Giving patients with dementia the NoSH they need

Plenty of fluids and a bit of what you fancy is commonly dispensed health advice to the sick – alongside a healthy dose of home-made chicken soup. But many patients with dementia who are in hospital suffer from poor nutrition, forgetting when they last ate or struggling to consume big meals. In this week’s Trust blog, dementia care team lead Jo James underlines the importance of food and drink to recovery, and what an innovative, new pathway called NoSH is doing to help.

As hospitals become more and more advanced at treating patients, we can sometimes lose sight of how important nutrition and hydration is to supporting patient recovery. In the case of patients with dementia, an approach to food and drink goes hand in hand with medical treatment. It’s an important factor in allowing patients to maintain their independence in hospital, and preserve the skills they need to return home sooner.

People with dementia in hospital who seem to be having difficulty eating or drinking are often automatically put on intravenous fluids or gastric tube feeding. While this does ensure a patient gets the right level of hydration and nutrition it can, for some, and especially those with dementia, take away an element of independence they had before admission to hospital and result in patients forgetting how to feed themselves.


Because we know how significant nutrition and hydration is to our patients we’ve developed a nutrition pathway we’ve come to know as NoSH (Nutritional Support in Hospital). At its heart, NoSH is designed to ensure patients get the food and drink they need while in hospital without losing the independence they had before being admitted.

All patients who are admitted to participating wards with a diagnosis of dementia are placed on the NoSH programme. NoSH patients have their weight, fluid and food intakes monitored throughout their stay with us. Patients who need more support are reviewed by the NoSH team regularly to ensure they are eating and drinking enough. The team sets eating and drinking goals with the patient in partnership with the nurse looking after them.

In addition, patients on the enhanced support programme can be moved away from the traditional three meals a day to a mixture of hot and cold ‘mini meals’ or finger food platters – so much easier to cope with when you are finding it difficult to eat. They receive special ‘bento’ boxes with healthy snacks to nibble on, as well as being offered alternative drinks to the water, tea and coffee normally provided. Sometimes patients just want a little sugar-free squash rather than plain water and small changes like this can have a big impact on their experience. 

Music at mealtimes

We are trying to improve the environment our patients eat in and one of our initiatives involves playing music at mealtimes, which has been scientifically proven to stimulate appetite. In fact, Daniel O’Donnell is already a firm favourite on many of our wards! If patients are physically able, we encourage them to get up and out of bed to eat their meals, even if it’s just into the chair next to the bed.

Most of what we’re implementing as part of the NoSH pathway is pretty simple, but these small changes can have big effects on the health and well-being of our patients. And there’s much more we would like to do. For example, we would love for there to be proper dining rooms in hospital as we know patients who eat together in social and familiar settings tend to eat and drink more than those eating in their beds. We’d also like to see our NoSH healthcare support worker team expanded so we could assign one team member to every ward in the Trust.

Ultimately receiving the right amounts of food and drink while in hospital is vital not only to patient recovery, but also to long-term well-being. When we care for our patients, nutrition and hydration mustn’t be an afterthought – especially if we want to help individuals with dementia to retain their independence for as long as possible.

The development of NoSH has been supported by the recruitment of two healthcare support workers (HCAs) and is funded by Imperial College Healthcare Charity. Read more about NoSH.

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