Many hospitals have taken steps to provide more personalised nutrition for people living with dementia. Some years ago, one of the Butterfly Scheme hospitals worked to create a Butterfly Scheme menu – not a replacement to the standard menu, but a supplementary menu, available only to those using the Butterfly Scheme. This menu, created by the Morecambe Bay team, has since been shared with many other teams across the UK and Ireland.
Why might people living with dementia benefit from a supplementary menu? I don’t know about you, but I very definitely have an eating routine. In hospital, the aspect of the meal routine I’d find most difficult would be the early evening meal; I’m used to eating much later. I really wouldn’t feel like eating a main meal before 7pm and I certainly wouldn’t feel like eating one at lunchtime. I’m also a massively slow eater; you might think I’ve lost interest in my food, but I simply eat slowly.
The advantage I have is that I could remember that the routine in hospital is different – and what the differences entail – and could try to adapt as best I could during the time I needed to. What if I couldn’t pace myself in that way? What if meals just appeared at apparently random times, when my body didn’t feel like having them? What if I couldn’t explain about my slow eating? How likely would I be to eat then? What if I ate better when my relatives or friends were around, but they weren’t able to be there at mealtimes? What if I had the habit of eating small amounts at intervals throughout the day, rather than one main meal?
When people think about menus for people living with dementia, they tend to talk about finger foods – and finger foods can indeed be helpful to some. However, that’s far from being the complete answer to how best to nutritionally support people living with dementia. My mother, for example, lived well with dementia and eventually died only of dementia, but always used cutlery at a set table. Like people without dementia, people living with dementia are individuals and should be treated as such.
That, of course, brings practical considerations into play; just as hospitals might not be able to serve me a standard meal separately after 7pm, they might well not be able to serve meals at times to suit all other individuals. We therefore need to be imaginative about ways to support people living with dementia while they’re in hospital. Ambient temperature nutritious snacks are a great bonus, as are packaged meals that can be kept and heated when friends or relatives are around – or whenever the individual feels that mealtime is here.
People living with dementia simply need to be supported, wherever possible, to continue with something as near to their own regular eating routine as possible. It’s really not unachievable; many hospitals are achieving it already, and with great results. Yes, there may be costs to that, but people not eating well won’t recover well or get home in a timely manner – and the costs of person-centred food options are surely far smaller than even one additional night in hospital!
There’s a lot more that can be done to support the nutrition of people living with dementia during hospital stays, so I could continue and talk about crockery, cutlery, the physical menu and how it’s offered to the person – and lots more – but for now I simply want to clarify that finger foods aren’t in themselves the whole answer and nobody should think they’ve “done dementia-friendly foods” by providing those.
I applaud all hospital teams providing flexible food options to people living with dementia. I’m convinced that, like all aspects of person-centred care for people living with dementia, everyone gains when it’s done well.