Food and dementia, #DAW2017 Day 2

The importance of good food for a person living with dementia

By Peter Morgan-Jones

We are continuing our series of daily blogs for Dementia Awareness Week UK Day, 2, and are thrilled to have a blog by Executive Chef and Food Ambassador Peter Morgan-Jones, from Australia, who as been working with Australian icon, Maggie Beer on  improving food in residential aged care (nursing homes). Thank you Peter for this wonderful blog.

Good wholesome food is the essential tool for everybody and especially needed for an older person and people living with dementia.

We know that people living with dementia do benefit enormously from good unadulterated food. What is good for the heart is also good for the brain. We also know that ensuring that smaller meals are served and offered more frequent can result in a positive dining experience by a person living with dementia and can also be less overwhelming for the diner.

Good smells from cooking a meal are one of the greatest tools and prompts for stimulating and appetite.

Understanding the needs and preferences of a person’s mealtime experience is a fundamental tool also in ensuring a positive mealtime experience.

Professor Charles Spence is an experimental Psychologist at Oxford University and works very closely in collaboration with Heston Blumenthal on the science of eating and engaging the senses.

With the publication of our two books ‘don’t give me eggs that bounce “and ‘It’s all about the food not the fork” we have touched on the importance of engaging all the senses at mealtimes for a person living with dementia and how they can be great tools in enhancing a positive dining experience of good food.

The senses

Eating is probably one of the few daily activities in which we harness all of our senses at the same time. Smell, taste, sound, touch and sight all contribute to the enjoyment of mealtimes and to engaging a person who is frail or living with dementia in them.

Taste and visual presentation are hugely important, of course, but we should not forget that the way food smells, whether it is eaten in a noisy or calm environment, and the feel of things like cutlery and crockery are well worth considering too.

I have cooked for the royal family and am now the executive chef for one of Australia’s leading care providers.   To be able to use my food knowledge and love of cooking to improve the quality of life of older people has been an amazing opportunity. In my career I have learned that the appreciation of food depends not just on flavour (vital though that is!) but on a great deal besides.

Smell

Our appreciation of flavours actually comes from our sense of smell. The human brain can register 10,000 different odours at any one time and this process starts before we are even born. It is these triggers that are so important, particularly for people with dementia. A long forgotten smell – such as the aroma of a sweet shop or baking bread – could awaken appetite in someone who shows little interest in food.

A fascinating fact about the significance of smell is that several catering establishments using the virtually smell-free cook-chill system to prepare food have started installing “scent clocks” that produce almond aromas at mealtimes to compensate for the lack of smell emanating from the food.

Taste

It ought to go without saying that taste plays a crucial role in the dining experience – but, unfortunately, I feel it needs to be restated. The five taste sensations are sweet, salty, bitter, and sour and “umami,” a Japanese loan word to describe savoury things / a natural MSG flavour enhancer. Sweet taste is a pleasurable sensation, salty taste improves the flavour of food and bitter taste is a primeval protection against poisonous and inedible foods. Sour taste aids digestion and umami taste arises from natural monosodium glutamate (MSG), which is found in the likes of tomato, Parmesan cheese and dried seaweed, to name a few. There is a possible sixth taste which is still being researched: the ability to taste fat.

Getting to know a resident’s preferences and taste palette can help improve their dining experience and increase the enjoyment they get out of their food. We know that tastes can diminish and change with ageing, and even more so with dementia. At thirty years old a person has 245 tastebuds but this falls to about 80 by the time they reach seventy years old.

Sound

Sound often contributes negatively to the dining experience in the form of distracting noises. Ambient noise should be kept to a minimum at mealtimes. The link between sound and food is the subject of an emerging field of research called “neurogastronomy,” which explores the ways in which music and other background sounds can stimulate (or not) the pleasure of eating.

