What does dementia mean for Scotland's vegetarians and vegans, and for those who care for them?
Older adults’ uptake of meat-free meals appears to be rising. A survey conducted by the Vegetarian Society (2015) found that older people have cut back their meat consumption at a faster rate than the rest of the population. This trend reflects practical concerns, such as perceived health benefits, and saving money. On top of this, a study into the food preferences of general older adults found that fruits, vegetables and beans were a more popular choice than red meat, milk and dairy products.
People who are fully vegetarian or vegan are already found in at least one in every four care homes. Their decision to be vegetarian or vegan may reflect deeply-held ethical, environmental, or religious convictions. Some years ago an older lady, who had been a dedicated animal rights campaigner, went into care after developing dementia. While in care, she was given food containing meat products, a practice considered acceptable by staff because she “wouldn't know any different”. Yet in spite of this she still identified herself as vegan. We would hope that something like this wouldn't happen today, but staff can still be daunted by the challenges of catering for vegetarians and vegans.
Many providers offer excellent meat-free dishes, with balance and variety. But some rely heavily on cheese and eggs. Nutritional balance is important as an unhealthy diet can affect a person's risk of developing many illnesses, including dementia. Someone with dementia who becomes undernourished is vulnerable to multiple complications and risks – such as infections, delirium, reduced muscle mass, falls, and ulcers, to name a few. The balance of evidence suggests that a diet high in cereals, fruits, vegetables and pulses may be of benefit not only to vegetarians and vegans, but to others too.
Recently, care providers have highlighted instances where a vegetarian/vegan with dementia has demanded meat, or tried to take it from someone else's plate. In such circumstances, those who care for them are faced with a difficult ethical dilemma. For an older person whose convictions will have been at the core of their identity for many years, a move away from their vegetarian/vegan beliefs may further undermine a sense of identity already threatened by cognitive impairment.
People with dementia and their carers have the right to be able to enjoy human rights and fundamental freedoms in every part of their daily lives, and wherever they are. This includes full respect for their dignity, beliefs, and individual circumstances (Scotland's National Dementia Strategy). Personal profiles, such as the 'Getting to Know Me' document (Alzheimer Scotland/Scottish Government) help staff to know and understand a person's wishes. There is a challenge, however, if a person's current wishes come into conflict with their previously held convictions.
Many people would be reluctant to compromise religious beliefs. You would expect care providers to think twice before offering a bacon roll to a Rabbi with dementia, even if a refusal causes distress. A lifelong vegetarian or vegan's beliefs should be similarly respected. There is some degree of legal protection for this, too. Veganism is recognised as a way of life based on deep convictions and is specifically covered by Article 9 (Freedom of thought, conscience and religion) of the European Convention on Human Rights. Consequently, preventing or limiting the life choices of vegans through indirect discrimination could be seen as acting unlawfully.
In addition to communication difficulties, people with dementia can experience specific issues around recognising food types, as well as sensory changes (including taste). It may be that someone desires the food that they see others eating, not realising that it is meat.
The new National Care Standards advocate a human rights and wellbeing approach, with care and support in a way that reflects the person's needs and circumstances. A challenge arises if a person's human's rights to be vegetarian/vegan come into conflict with their current wellbeing. If someone loses the vegetarian/vegan aspect of themselves – perhaps especially if they have not been a lifelong vegetarian/vegan – then it is possible that they may be tempted to eat meat again on occasion. In this way, their needs and circumstances could keep changing. There is an argument for accommodating the person they are that day, “wherever they are at”, and perhaps in some circumstances this may mean eating meat.
But this should surely be the exception rather than the rule, and only if a failure to provide meat would impact on the person's human rights and dignity, and careful management may help minimise such eventualities. Clare Mills, Manager at Anam Cara Dementia Respite Unit, has spoken about the challenges inherent in managing such situations. She emphasises the importance of respecting a person's beliefs. A failure to do so is not only upsetting for the family, she says, but may distress the person with dementia if they experience periods of heightened cognition and realise they have eaten meat.
Furthermore, a vegetarian or vegan who has not consumed meat or fish – or, in the case of a vegan, dairy products – for perhaps 50 years or more, may well find such foods hard to digest. Possibly meals could be provided that look similar but which allow vegetarian/vegans to eat in accordance with their beliefs without feeling excluded. Vegetarian or vegan meat alternatives ('mock-meats’) are an obvious example.
For those for whom being vegetarian or vegan is a deep-rooted belief and at the core of their identity it can be beneficial to have an Anticipatory Care Plan.
As well as guidance for care caterers, Vegetarian for Life has produced a free guide to advanced care planning to help ensure that a person's wishes are respected in the future. Available from October 2016, you can pre-order your copy by contacting VfL: http://vegetarianforlife.org.uk/contact
Dr Kim Stringer is Vegetarian for Life’s Director (Scotland). For a number of years she has also been a research officer in primary care, working on many studies focused on improving the health of older people. Prior to this she completed a PhD in English Literature and spent some time teaching in college, university, and adult education, as well as working in the theatre for a number of years. Kim supports a variety of vegetarian and animal rescue charities and takes a keen interest in environmental issues and in promoting the wwell-beingof older people.
Eating, Drinking and Dementia: A Pocket Guide About Nutrition: This book discusses all aspects of eating and drinking for a person with dementia. It includes strategies for ensuring that the person is able to continue enjoying their food, while at the same time making sure that they get the nutrients they need to stay as well as possible. It talks about some of the problems that can arise, and how to tackle them
DSDC has developed the Best Practice in Dementia Care programme with a focus on person centred care the program can help you achieve national and regional care standards. The programme is accredited by the Royal College of Nursing and City & Guilds