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• Reflective – think about an experience, learn from it and do something different next time

• Observant – watch the person. Are there physical problems which prohibit good eating and drinking?

• Anticipate and Analyse – anticipate someone’s needs before they become a problem. Analyse what is behind a behaviour, don’t just respond to what you see

• Cue and mirror (more on that below)

• Think for the person – when did they last have a drink, go to the toilet, or when did they last move?

• Initiate – don’t expect a person to start something by themselves

• Validate feelings – don’t just brush off someone’s despair or distress

• Enjoy time together – be with the person for that moment

Recognising Signs

of Dehydration Ten years ago, a project in Buckinghamshire achieved startling success in reducing hospital admissions. The ‘Thirst 4 Life’ project involved health and social care professionals working in collaboration with nursing homes and focused on the issue of dehydration.

As a result of their joint working, there was a 45% reduction in the number of admissions to hospital of older people with dehydration who lived in care homes and care homes with nursing. One simple tool that staff carried everyday was a pocket sized card on which were printed the signs and symptoms of dehydration:

• Dry mouth & lips • Persistent tiredness • Dizziness • Colour/smell of urine • Confusion • Dry skin • Back pain

• Rapid breathing • Headaches • Dry eyes • Constipation

This daily reminder alerted staff to the signs that might be associated with dehydration and aided with reporting when a person with dementia was at risk, as well as ensuring appropriate corrective action was taken.

Techniques and Strategies Cueing and mirroring (or copying) are simple techniques that can overcome some of the difficulties experienced when a person fails to initiate eating and drinking. Cueing involves a tactile experience – helping the person to hold a cup, explaining what you are doing and lifting it towards the person’s mouth. Often that first sip will lead the person on to drink more.

Mirroring is a visual cue, showing the person what to do by taking a drink oneself can help. For example, if a member of care staff always said ‘cheers’ in a lively way, when raising a cup or glass this stimulates a habitual response to follow suit.

We have a duty of care as well as a moral responsibility to reduce these risks and focus on ensuring individuals in our care eat and drink well.

Environment The optimum eating environment has also been well researched. A small, quiet, café style setting allows the person to be cued in to the experience of eating. Smells of food such as toast or frying bacon prompt salivation. Removing distractions like loud music and dishwasher noise, and minimising the unsettling clatter of crockery and cutlery, gives the person the chance to concentrate on this vital activity. Eating alone may be preferred by some, so a

café table near or in the person’s room may be preferred. Contrasting colours of crockery and tableware give the older eye the chance to see where food is placed on the plate, and what food is on offer.

Flexible Menus Giving people real choice is a requirement, not an option. At The Fremantle Trust we deliver eating and drinking workshops and acknowledge that a person living with dementia has individual demands depending on who they are, where they are on the dementia journey, and how they now respond to food and drink.

We create four different menu options so that most tastes are catered for.

These are:

• Water-rich menus. These optimise fluid intake for the person who is reluctant to take fluids

• Sweet meals. These are for the person who (now) prefers only sweet foods

• Calorie rich. These are for the person who needs to increase their calorie intake

• Finger foods. For the person who has difficulty with cutlery or who walks and needs to ‘graze’ at frequent intervals

Everyone’s experience of living with dementia is different as the condition affects people in very different ways and to varying degrees. Therefore, it’s important to consider an eating and drinking plan from the start of a diagnosis while keeping the person’s individual needs, tastes and preferences in mind. That way, we can keep people as healthy as possible for longer.

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