you can use and the best base is full fat milk.  

 

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Planning meals

When you’re trying to think about what food to prepare each day it’s worth paying thought to a few factors that may make mealtimes more enjoyable for people with dementia.

  • Combine colours on the plate to help meals become more visible. Choosing three or four is a good target such as steamed fish with carrots and peas
  • Combine textures to make food more appealing. Mix up crisp, crunchy, chewy, soft and smooth foods (unless someone is having difficulty swallowing)
  • Vary taste but don’t add too many favours to any one meal
  • Have a buffet day with finger foods such as quiche, scotch eggs, vegetable sticks, cocktail sausages and yoghurts

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Quick fixes 

If you don’t have the time to prepare something from scratch or are just too exhausted then there is nothing wrong with turning to good quality ready meals as a quick option.  Dishes such as lasagna, cottage pie, fish pie, macaroni cheese and risotto all provide a good soft food option.  Canned foods can also save time and offer a quick nourishing meal.  Canned fruit, fish (watch out for bones that pose a choking risk) or even baked beans are good examples and can be partnered with other ingredients.  Eggs are also a quick food option and can be scrambled with soft vegetables such as tomatoes and mushrooms or made into a simple omelette.

Pre-prepared foods can be used to make an interesting buffet meal that is also suitable for people that require a finger food diet.  You can also cook foods in batches and keep individual portions in the freezer to help save time. 

 

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Food textures

Some older people with dementia may need the texture of their food altered.

  • Difficulty using cutlery or with a tremor may need finger foods
  • Difficulty chewing and poor teeth may need softer foods (mash, tender meats and fish, soft vegetables)
  • Difficulty swallowing may require a pureed diet (you must seek professional advice to assess someone’s potential swallowing problem before pureeing their diet) 

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Hydration

Dehydration is common among older people with dementia as they may not recognise they are thirsty, may forget to drink, may be unable to communicate that they are thirsty, or may refuse to drink because they are worried about incontinence.

Dehydration can cause headaches, confusion, irritability and constipation which can contribute to urinary tract infections.  Older people who are incontinent need to drink more, not less, to encourage the bladder to empty regularly to prevent infection and to exercise the bladder muscles.

We get some of our fluids from food, particularly foods such as soup, stews, fruits and vegetables, jelly, sauces, ice Lolli’s and yoghurt.  All drinks help us to remain hydrated, including tea, coffee, water, milk, fruit teas and fruit juices.

 

Caring for someone with dementia is a full time job and mealtimes present a whole new set of challenges however, maintaining a well-nourished body will help someone with dementia achieve a better quality of life and help to deter the onset of other illnesses that may make caring for them even more challenging.

 

More informtation

 

Dementia UK

Caroline Walker trust

Alzheimer’s research UK 

Age UK

 

Download PDF here Guide to help loved ones with dementia to eat well 

 

Time to join the culture club – your guide to probiotics

Time to join the culture club – your guide to probiotics

Time to join the culture club (download PDF here The culture club)

So, you’re clean eating, gluten free, fasting, eating avocados like their going out of fashion, chugging down green juices with the latest wonder powders and using coconut oil to cook and apply to every part of the body from top to toe to achieve an enviable state of health and wellness.  But health trends come and go, and whether they stand the test of time is usually based on popularity over real results.

One area of health that has always been popular is the gut and the one thing we know for sure is that an efficient gut equals good health.  Probiotics have been hip for a while now and this is one trend with a lot of research to back up the claims. The discovery of how to sequence the bacteria that live in the gut has widened this area of research and allowed scientists to explore it in a similar way to DNA 20 years ago.

Good digestion insures that your body can process foods efficiently and deliver all the essential nutrients without bloating or other digestive complaints that can impact on how you feel day-to-day and the role of gut bacteria in this context is well established.  But these clever microbes are not just about good digestion and new exciting research is drawing associations between the microbiome and areas of healthy you may never have considered before. 

 

What’s the deal with bacteria?

The body is full of bugs that make up one of the most complex ecosystems in the world with over 400 different species living in the gut.  Generally, these bugs are not harmful and many have a beneficial role to play in the body. 

Gut bacteria are essential in the process of breaking down food to extract nutrients that are required for our survival.  Bacteria help to synthesize certain vitamins including B12, folic acid and thiamin that are required for energy metabolism, red blood cell production and maintaining a healthy nervous system.   These microbes also teach our immune systems to recognize foreign invaders and produce anti-inflammatory compounds that fight off disease-causing bacteria.  Clever stuff.

 

Nurture your own culture club

 The community of bacteria in your gut is specific to you and is referred to as your microbiome.  The diversity of your microbiome is especially important to help maintain a healthy gut as bad bacteria are limited and tightly controlled by the good variety.  If your diet is unhealthy and rich in sugary or processed foods then there’s a chance that the good bacteria in your gut will become weakened, impacting on health as you provide an all-you-can-eat buffet for bad bugs to thrive on and take over.   A buildup of bad bacteria may result in a number of health problems such as food allergies, yeast infections or inflammatory bowel disease. 

