Around 850,000 people in the UK have dementia. One outcome of the condition is that eating and drinking becomes increasingly difficult, which heightens the risk of severe malnutrition and weight loss. As a result of research conducted by Professor Jane Murphy and Dr Joanne Holmes, lecturers at BU, best practice guidance is now available in the form of a toolkit for front-line nurses and care home staff to help people with dementia to eat and drink according to their needs.
Ensuring appropriate food and nutrition is a vital part of delivering dignity in care for people with dementia. Yet as dementia progresses, it’s not uncommon for people to lose weight, which can lead to further physical and mental decline.
The reasons behind weight loss are diverse. Some people face physical difficulties with chewing and swallowing, while others may struggle to identify when they feel thirsty or hungry. For busy care home staff, managing this and knowing how best to support people they care for – each with their own needs – can be a real challenge.
Despite these known concerns, there are no standardised ways to maintain adequate nutrition in people with dementia.
The launch of the research
To tackle this gap and assist front-line care staff, Professor Murphy and Dr Holmes were awarded a grant by The Burdett Trust for Nursing to undertake a groundbreaking research project.
“We worked with local care homes in Dorset to find out how much people were eating and drinking each day. Our results showed that around half of our participants weren’t eating or drinking enough to meet their daily energy needs. We also found that many people were spending a high proportion of their day sitting or sleeping, which may explain why some had small appetites,” says Professor Murphy.
The next stage was to work with local care homes to draw out examples of best practice and strategies to help people with dementia to eat and drink well. A whole-care-home approach was a key element of the project, involving service users, families and carers of people with dementia who were able to inform and guide the research.
“Working collaboratively with care staff was essential to developing these resources as we were able to draw on the expertise of and best practice used by frontline staff,” continues Professor Murphy. The BU team also worked in partnership with local councils, Partners in Care, the Dorset Local Enterprise Partnership and national and private care home organisations.
The Eating and Drinking Well with Dementia Toolkit
Programme Director for Greater Manchester Nutrition and Hydration Programme
The guide is simple yet comprehensive. It focuses on supporting people living with dementia to eat and drink well in a dignified way with positive and practical tips for care staff. It has the potential to transform nutritional support in care homes.
Testimonial commissioner of care services
We used the workbook as a superb resource to input in our action plan to improve nutrition care in our borough across health and social care providers for people living at home and in a residential home.
Professor Jane Murphy talks about nutrition in dementia care
“We chose to make resources that can be used at any time, as we know that care staff are extremely busy, and taking time to travel to training sessions can be difficult,” explains Professor Murphy. “The training tools explain why ensuring good nutrition is essential and provide practical tips for how staff can support people to eat and drink as part of their person-centred care. These range from getting to know people’s personal preferences, to ideas for encouraging people to drink enough, developing appealing menus and even improving the environment for meal times.”
The response to the resources indicates the impact and difference small changes can make on nutritional care. To date, over half of the recipients have reported that people with dementia who had poor appetites or were losing weight are eating more as a result of the suggestions and interventions in the guide. Quality improvements in nutritional care have led to increased Care Quality Commission ratings in care homes.
One user has commented how “we are now developing taste sessions within the home and being more creative with the menu and presentation.”
Another said: “This workbook has been a hugely useful tool… I have been able to communicate best practice in supporting people re eating and drinking well with dementia just by handing them this work book and explaining the relevant information.”
“Most encouragingly,” says Professor Murphy, “we’re beginning to hear stories of people with dementia who were at risk of or actually losing weight, beginning to reverse that trend – as many as 40% of those who have reported back since engaging with the resources. This shows us that the strategies we highlighted in our resources are making a real difference.”