Thirteenth edition

Newsletter No 13: New ESPEN BMI cut off for Older People  | Updated DMAT Interventions | Mealtimes in Care Homes | Resource (Love to Move) and Recipe (Puree Food Molding) of the Month…

Dementia Friendly Mealtimes Newsletter (August 2017)

We have a really excellent set of resources this month. From ESPEN there is important open access research highlighting better diagnosis of malnutrition in older people through new BMI cut off values. Many people including myself always thought the old value (<18.5 kg/m2) was too low. Especially considering the inaccuracies of calculating height to work out BMI as older people can lose height as they age or cannot stand, or indeed stand tall for accurate height measurements. Take a look at the linked research for the new recommendations.

Also we have two excellent free pdf. resources including practical ways to make mealtime care better in care homes from My Home Life, and a chair based exercise programme for people with dementia from the British Gymnastics Foundation. For those involved in producing puree foods there is a very useful ‘how to’ YouTube video from Puree Food Molds.  

The DMAT (online system has had a major update to its range of evidenced based mealtime interventions. We have also made the interventions more structured which should help when implementing multi-component interventions. Follow the link below to access your account or sign up for a free thirty day trial and use the DMAT to create a mealtime care plan based on research evidence.     

Do you think your colleagues or friends would find this information useful? Please do forward the newsletter to them or ask them to follow this link to sign up to our newsletter.

Diagnostic criteria for malnutrition e An ESPEN Consensus Statement

Changes in Body Mass Index (BMI) recommended by ESPEN to help diagnose malnutrition in older people

The World Health Organisation (WHO) advocates BMI <18.5 kg/m2 as a general cut-off for underweight. This cut-off is justified at a public health population level whereas its relevance for clinical and care settings may be questioned. The recent ESPEN consensus statement linked above (and here) recommend BMI <20 kg/m2 for subjects <70 years of age, and BMI <22 kg/m2 for subjects 70 years and older. These higher BMI measurements make sense and I completely agree. Often in clinical practice a cut off of BMI <18.5 kg/m2 is too late and by this stage the person with dementia may struggle to regain the lost weight no matter what interventions are put in place. This is also why screening tools such as MUST (malnutrition universal screening tool) which use the 18.5 BMI cut off may not be specific enough to identify those with dementia and at risk of malnutrition. In fact ESPEN also recommend to use the MNA (mini nutritional assessment) instead of MUST when assessing older people for risk of malnutrition. We linked to this guidance document back in May in the newsletter so if you are interested please follow the link here to see this research and recommendations for better assessment of older people and those with dementia.


The DMAT doesn’t just provide a list of common mealtime abilities that need to be assessed. It also provides an extensive choice of researched interventions. To access the full range of evidenced based interventions for supporting the self feeding abilities listed in The DMAT’s Initial Measurement Form (shown in the image above) simply visit To access the updated interventions logon to your DMAT account here or if you need to create an account just follow this link and sign up for a free 30 day trial. Through supporting an individuals eating and drinking abilities appropriately you can increases their independence and dignity at mealtimes and improve their quality of life.

How to make the most of mealtimes in care homes.

Practical ways to make the most of mealtimes in care homes

The DMAT is a huge fan of My Home Life an organisations that promotes quality of life and delivers positive change in care homes for older people. In this downloadable pdf they focus on food – everyone’s favourite subject. But, it is not just the food that makes mealtimes enjoyable. My Home Life asked care homes around the UK for their best practice tips for when it comes to creating a social mealtime, increasing appetites and involving residents, relatives and staff in decision making. You can find other useful information on their resources page on the website

Resource of the month!

Not everything we do has to be about food! The Love to Move Programme is an age and dementia friendly seated gymnastics programme. Developed by the British Gymnastics Foundation this exercise booklet (pdf) is available to help you try their Love to Move programme in your own home / care home with your loved ones. It contains some of the key exercises from the programme, as well as more information about why the programme is working. If you find this useful you can support further expansion of the project on the British Gymnastics Foundation website.

Puree Food Molding - How To Video

Recipe of the month!

More of an instruction video than a recipe this month but an important lesson none the less: Puree Food Molding – How To Video. When making puree foods it is so important the food is presented to look like it originally was before being blended. Recognition of familiar foods is important to all of us but even more so to someone with later stage dementia who may need increased sensory cues to eat as well as enhanced familiarity. This short video goes through the 6 stages shown above required to create an appetising puree meal. There are also some excellent puree food recipes linked in other videos on the DMAT YouTube playlist where this video is found (see here).
You can find more cooking ideas and dementia mealtime information on The DMAT Pinterest boards. Just click on the Pinterest logo and take a look.  

Thanks for reading, see you next month

Lee Martin MSc RD


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