3 steps to great food and fluid awareness

I always welcome ideas of topics to write about and this was one of those – a care home support worker called Anne asked me to write about good food and fluid to raise awareness.

Malnutrition in the UK

I was shocked to learn that there are around 3 million people in the UK are at risk of malnutrition, including:

• 38% of people in care homes
• 39% of people being discharged from hospital into social care
• 30% of people living within their own homes who receive care and support.

Nutrition and hydration form such a large part of our lives, so why are people at such a risk, just because they draw on care and support?

Recognising the signs of inadequate nutrition and hydration

Nutrition

• Unexplained fatigue – this is a common side effect of iron deficiency, which can lead to anaemia
• Brittle and dry hair
• Ridged or spoon-shaped nails
• Mouth problems
• Diarrhoea
• Apathy or irritability
• Lack of appetite

Inadequate hydration

• Dryness of the mouth, lips and tongue
• Sunken eyes
• Dry inelastic skin
• Drowsiness, confusion or disorientation
• Dizziness
• Low blood pressure

Tackling the issue head-on

I’ve got a three-pronged approach to promoting good food and fluid awareness:

1. Create a welcoming dining environment
2. Encourage good oral health
3. Promote a well-balanced diet.

1. Create a welcoming dining environment

When you think of mealtimes, what do you think of? For me, it’s a chance to sit down with the family, talk and just enjoy the moment with some nice food. If you draw on social care, why should this be any different?

A good dining experience can increase social interactions, build the family/community feel and has been proven to increase nutritional intake, which in turn benefits mental and physical wellbeing.

Here are some of my tips to encouraging a great dining experience:

Set the scene

Regardless of the service, first impressions count, both in terms of where you are eating and what you’re eating. It’s important to create a comfortable and welcoming environment with calming décor to create that first visual impression.

I always think you should treat the dining experience like a meal in a restaurant, greeting people as they arrive and asking where they would like to sit (remember the small things set the tone) and where needed, support people to their seat and tuck them under the table.

The table itself should be clean and set with the cutlery, have fresh water available and have something in the centre to promote conversation, like flowers. In some care services, menus are available to help people know about food choices, with a description of each meal. It’s important to remember that not everyone will know what all meal choices are and to make the font legible and clear.

Consider eating times

Remember, everyone is different and people like to eat at different times. It’s good to have set mealtimes to encourage social interaction, but some people will prefer to eat at different times. If a few people want to eat at the same time, you can try sitting them together.

Present food in an appealing way

Presentation of the food we’re serving is crucial. We eat with our eyes and if we’re looking at a meal that’s unappetising, then we wouldn’t want to eat it – it’s no different for the people we support. Thought needs to be given to the colours and textures of food. If you’re supporting people living with dementia, remember to think about contrasting colours between the food and the plate/bowl.

For people who are unable to eat solids, you can use moulds to help enhance the appearance of pureed food.

It’s important to remember the portion sizes and the size of the bowl/plate as for some people a large meal can be off-putting while others will want more (we all love seconds, right?). Remember, if people are choosing a small portion, they’re still getting enough nutrients.

Get people involved

Getting people who want to be involved in the mealtime process is something I’ve always felt is crucial. It could be supporting people with chopping food items, making dishes, washing up, laying the table, serving meals etc.

This gives the person helping a sense of purpose and achievement. I used to love announcing who’d made the meal to give the individual credit, boost their self-esteem and recognise their skills.

Other ideas

• Try asking relatives to come and join their loved ones for lunch and/or dinner.
• For people who are bed-bound or prefer to eat in their bedrooms, try to establish the best mealtime routine. Find out if they’d like to use a lap tray or would prefer to have a separate table etc. Also, we should be ensuring a carer be with the person whilst they eat, if this is what the person would like.
• Find out people’s favourite meals and build this into the menu.
• Celebrate birthdays, anniversaries and special occasions. These are a great way to bring people together, especially if you’ve made food you know those in your care love.
• Try meals from around the world to introduce new flavours and dishes.
• Adapt menus to incorporate people’s allergies and dietary requirements for medical, religious and/or cultural reasons.
• Have snack and fluid stations available throughout the day for people (we all get peckish after all!) This can include fresh fruit and various sizes of foods.

2. Encourage good oral health

Remember that oral care is vital to prevent dehydration and further health issues. Here are some tips from my previous blog on oral health.

3. Promote a well-balanced diet

The government’s Eatwell Guide covers all the main recommendations to maintain a well-balanced diet. If you’re working in a care home, here are some tips from my time running a service:

• Keep water accessible – try putting a lightweight jug of water and a cup near residents’ favourite seats. Some people won’t like water, but remember, coffee, tea, fruit juice, soda water all count. You can even make ice lollies from juice!
• Food can account for approximately 20% of your daily fluid intake, so opt for foods that naturally contain water, like cucumbers and watermelons.
• Creatively incorporate at least 5 portions of different types of fruit and vegetable a day, through smoothies, milkshakes, hot soups/broths etc.

For some residents, you may have more unique needs to consider:

• Food no longer tastes good
  Try new recipes or add different herbs and spices. Some medicines can affect appetite or sense of taste, so you may need to speak to the individual’s doctor if you’re worried.
• Chewing difficulty
  Try softer foods like cooked vegetables, beans, eggs, apple sauce and canned fruit. If eating 3 main meals a day seems overwhelming, try 6-8 smaller, more frequent ones.
• Poor digestion
  Talk to the individual’s doctor to figure out which foods to avoid while still maintaining a balanced diet. Visit the GP to rule out any underlying illnesses or for further guidance.

Laying the foundations

There’s a lot to take in here. But don’t worry, nobody is expecting you to incorporate everything overnight.

Start small – try adding things into your daily routines, bit-by-bit. Before you know it, you’ll start seeing the benefits.