Helping people eat enough to stay healthy

As we get older our sense of taste and smell can change which can affect our appetite and enjoyment of food.

Covid-19 update: Adult Nutrition and Dietetics service

During this difficult time overall wellbeing of all individuals is of paramount importance. To both reduce the risk of catching Covid-19 as well as the ability to recover and the speed and completeness of that recovery. As is well known nutrition and hydration are key aspects of that well-being.

Though the service have temporarily suspended their face to face assessments they continue to offer telephone advice (Every Care Home has a named dietitian and contact number). If you do not know who your named contact is you can contact the service to find through their contact page.

In addition to providing advice and guidance they may signpost care homes to the British Dietetic Association, BDA website (Inc. COVID-19 specific resources).

Malnutrition Pathway COVID-19 Leaflets | British Dietetic Association (BDA) section including:

  • Eating Well During and After COVID-19
  • Improving Your Nutrition During and After COVID-19 Illness
  • Nutrition Support During and After COVID-19 Illness

Adult Nutrition and Dietetics service

The Adult Nutrition and Dietetics service can provide a range of support from tips on managing taste changes, eating when short of breath, managing a dry mouth and guidance fluids (A Fluid Food Fact Sheet)

There is also a guide to Nutrition Support in End of Life Care on the Care Quality Team website  

For swallowing difficulties we would always advise care homes to speak with the GP for a referral to a specialist Speech and Language Therapist. If a texture modified diet is advised / in place we would encourage homes to visit the International Dysphagia Diet Standardisation Initiative, IDDSI website for additional information

People who lack good nutrition are at risk of malnutrition. Malnutrition is usually caused by not having enough to eat or not getting the essential nutrients you need to keep healthy. It's more common in older people and those with long term health conditions.

Malnutrition can cause:

  • muscle loss
  • weakness and fatigue
  • poor mobility
  • depression
  • delayed wound healing
  • increased risk of infection with a slower recovery

These could lead to a general deterioration in a person’s health and wellbeing.

Dementia and delirium can make these issues worse. The Alzheimer’s society produce useful guidance and, though targeted at dementia, is applicable to nutrition in older people.

Encouraging people to eat

It is important to offer residents that you care for a varied diet that takes into account personal preferences. Simple things can make a big difference, such as:

  • encouragement and help at meal times
  • meeting cultural and ethnic needs
  • using food aids
  • creating a pleasant environment at meal times
  • encouraging good oral hygiene
  • making meals that look good enough to eat
Support the person

Encouraging an older person to eat enough nourishing food can be challenging. The Social care Institute for excellence - Eating well with dementia has useful advice and tips on encouraging eating and maintaining dignity:                                       

  • make sure that glasses, hearing aids and dentures are properly in place before starting to eat
  • make sure that the person is in a supported, upright and comfortable position for eating and drinking
  • be flexible with meals and meal times

Make sure that different food choices which respect religious, ethnic and personal preferences are offered at each meal time.                                       

If the person needs assistance with feeding, explain what the food is before you start to feed them. See if they can still hold the spoon even if they need you to help them load it.                                       

If you have concerns about continued and unintentional weight loss please contact the person’s GP for advice.                                        

                                       

Creating a suitable environment
  • mealtimes should be enjoyable social times as eating is not just for the nutrients
  • being with someone at mealtime may help improve appetite
  • make sure any special eating and drinking equipment that is needed is used at each mealtime for example specialist cups, stay-warm plates, teaspoons
  • plain coloured crockery usually contrasts well with food
  • if using a tablecloth or placemat, choose a plain colour to avoid confusion, and choose a different colour to that of the crockery so that the edge of the plate is clear
  • removing table decorations may also help
  • eating in a calm setting that is distraction free is a pleasant experience
Serving food

It's often said we ‘eat with our eyes’ and the look of our food is the first thing that makes us want to eat. it is important that:                                       

  • food should look and smell appealing
  • small portions are offered if someone is finding a large plateful off putting
  • plenty of eating time is given and food reheated if necessary to maintain meal appeal
  • confusion is avoided by serving one course at a time
  • the table is not cleared before the meal is finished

Resources

  1. The malnutrition task force website is a source of useful information. It has resources including nutrition and end of life care.
  2. Further resources and ideas to help with eating and drinking difficulties are available by attending the ‘Eating and Drinking with Care’ training for care home managers. The training is facilitated by Leeds Community Healthcare NHS Trust Dietitians and the Speech and Swallowing team. It is free to attend. For more information contact the Dietitians team on 0113 843 0890 or email eatinganddrinkingwithcare@nhs.net
  3. The Caroline Walker Trust book ‘Eating well: supporting older people and older people with dementia provides useful advice
  4. React To Malnutrition on Vimeo   This video is produced by Bassetlaw CCG around nutrition and placed on Vimeo for general viewing.
  5. MUST Training and supporting with nutrition  This is a very comprehensive free online training package for care home staff with a certificate of completion for those who complete the online quiz
  6. The Leeds observatory has an overview of nutrition and dehydration across Leeds.