If you need convincing, next time you are on an aeroplane bring some noise cancelling earphones. Start eating your meal with the headphones on and then, midway through the meal, remove them and continue eating. You will find that the noise of the plane affects the “flavour” of the food.

Touch

The feel of the food we eat and the cutlery and crockery we use to eat it influence the way we receive it. For example, if you have a barbeque and serve the meal on a paper plate with a plastic knife and fork, the meal does not taste the same as it would when served on china with a metal knife and fork.

Sight

Visual presentation is a paramount factor in whetting the appetite. When we look at food our eyes take in the colour, gloss, physical form and the mode of presentation, such as the crockery and cutlery. Other sight factors are good lighting and distinguishable plates, like those with borders that “frame” the food and draw the diner’s eye to them.

In fact, sight and smell are the two predominant senses that coax the brain into liking the meal about to be consumed. Presentation has a key role in making it look appetising – “we eat with our eyes”.

Appetite begins in the mind – poorly presented food stops people feeling hungry. How food is plated, or arranged on the plate and garnished, figures deeply in one’s reaction to it. It even affects how we think the food tastes and is key to gourmet cooking.

Painting, balance and colour

A plate of food is like a painting, and the rim of the plate is the frame. This does not mean that you have to spend as much time arranging the plate as Rembrandt did painting a portrait, but it does mean that you need to think a little like an artist and strive for a pleasing arrangement.

Select foods and garnishes that offer variety and contrast, while at the same time avoiding combinations that are awkward or jarring. Two or three colours on a plate are usually more interesting than just one.

Visualise the combination: poached chicken breast with cream sauce, mashed potatoes and steamed cauliflower. Not too good? Or how about roast chicken, chips and sweetcorn? Not quite so bad, but still a little monotonous. Now picture roasted red peppers, grilled stuffed chicken breasts on herbed orzo and a drizzle of green pesto. Visually more appealing!

Many hot foods, especially meats, poultry and fish, have little colour other than shades of brown, gold or white. It helps to select vegetables or accompaniments that add colour interest – one reason why green vegetables are so popular.

Shapes, textures and flavours

Another food presentation tip is to plan for a variety of shapes and forms. For example, you probably do not want to serve Brussels sprouts with meatballs and new potatoes. Green beans and mashed potatoes might be better choices for accompaniments. Cutting vegetables into different shapes gives you great flexibility. Carrots, for example, which can be cut into dice, rounds or sticks (batons, julienne), can be adapted to nearly any plate.

Though not usually included in food presentation tip lists because they are not strictly visual considerations, textures are as important in plating as in menu planning. Good balance involves a variety of textures on the plate. Perhaps the most common error, unless it is a dietary requirement, is serving too many soft or pureed foods such as baked salmon loaf with whipped potatoes and pureed peas. Of course, you cannot see flavours either, but they are one more factor you must consider when balancing the various characteristics of foods on the plate.

Portion sizes and temperature

Match portion sizes and plates. Too small a plate makes for an overcrowded, jumbled, messy appearance, but too large a plate may make the portions look skimpy. And balance the portion sizes of the various items on the plate: one item, generally a meat, poultry, or fish preparation, is usually considered the main item on the plate. It is the centre of attention and is larger than the accompaniments.

Don’t let the main item get lost amid excessive garnish and huge portions of vegetable and starch items. Where there is no main item, as in some vegetable plates, strive for a logical balance of portions.

My final tip would be to serve hot foods hot and cold foods cold! Hot foods should be on hot plates and cold foods on cold plates. Your arrangement of beautiful food will not make much of a final impression if you forget this basic rule.

Bio: Peter Morgan-Jones is executive chef and food ambassador for HammondCare. His culinary highlights include catering for Buckingham Palace garden parties with 8,000 guests, managing 120 chefs on-site for the Wimbledon tennis championships and working in some of the most iconic restaurants in Sydney, Australia. He is the author of two dementia specific cookbooks, don’t give me eggs that bounce and the newly published It’s all about the food not the fork!