The fact that there is a week dedicated to raising awareness around Nutrition and Hydration across the health and social care sector not only shows its importance, but also indicates that more can be done in our industry to ensure everyone is entitled to, and enjoying vital nutrition and hydration.
To be hydrated and well-nourished is generally thought of as a ‘right’, and something the majority of the population in the UK do not have to worry about. People drink when they’re thirsty, and eat when they’re hungry.
But shockingly, we hear many stories about care homes around the country where residents are malnourished and dehydrated. Age UK estimate that malnutrition effects 10% of the elderly population. The importance of both nutrition and hydration should not be underestimated – it is vital to everyday life and also health, brain function and wellbeing. Poor nutrition can have an effect on energy levels, alertness, mobility, steadiness and healing. People who are healthier are likely to need less medication, reduce the risk of falling and fewer incontinence issues.
There are a number of reasons why residents may lose their appetite, which I have listed below. These all mean staff need to be aware of possible changes and monitor these to ensure we can respond in the correct way and ensure residents are taking in the correct levels of nutrition. Often residents have experienced a big change in their life when they enter a care home, and it becomes our responsibility to ensure they are eating and drinking as they should be, to maintain a healthy lifestyle but also replicate the choices they would have had at home, in terms of mealtimes, the type of food they eat, and the social setting in which they eat.
Although this shouldn’t be a challenge, it is all too often seen as one.
Even the process of sitting down and eating a meal should have its benefits, as it’s important for social and spiritual wellbeing and encourages residents to socialise with each other. It also allows those in care homes to replicate past memories of family meal times or eating out in restaurants.
It is also important for staff to understand the whole process of keeping hydrated and eating well, and this responsibility lies with the care home and managers to raise awareness. Not just about the residents, but emphasis should also be placed on staff ensuring they also keep hydrated and eat well, especially when many of them work on their feet for a lot of a shift.
At Nightingale Hammerson, nutrition and hydration plays a huge part in my role as Head of Nursing, which in itself shows the importance we place on this key area of day to day life for our residents and staff.
We have a forum made up of ‘Nutrition and Hydration advocates’, who are a group of carers and nurses who have bi-monthly meetings to discuss and share ideas about different ways of encouraging better nutritional and hydration intake for residents. Every resident is different, and we work closely with a local community dietician who attends meetings, offers information and advice and indicates when residents may be becoming at risk of being clinically underweight. Even though weight loss can be attributed to the ageing process, it is important we spot this early and ensure residents are receiving the correct food and nutritional values to maintain a healthy weight.
We also run a number of initiatives for residents, to ensure they also enjoy meal times. Our Breakfast Club runs every Friday, and residents get involved with choosing and preparing their food, which evokes memories of them eating out in cafes. This is a healthy and fun alternative to their normal breakfast routine, and means residents are picking and enjoying food and drink in a friendly, sociable and engaging atmosphere.
We also have ‘Meals Matter’ where staff are invited to join residents for lunch to improve the dining experience and encourage residents to eat well. Mealtimes are great for positive social interaction and communication, and eating together promotes companionship. It is also a great way for us to ensure that residents are eating well and enjoying mealtimes.
As part of motivating staff to engage in promoting better eating and drinking, we have also introduced a competition across the home. Nutrition and Hydration staff advocates who go the extra mile in being creative in promoting the cause have recently received certificates, and two staff members were presented with trophies for coming up with a wider range of ideas and implementing them, to benefit our residents. These included a brief educational session for both staff and residents about the advantages of eating and drinking well.
Nutrition and hydration should be integral to resident’s lives, and one of the key things is not making a huge deal about it. It should be incorporated into all meal times and day to day life, and should be a right, not a privilege. When thought through and done correctly, this should not be an arduous task, but simply an exercise in replicating how residents are used to living in terms of what they eat and drink, and when. Each resident has different likes, dislikes, needs and wants, and it is important all of these factors are taken into consideration to enable them to maintain good nutrition and hydration.
We take pride in being a leading care home in terms of nutrition and our approach to it, from staff training to meal initiatives, to ensure all residents are healthy physically, mentally and spiritually. It’s amazing how much of an impact nutrition and hydration can have on wellbeing and life.
Reasons why residents may have a loss of appetite:
- Dependency – a significant number of our residents have reduced co-ordination and have lost the ability to eat by themselves
- Difficulty chewing and swallowing – this can be caused by behavioural changes or deterioration in health or illness. Positioning in a chair can affect how muscles move and consequently have an effect on chewing, swallowing and arm movement. The risk of choking may lead to residents having to eat foods which have been modified in texture i.e. soft or puree meals
- Issues with dentures, sore gums or painful teeth causes discomfort and can make residents not want to eat
- Feeling bloated or being constipated – At Nightingale Hammerson, we work with General Practitioners and our local pharmacy if we suspect loss of appetite might be stemming from changes in medication or resulting from constipation
- Environmental – It is quite important for us to ensure noise is kept to a minimum, that there is less visual stimulation, and unnecessary items are removed from the table
- Communication – being unable to communicate likes and dislikes can affect residents appetite
- Altered eating patterns, where residents maybe eating at night.