Think back to the last time you got fish and chips from the chip shop. What can you remember about it? Do you remember the smell of the fryer, the heat radiating from the the wrapped food, or texture of a hot, freshly fried chip in your mouth? Do you remember sharp smell of vinegar in your nose or how it stung your eyes? How we think about food is wrapped up in sensory information. Our vision, smell, taste, touch and hearing all play an important role in the eating and drinking experience.
Unfortunately, many of our senses become less sensitive as we age. Take eyesight as an example. While many people are used to wearing glasses or contact lenses to compensate for being long or short-sighted, it is easy to forget that there are other changes that occur to our eyes as we age. One of these changes is a thickening on the eye lens, which means that in addition to being long or short sighted (or both) an older person may also need brighter lighting than someone younger if they are to pick up the same level of detail. This is further complicated if the older person has a disease which causes dementia, as structural changes in the brain can impact how well an individual can understand what their eyes are ‘telling’ them.
If a person with dementia has changes in the areas of their brain that help them make sense of what they see, they may find it difficult to recognise what is in front of them as food or drink. If they don’t recognise the food in front of them, they may not be cued (or prompted) to realise that they are hungry and that it is time to eat. People with dementia may also find it difficult to tell if a plate or bowl has food in it if the food and dishware do not strongly contrast against one another. This might mean that they eat only a small proportion of the food available to them, despite still feeling hungry. These are just two examples of how visual and cognitive changes can make it difficult for someone with dementia to eat or drink enough on day-to-day basis.
While only a medical professional can provide in depth guidance about how to address a change in someone’s vision, there are some basic steps that we can take to account for the way that aging eyes and cognitive changes can affect someone’s vision. Consider, for example, increasing the brightness of light in areas where people eat or prepare food to account for the thickening of the lens of the eye. Natural light is best for seeing things in their true colour, but if the area the individual eats in does not have good natural light levels, supplement it as necessary with artificial light. While aesthetically pleasing, better mood lighting is not particularly effective when you are trying to support someone with dementia to eat well.
Contrasting the colour of the plate with the colour of the food being served can also support better nutrition and hydration. This is often to do with contrast, as it can be more difficult to make out the boundaries of mashed potatoes on a white plate than it would be to see the same pile of mashed potatoes against a dark blue plate (for example). Remember, however, that the colour of the dishware is less important than is its ability to contrast with the person’s most commonly eaten foods.
This principle can also be applied to drinks. It can be difficult to see water in a clear glass because of the transparency, but diluting juice or water with added cordial is often makes it easier to see. Likewise having teacups and coffee cups that provide good contrast to the liquid usually served in them can be helpful for increasing visual awareness and recognition and ultimately increasing consumption.
Supporting someone’s vision can also help counteract some of the difficulties they are having with their memory. For example, a person with dementia may feel hungry, and head for the kitchen but forget what they were looking for when they get there. Without visual cues to entice someone to eat, the person may leave again without having consumed anything. Cutting down on unnecessary clutter in the kitchen can help to bring the person’s attention to the cues (or clues) that prompt them to make healthy choices to meet their need for nutrition or hydration. When stocking the kitchen, use the principle that “out of sight is out of mind” and place some nutritious food and drink options where they can be seen and prepared easily. Items that are obvious are more likely to be chosen than something that is tucked away in a cupboard or refrigerator. While it is clear that not all options can be safely left on the counter at room temperature we recommend taking some time to identify healthy snacks and drinks that can be left visible in the kitchen.
Not everyone struggles to get enough to eat over the course of the day, some people may eat more as a result of changes to their short term memory. In addition, some people with more advanced dementia may not recognise when they are full and continue to eat. Though this is relatively uncommon, if you suspect that the person is overeating due to memory impairment, look at the visual ‘clues’ that are present in the environment which may prompt the individual to over-eat. For example, some people might open the fridge to find it stocked with several days’ worth of meals, which may prompt them to eat again, even though they have just eaten. In a situation like this, reducing the quantity of food kept stocked to what will be needed for the next day or two may help.
If you are interested in learning about other practical tips to support better nutrition and hydration for someone with dementia, The DSDC has a produced a short book: 10 Helpful Hints to support eating and drinking for people with dementia as a part of their Helpful Hints for Carers series which can be purchased at the John Smith Bookshop.