As a child I remember visits from my gran, who lived far away. I remember her as an amazing cook who made her own pasta and yogurt and pastries. She took a childlike delight in fresh strawberries, and in surprise chocolate bars, giggling and savouring them in the middle of an afternoon. She once told me a story about how she, as a sixteen year old bride, had no idea how to cook anything. One tearful afternoon she tried baking bread for her new husband. Ultimately it turned into rocks of baked dough because she hadn’t understood how to activate the yeast. She later carried the resulting bread “rocks” out to the back garden and buried them because she didn’t know how else to get rid of the evidence of her failure. That story always stuck with me. My grandmother had quite a history with food, both joyful and traumatic.
We all have a history with food, and that history matters when an individual experiences the symptoms of dementia. Sometimes within care services we talk about dietary choices made because of ethical or religious beliefs. These are prime examples of how our “food history” matters. Even if we are not self-proclaimed “foodies”, food will have played a part in our identity from a cultural, celebratory, and comfort standpoint.
Food is used for nourishment of the body, but plays many other roles for us as well. When we are ill, there are frequently foods we tolerate, often because of our history of eating those foods when we are ill. Chicken soup or tea and toast may be examples of this. You might say that we eat certain things because they are good for healing or for upset stomachs, which is undoubtedly true, but these foods may be different depending on the culture in which we were brought up. Knowing what foods bring someone comfort in times of illness or sadness can be really important information as someone’s dementia advances. Comfort foods can be used strategically to encourage someone to eat, who has not been eating enough, or who seems to have lost interest in food.
Another important aspect of our food history has to do with our natural body rhythms. Most people will have had a pattern to their eating schedule that was often determined by occupation or family demands, but over time becomes ingrained. So for those individuals, rising early or staying up late at night may have skewed their normal eating times. This non-traditional schedule can be accommodated so long as the individual remains independent in their ability to cook for themselves or has a carer that can preserve those normal routines. However, when someone becomes more dependent on in-home meal delivery or meals provided by a care provider, the flexibility around timings are reduced, making it more likely that someone will be served meals at times when they would not traditionally have eaten those meals. By mapping out when a person normally ate their meals and looking to schedule support around those times, there may be increased interest and intake of food for the individual.
An person’s life eating schedule may also have dictated when they ate their larger meals, and this may continue to be an important meal where they consume the greatest nutrition and calories for the day. For some people breakfast may be the time when their appetite is best and so ensuring that they have a large nutritional meal available at breakfast time may be the best way to maintain their weight and provide the nutrients the brain and body need to function well. For others that meal may be lunch or dinner depending on their historical routine. This routine does matter in so far as many individuals will struggle to eat a big meal at a time of day when they would normally have had a light snack or something small to tide them over.
Having an understanding of an individual’s history with food can guides us to providing personalised support, and can help us to enhance the person with dementia’s daily experience through tapping in to past preferences and cultural standbys. It can also be key in reinforcing the sense of long term identity for the person with dementia and trigger long term memories. For more about nutrition and dementia the DSDC has a carers guide called Helpful Hints to support eating and drinking for people with dementia.