Interestingly, the trend for carbohydrate free diets could have an impact on the diversity of bacteria in your gut.  A high fat and protein diet is not necessarily the issue as bacteria will find something to live on in the gut but the diversity of bacteria and their activity may change in the absence of carbohydrates.  Like us, bacteria prefer to live on carbohydrates (glucose) and from this they produce short chain fatty acids that are good for your gut.  Once carbohydrates are taken out of the diet, bacteria start to thrive on amino acids that make up proteins, which produces other compounds that are considered more poisonous than beneficial

 

What are probiotics?

Probiotics are beneficial bacteria that contain strains that have been shown to have a positive health benefit.  There seem to be a lot of interesting foods labelled as being probiotics ranging from chocolate through to tea but to get the most benefit you need to look for well researched strains such as Lactobacillus or Bifidobacterium with at least 10 billion bacteria per serving.  Some foods such as kimchi are also touted as being a probiotic and although they may have health benefits for your gut the strains they contain (and there are many strains) are often not well researched and so cannot be classed as such.

 

How do probiotics benefit health?

One of the key benefits of probiotics is in maintaining good digestive health and research has shown how they can help with common digestive complaints such as diarrhoea and constipation.  Probiotics have also been shown to be of benefit for people suffering with IBS and food intolerances such as lactose intolerance. 

Immunity is also a key area of research.  Around 80% of the immune system resides in the gut and studies have shown that probiotics are successful in preventing upper respiratory tract infections (coughs and colds) as well as reducing the infection time.  Probiotics are also essential for anyone that has had to take antibiotics that have an apocalyptic effect on all the bacteria in the gut.   Taking probiotics alongside medication and for a few weeks afterwards should be a common place recommendation to help restore your microbiota.

 

The future of probiotics

Where things get very exciting is in the research that is starting to put science to the concept of that “gut feeling” by exploring the relationship between gut bacteria and how this may impact on behaviour, metabolism and mood via a signaling pathway called the gut-brain axis with early findings suggesting a possible link to conditions such as obesity and depression.

The future of gut bacteria is also fascinating as researchers at Kings College London predict that we may be able to receive individualized probiotic advice relating to the unique diversity of strains that make up our own personal microbiota.  Researchers have commented that it is naive to think that a ‘one-size-fits-all’ approach to probiotics and that in the future.  Metagenomic testing may be able to map your microbiome by sequencing every gene in every living organism in your gut.  This would provide data on the functions of your microbes as well as viruses, fungi, virulent genes and antibiotics resistance.  Understanding this may help link in with the research around the how certain bacteria strains are associated with specific health conditions.

It may also be time to ditch expensive skin care products in place of probiotics to achieve a healthy, clear, glowing complexion.  Whilst the link between skin and gut bacteria is complicated, it has been shown that the health of your microbiome may be a significant player in the quest for healthy skin.  If your gut is overrun with bad bacteria or yeast then this can increase the permeability of the gut, which can result in inflammation as the immune system produces inflammatory cytokines in response to microbial toxins that enter your system.  Inflammation is at the root of skin conditions such as acne and research has shown how probiotic strains such as Lactobacillus casei and Lactobacillus plantarum may help to regulate the cytokines.  This doesn’t mean you can just pop a probiotic and expect great skin but there is an association with your microbiota.

 

Do we need to take probiotics?

If you have a healthy lifestyle and balanced diet then their maybe no need to invest in a probiotic but there is certainly no harm in taking them daily.  Probiotics are intended to be used in a therapeutic context as they help to deliver a beneficial dose to the gut that you may not be able to achieve by eating foods such as probiotic yoghurt.

 

What is the best way to take probiotics?

This is up to you really.  Probiotics are available in a capsule or tablet form such as Healthspan Super50 Pro (60 capsules for £28.50).  This form of probiotic is freeze-dried and activated on entering the gut. Other sources of probiotic yoghurt and drinks do contain beneficial strains but these are often not in as greater volume as a supplement or with as much variety.  You also need to be aware of the high sugar content of certain probiotic foods as some brands of ‘shot’ drinks have been shown to contain as much as 2 tsp of sugar. Probiotic foods are a good way to help maintain good bacterial levels but to make a real impact on the diversity of your microbiome you need a supplement.  Like all supplements, the key is to take them regularly to get the most benefit and this is even more important with probiotics as you are essentially trying to increase the amount in the gut.

 

What to think about when choosing and taking supplements

 If you’re considering taking a probiotic supplement then there are a few things you should consider when buying and whilst taking them.

  1. To be effective you need to choose a supplement that contains at least 10 million bacteria per serving.   
  2. Don’t take a probiotic supplement with hot food and drinks like tea or coffee as this can lessen the chance of the bacteria getting to your gut unharmed. Give it 30 minutes after taking them before you reach for the teapot.
  3. Alcohol can also render the bacteria in probiotic supplements useless so avoid knocking back with a glass of pinot!
  4. Research suggests that breakfast might be the best time of day as this is when bacteria have the greatest chances of surviving the acidic conditions in the upper part of the gut.
  5. Make sure you check the check the expiry date because once that’s passed there may not be any live bacteria left in the product.
  6. Choose a probiotic that includes a wide variety of strains to get the most benefit.

 

 Download PDF here (The culture club)