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Poor nutrition is commonly experienced by people with dementia. So it was with interest this week to see a new initiative from the Imperial College Healthcare NHS Trust for the provision of specialist support to dementia patients to ensure that they are eating and drinking enough. The programme, Dementia Nutrition Support in Hospital Pathway (known as NoSH), has 3 levels and aims to provide a tailored response to individual needs.
Pathways for nutrition support in patients with dementia
In NoSH, all patients admitted with dementia are placed on the first level of the programme– core support. This includes having their weights monitored, foods and fluid recorded and access to special snack boxes.
For patients that require more support ‘enhanced’ and ‘intensive’ levels of the programme provide:
one to one support for dementia patients who struggle to eat and drink
development of eating and drinking goals for the patients in conjunction with the family and nursing team
provision of 5 smaller meals, which can be easier for some people with dementia to manage than the traditional 3.
Music and food intake – is there an association?
But the provision in the programme that caught my eye was the use of music during meals. Can playing music really stimulate nutritional intakes?
Looking at scientific research, several studies have demonstrated the calming effect of music on service users with agitation and anxiety related to dementia. However fewer studies have directly measured the effect of music on meal intake in long term care settings.
In a study of 27 nursing homes, it was reported that residents with dementia increased the percentage of the meal consumed by around 10% when relaxing music was played in the dining room with the evening meal over a 4 day period. However the study was limited by short duration and estimation, rather than a weighed measure, of food intake.
In another study involving 12 nursing home residents with Alzheimer’s disease, researchers played familiar music during the midday meal every other week for 8 weeks, and meal intake was compared for music vs no music weeks. The authors reported an increase of 20% in calorie intake when the music was played. In this study, musical preferences were determined by obtaining input from family members. Interestingly it was suggested that it was the familiarity of the music, rather than the relaxation quality, that contributed to the significance of the results.
And in a charming report from the Slough Public Health team on the Sing for Life programme in 6 care homes, they noted that therapeutic singing increased the weight of those participating in structured singing sessions.
This evidence is clearly limited but music or singing may be worth trying as part of a range of interventions to increase nutrition intake for people with dementia in care home settings. What is also worth considering is whether any parts of the NoSH Programme are not currently in place in your care homes and whether they perhaps should be.
Reproduced with thank to Ayela Spiro, British Nutrition Foundation