Diet and dementia: providing person-centred care while taking emerging research into consideration
11 February 2019
It’s natural to worry about family members who are in care facilities, and mainstream media stories can often heighten this concern. Recently we have seen an increase in media reporting on the effect of dietary changes in managing the deterioration of dementia, which is likely to lead family members to consider the impact of their loved one’s diet whilst in care.
Whilst it has been scientifically proven that lifestyle choices such as alcohol misuse can cause Korsakoff syndrome - a chronic memory disorder within the dementia family - there is not yet widespread scientific evidence to highlight that certain foods or food groups can decelerate or indeed halt the development of dementia.
For Korsakoff syndrome patients in particular it is vital that food plans are continually reviewed due to its associations with poor nutrition and malabsorption. Aligned with expected nutritional difficulties, and while residents are reviewed on a case-by-case basis, it is common for residents to require a liquid or pureed diet.
In many instances, it is not the inability to chew that has led to the recommendations of a liquid or puree diet, but rather the risk of choking due to insufficient chewing.
Physiologically the muscles and jaw have the capacity to break the food down appropriately but psychologically the resident may lack capacity to do this in a safe and consistent manner.
The form which food takes is not the only consideration for care staff. With an increased focus on person-centred care from residents, their families and CQC regulators, it is imperative that care staff are continually working to deliver the right menus that also appeal to individual’s tastes and preferences.
There is the balancing act of providing appealing, nutritional food which is presented in the appropriate form for the resident, whilst also acknowledging that the smell, texture and form of the food can evoke memories and emotions for individuals
The potential for foods to remind a person of previous experiences and moments is intrinsic to that individual, reinforcing the need to adopt a tailored approach for each person, rather than offering a single menu designed for all dementia service users.
Whilst removing a type of food might have shown a potential link in slowing down the decline in one person’s dementia, in another it could trigger memories, give them confidence to talk on a subject from their past and help them feel less alone and confused.
This level of understanding of an individual and their triggers is central to our care and the evolving regulatory environment. Without there being widespread evidence highlighting a profound impact in the delay of deterioration in dementia patients it is unlikely that there will be additional dietary recommendations introduced for dementia patients in the short term.
However, while this may be the case, care staff, community dietitians and speech and language teams will continue to review the nutrition patients require which will support their quality of life.
For people with Korsakoff syndrome this involves providing a menu which is rich in thiamine to help support the management of symptoms caused by a deficiency (while noting that there may be other underlying causes due to there being little understanding of how Korsakoff syndrome damages the brain).
In this instance, we would consider menus which feature yeast, cereal grains, beans, nuts and meat at the right levels for the patient in question, considering any food preferences or allergens as appropriate.
However, due to Korsakoff syndrome often being entwined with - and developing as a response to - other disorders and diseases, the diet and nutritional research surrounding the other comorbidities will also be considered by care staff and community teams when developing their food plans.
The complexity of the variables and considerations made by care teams will, at times, be difficult for families to understand and as such, it is for care home providers to empower their teams to build positive, long lasting relationships with the families and residents.
The positive relationship between the families and care staff is imperative for residents with degenerative illnesses such as dementia in particular. The arrival of a resident with no or little capacity can lead to their families feeling increasing pressure to make the right decision on behalf of their family member, and in some cases, feel that they need to challenge the care package being delivered.
In these instances, it is the empathetic, compassionate approach of care staff along with appropriate, understandable communication which helps families and care staff alike navigate challenging situations. Only then can they work together to support the care of the person central to their relationship; the resident.
Focus on Korsakoff syndrome
Korsakoff syndrome is a chronic memory disorder caused by the severe deficiency of thiamine (vitamin B-1). It is most commonly caused by alcohol misuse, but other conditions can also cause the syndrome such as anorexia, AIDs and cancer.
It is not known how many people are anticipated to suffer from Korsakoff syndrome and it is widely considered that it is less common than Alzheimer’s disease and vascular dementia. However, like more common types of dementia it is possible that Korsakoff syndrome may be underdiagnosed in the UK.
Scientific research has not yet shown how Korsakoff syndrome damages the brain though researchers have found several genetic variations which may increase susceptibility of the syndrome, as well as poor nutrition.
Symptoms and diagnosis
Symptoms include being unable to remember recent events, long-term memory gaps and problems learning new information. Memory difficulties may be obviously severe while other thinking and social skills appear unaffected.
In addition, those with the syndrome may make up information that they can’t remember and may believe the explanations that they have invented to bridge the gaps between memories. They may also hallucinate.
The syndrome is recognised via a clinical diagnosis and there are no specific laboratory tests to confirm that a person has this disorder. It can be hard to identify as it can be masked by symptoms of other conditions common with alcohol misuse.
For more information about the care Exemplar Health Care provides for adults with complex dementia needs please click here.