FOOD REFUSAL - A HEALTH CARE ASSISTANT GUIDE

Food refusal is a common problem amongst people with dementia, however it can be very distressing for carers.

  1. If a person resides in a Nursing/Care Home, they may be refusing the food because they do not likeit. It is important to keep a record of each resident’s food preferences.

CHECK! Does your resident like the food you are offering? LOOK AT THE CARE PLAN

  1. There may be a physical problem such as a sore mouth or thrush, which may require medication.

CHECK! Does your resident’s mouth look dry? Sore? Is their tongue coated? INFORM THE NURSE

  1. There may be a mental health reason such as depression, which can cause loss of appetite and can be treated with anti-depressants. Paranoid ideas and delusions are common in older people with dementia. Some Patient’s may believe their food is being poisoned and so refuse to eat it. Paranoia can be treated with medication.

CHECK! Has the resident’s mood changed recently? Do they look suspicious of the food you are giving? Do they look suspicious of you? LOOK AT THE CARE PLAN – INFORM THE NURSE

  1. Some people with advanced dementia may not recognise that it is time to eat, will not open their mouth and may behave aggressively. Patients who will not take food from staff will sometimes take it from their loved ones. This can allow relatives to play an important part in their care.

CHECK! Does your resident have relatives that live close to the home that may be able to come and help at mealtimes?

  1. Touch is one way for staff to attract and focus a person’s attention on eating. Holding hands, giving reassuring touches and singing softly have been found to help overcome resistance to eating.

CHECK! Have you tried different strategies to encourage your resident with meals and drinks? Have you discussed strategies that work? Have you made sure these are documented in the care plan?

  1. Sometimes having stronger flavours can stimulate interest in food and the swallow e.g. citrus drinks, slightly spicier foods, generally stronger flavours and sweeter flavours. Also cold drinks can sometimes stimulate interest in drink.

A person at the end stage of life may refuse to open their mouth and accept any food and drink. It is important to continue to try feeding at every meal, whatever the outcome of the last meal unlessthe GP and SALT have indicated that feeding is unsafe. Any feeding difficulties should be documented in the care plan. The outcome of each meal should be written down.

If it isn’t possible to make someone accept food or drink without using force, anumber of ethical principles need to be considered:

♦The wishes of the resident ♦ the wishes of the resident’s relatives ♦ the quality of life of that resident.

Any decisions of what should be done should involve relatives, carers and doctorsvia a Best Interests meeting