Cognitive behaviour is dysfunctional emotions and behaviours caused by damage in the brain affecting part of the brain responsible for memory and all that we learn from birth- how to talk, eat etc. This means that a person with dementia can forget how important it is to eat and drink and may need reminding. They may also lose their sense of hunger and thirst. It can become a problem and put a client’s health at risk. Functional change is losing the ability to remember how to eat using cutlery. Instead, some people find easier to pick up food by hand, so finger food should be provided.
This might be a good way to avoid confusion and distress for a client. If a person finds it easier, food should be laid out for a client promoting their dignity. They may have difficulties chewing or swallowing, this can be caused by the mind forgetting how to do something, or making that task become more difficult to perform. Emotional change can be negative emotions about their confused state because the individual may not understand that there is something wrong, but behaviour of others may lead them to feeling something is wrong, which often causes stress to the individual with dementia.
They may refuse to eat or drink altogether. Poor nutrition can make the symptoms of dementia worse and increase the risk of more frequent infections requiring use of antibiotics. Malnutrition also affects the immune system making it difficult to fight an infection. It’s more likely that as well as dementia, older people are more likely to develop other chronic illnesses and therefore will have specific nutritional needs.
Dementia can be effected by other conditions that may prevent the individual from eating or drinking: Health – it is quite often for individuals with dementia to end up with Urinary Tract Infection or UTI for short, and while having a UTI the individuals may get more confused or angry causing them to not wanting to eat. Emotional – quite a few Dementia sufferers end up with depression because of the drastic changes in their life, such as being taken away from your home and your family. Routines and rituals provide important cues that it is time to eat and trigger the familiar actions involved in feeding oneself.
Experts suggest a variety of ways to maintain lifelong habits and routines: Identify and respect personal, cultural, and religious food preferences, such as eating tortillas instead of bread, avoiding pork or milk products, and not liking certain kinds of vegetables. If the person has always eaten meals at specific times, continue to serve meals at those times. Serve meals in a consistent, familiar place and way whenever possible. If the family has always said a prayer of thanks before meals, continue to say the prayer.
Avoid introducing unfamiliar routines, such as serving breakfast to a person who has never routinely eaten breakfast. It is important to include a variety of food and drink in a person with Dementias’ diet because they need a varied healthy diet to keep them as fit and well as possible but also because they may go off food that they used to love because their taste may change so you will need to offer them alternative foods. They may go off squash and start liking milkshake for example. They may have difficulty chewing or swallowing so they may need to be offered softer foods like scrambled egg.
Regular snacks or small meals are better than set mealtimes and make food look and smell appealing. Use
Their tastes may have changed and may not wish to eat the meals set out for them in a particular ‘traditional order’. They may not wish to eat at the same time as everybody else or may wish to eat small amounts more often. By trying to stick to normal meal time cultures, this can be a barrier to the nutritional needs of the individual. The care they receive should be person centred and must fit in with what the individual needs, this should also be true with the meals the person receives. Setting strict regimes could just upset the individual and could result in them refusing to eat or drink altogether.
Environmental factors such as being around lots of other diners, loud noises, music or busy restaurants are not ideal for a person with Dementia as they can become easily distracted and overwhelmed by too much information being processed at once. This can be a barrier to them being able to focus on their food and can again result in them getting upset and refusing to eat or drink. Provide food the person likes and try not to overload the plate with too much food, small and regular portions often work best. A relaxed, friendly atmosphere with some soft music may help.
Use eating and drinking as an opportunity for activity and social stimulation. It is always best to aim for the least stressful solutions. Common sense and a creative approach often help. Use colour to support the person – the colours of the food, plate and table should be different. Avoiding patterned plates is important. Treating everyone as an individual and giving them informed choices are the best person centred approaches. We must try to treat everyone as an individual and respect his or her wishes and preferences. Many people with dementia can make their own choices such as what they like to wear, what they like to eat or drink.
If they are unable to make a decision, we can inform them of available choices. They may not be able to communicate or tell us anything sometimes so we need to show them the available options. We may also be aware of their choices such as what do they like to eat or drink by asking the individuals family and friends. Another important thing is observation. By observing, we may make note what they like to eat and drink most or what went well at a particular meal time. We must always offer them options and choices. Clear, easy-to-understand verbal prompting may also be needed.
Depending on the person’s language ability, this may mean giving very specific, step-by-step directions, or it may mean offering simple choices, such as “Do you want peaches or apples? ” or “Would you like cream in your coffee? ” Verbal prompts, such as “Do you think the beans have enough salt? ,” can focus the person’s attention on the food. Sensory cues, especially those involving smell, can let the person know it is time to eat. Smells can trigger the appetite, even the smell of toast can help. People with more advanced Dementia may also need physical prompting to initiate the process of eating or to continue eating.
For example, the caregiver might place a finger or hand under the person’s grasped hand on the fork and guide it to the mouth. After getting help with initiating eating, the person may then take over. However, carers should not step in too soon as doing so can diminish the individuals sense of personal control and independence. A person centred approach will improve the well being of an individual with Dementia by making them still feel in control of their lives even though they may feel they are losing control and can build trust between the individual and the carers.