Food and Drink Safety

We're stunned by the number of times we see carers putting a boiling hot drink in front of someone with dementia and saying "It's hot, leave it a few minutes". Either they'll not notice the mug again and never have the drink, or they'll see it in 30 seconds (having forgotten what was said) and try drinking it - potentially scalding their mouths and/or spilling boiling hot water all over themselves.

There's a very simple solution - make the drink with half of the water coming from the kettle and half from the cold tap. Then it's safe and ready to drink straight away.

Note that you shouldn't use water from a hot tap instead, because bacteria (such as those that cause Legionnaires' disease) can grow in hot water tanks and pipes. You should only ever drink water from a kitchen cold tap - other taps that have come through a cold water tank will have lost their protective chlorine.

There are now several makes of kettle on the market that have a temperature dial on the side, so potentially you could shut it off when you see the temperature you want. However, we think mixing kettle water with cold water is just as easy.

If you need to, you can also use a 'milk frothing thermometer' to check the temperature of the drink before serving - these are like a meat thermometer but with a more appropriate temperature range.

There are also several makes of temperature control kettle that can be set to shut off at a chosen temperature from 70 degrees Centigrade (160 degrees Fahrenheit) upwards, but these may still be too hot.

For the elderly without dementia who make their own hot drinks, there are 'kettle tippers' to avoid the risk of spilling a heavy kettle full of boiling water. Any kettle can be strapped into it, and then filled using a jug (with the power plug switched off in case of spillage). When boiled, the kettle is then simply pivoted to pour into a mug.

We've all done it occasionally, but if it becomes a more frequent event then it should be resolved. Apart from the distress to the person, if the situation were allowed to progress then coughing would no longer be enough to clear the airway and drink or food could go down into the lungs - carrying bacteria and a ready food source for them, which could give rise to aspiration pneumonia.

When coughing is more than a rare issue the condition is known as dysphagia, and should be referred to a Speech And Language Therapist (SALT or SLT). In the UK your GP can refer you to one. It's useful to keep a cough diary, of when and under what circumstances the coughing occurs, to help diagnosis (for completeness this needs to be annotated with periods when observations weren't possible, to distinguish them from when coughing didn't occur).

The speech and language therapist will investigate the cause, which is likely to include observing eating and drinking a little, and seeing how that changes with mashed or pureed food and with thickened drink. They will also consider potential causes such as acid reflux, which may irritate the throat and cause coughing.

We give more information in our section on thickened drink and textured/pureed food.

Drinks sold as concentrates to be diluted with water may potentially be drunk neat by someone with dementia. Consider making up a day's or two's supply to the correct dilution, and keeping the concentrate in a cupboard with a child-proof lock. There should always be plenty of access to diluted drink or drinking water, but avoid making individual bottles too full and heavy to lift and pour easily.

Someone with dementia may not recognise that a drink is alcoholic, or that consumption should be limited. It's safest to remove all alcohol, and if necessary replace it with a low-alcohol alternative or greatly dilute or replace the contents of a bottle with something of a similar colour and taste.

Thickener prescribed for thickening drinks might potentially be ingested by someone with dementia, and should be kept in a way to prevent this (such as in a cupboard with a child-proof lock).

Drinks thickened with starch-based thickeners will be thinned if laxative is added to them, so use ready-thickened laxative (or guar or xanthan gum-based drink thickener) instead.

Consider how food supplies are stored (and not simply from the point of view of whether things may be taken and left out of the fridge too long). For example, if someone with dementia doesn't know when their next meal will be provided by a visiting carer, but has access to a whole weeks' supply of snacks, then they may eat a large quantity of them all at once. Whilst it's a good thing to have independent access to healthy snacks such as fruit, if necessary have enough for a day or two kept out and the rest kept in a cupboard with a child-proof lock so that the carer can put more out each day. If you're considering putting a child-proof lock on the main fridge and having a separate mini-fridge then see our section on mini 'cooler' fridges.

(There is, incidentally, no truth in the rumour that too many bananas are bad for a healthy person, although eating more than two a day isn't recommended. Many other fruit and vegetables contain as much potassium as bananas, and in fact the body needs potassium. Someone with kidney problems, however, may receive specific advice on diet.)

Ensure out-of-date food is removed.

The oval plastic labels on apples and other fruit are a choking hazard and we strongly recommend taking them off as soon as they're in the house (and yes, we have seen a care home serve sliced apple with the label still attached).

Look out for the odd time when there's more than one label on the same piece of fruit. Fruit sold in sealed packs usually doesn't have labels, but this isn't absolutely always the case.

It's sensible to wash the fruit straight away as well, to ensure this is done.

Margarine containing cholesterol-lowering ingredients shouldn't be eaten in large quantities, such as may happen if someone mistakes it for yoghurt. Also, it's not recommended for people prescribed cholesterol-lowering medication (such as simvastatin).

If someone else in the house has food the person with dementia is allergic to, then make sure it's kept safely, for example in a cupboard with a child-proof lock, and not left out.

Sharp knives and sharp utensils used in food preparation should be kept safely, for example in a cupboard with a child-proof lock. Don't forget tin openers, since they create a very sharp edge on the tin.