This blog focuses on the practicalities of providing a nutritious diet for those with cognitive impairments as part 2 of a 3-part blog series. However, this approach can apply generally across the board to all people living in residential homes.

Recent research indicated that food, nutrition and a quality nutrition policy was rated as very high in people’s priorities when choosing a care home. 85% said nutrition is a very important consideration and over 70% would recommend a home based on their nutritional policy alone. https://chmonline.co.uk/nutrition-tops-nations-care-home-priorities/

Here is a quick recap of the main principles highlighted in Part 1 of this series.

• Meal plans tailored to the
• Small and frequent meals,
• Fresh colourful fruit and vegetables.
• Healthy fats.
• Keep sugar to a minimum
• Probiotics
• Supplements

Finger foods.

Serving food as finger foods solves many of the practical issues associated with declining  cognitive abilities, dispensing as it does with cutlery,  for example.  A good variety of colourful  foods can be presented this way and is an ideal option for giving healthy snacks. Finger food can be arranged attractively on a small plate or a pretty bowl so it’s visually appealing as well as supporting independence and personal choice.

Any meal can be arranged as finger food but to start with introduce it by replacing unhealthy   sugar loaded snacks, such as biscuits or commercially produced cakes. They can be savoury or sweet or a mixture. They can also be used instead of traditional desserts or as an alternative to a main course.

• Some suggestions for finger food as desert or
• Half banana sliced, 2 Tablespoons of blueberries, 2 small squares dark chocolate
• Half banana cubed, 3 strawberries quartered, small homemade muffin
• Mashed avocado on toast, salt and pepper, cut into fours / soldiers. Few grapes cut lengthways
• Orange or satsuma slices, cut in half, few grapes cut lengthways, dark chocolate
• Small cubes cucumber, cubes of cheese, grapes
• Soldiers of buttered marmite toast, cubes cheese, cucumber cubes or
• Small squares of homemade flapjacks, made with
• Dates (destoned), cheese cubes, cucumber cubes or red pepper
• *Pineapple chunks (fresh), hard boiled egg wedges,
• Blinis or scotch pancakes or mini scones spread with clotted cream and thin layer of jam

*Pineapple is an excellent food to give residents with poor nutritional status as it is rich in digestive enzymes and excellent for cleansing the mouth where there has been chronic dehydration.

Nutritious snacks

The suggestions above all make excellent snacks.

Nutritious drinks

Homemade smoothies are an excellent source of nutrients and are easily prepared. The beauty of smoothies is that extra nutrients can be added without compromising the flavour especially for residents with behavioural or compliance issues.

The following fruits and veggies can be used in any combination with a different recipe for every day of the week:-
Bananas, blueberries, strawberries, mango, apple, cucumber, avocado, whole milk or  bio-  yoghurt, flavoured kefir, protein powder (good quality), coconut milk, MCT oil,  contents  of  probiotic capsules. Etc.

(Please refer to Part 1 for further information about some of these ingredients.)

Soups, homemade.

Tinned and commercially made soups are to be avoided as they have little if any nutritional  benefit.

Soup can be conveniently served in a cup. A homemade vegetable rich soup is a wonderful  source of vegetable fibre and nutrients. A protein powder can be added as well as a good fat source like butter, or coconut oil, fo added calories. Again the contents of a probiotic capsule can be added once the soup has cooled to safe serving temperature

Breakfasts

Porridge is an excellent breakfast food, make with whole milk and extra butter or coconut oil.    Light sprinkling with brown sugar keeps the sugar content low and extra nutrition can be added  like Vitamin E and D drops or probiotic capsule contents. A few blueberries or chopped soft  prunes can ring the changes.

[Commercially produced cereals and muesli, apparently healthy foods, have high levels of sugar. They are not always easy for the elderly to eat. ]

Eggs are ideal for breakfast. Scrambled, boiled, poached made into savoury omelettes.

Desserts

• As long as desserts are kept low in sugar and are homemade they can provide extra calories and nutrition.
• Jellies made with added fresh fruit with cream instead of ice
• Rice pudding, made with whole milk, added butter, minimal sugar, lemon rind, sprinkled with nutmeg.
• Puréed fruit frozen into lollies.
• Finger fruit platters
• Kefir flavoured instead of bio yoghurt as a drink in a cup. Excellent source of

Dysphagia

Claire Fretwell a chef who has a passion for creating visually attractive foods describes her innovative approach to puréed food.

“Dysphagia is a growing condition in the UK, with all age groups and more and more people are

needing to have their meals pureed. As a catering manager within a care setting, it is important to me that our Residents meals are varied, nutritious, tasty and visually appealing.

Unfortunately many of those who require a pureed diet, don’t always have the benefit of the latter. Many times, they will be provided with food, that looks like soup.

After hearing some of our Residents who have a pureed diet were losing weight, I did a little research, spoke with those who were on the diet and found the main problem was that they were just visually disappointing.

Over the past 18 months, I have developed a new way to puree and make the food look like how   it did in its solid form. Methods that rely on moulds, which you then must freeze to maintain the

shape and then reheat…have so many disadvantages as the food loses texture, flavour and nutritional value.

When I create my pureed food, I don’t use moulds, but choose instead to use piping bags, piping the food as soon as it is ready. I also use soaking solutions to help with foods that may not have even been considered for a pureed diet at one time. This not only means that it retains its flavour, but also the texture is better, and our Residents love it.“

https://www.qcs.co.uk/pureed-diet/

Supplements

(See Part 1 of this series for rationale behind the supplement suggestions)

1. Vitamin D. The natural form D3 not synthetic versions. Available in drops so can be added to food or drinks
2. Vitamin C: for its anti oxidant and anti- inflammatory Available in powder or tablets.
3. Vitamin E: powerful antioxidant. Available in drops
4. Fish oils
5. Probiotics