Jam Sandwiches (Community Story)

Community story

By Spark of Life Team © dementiacareinternational

A Case Study in Dementia Nutrition

The staff told me that Pamela* would only eat jam sandwiches. As a clinical nurse with a mental health nursing background, I knew that this was not good nutrition. Refusal to eat can be associated with dementia but I knew this mealtime scenario was not right!

Pamela was difficult to engage, a fussy eater and stubbornly held onto her English heritage. She always had to get her own way or the consequences were a fight and she would refuse to eat. Pamela was always a fussy eater, obviously homesick and sometimes rude to staff and her daughter.

For all her meals, Pamela was offered a plate of daintily cut two rounds of triangular wholemeal bread jam sandwiches. She always ate with gusto, politely leaving the crusts! When I questioned this meal plan I was told, ‘But she drinks tea as well!’ The crunch came when Pamela had bowel problems and had to have a medical procedure. I knew it was my challenge to change this eating pattern.

I remembered my own mother liked jam with cheese sandwiches and I persuade the kitchen staff to introduce a cheese spread. Success! In the first positive step, Pamela never noticed the change. I made a referral to the regional dietician to support the changes and for further nutritional advice. The dietician suggested including nutritional supplements and fibre in her tea.

With the support of the nursing manager and Pamela’s daughter, I encouraged all staff members to organise the nutritional changes. The changes were not easy; everyone felt it was simpler to serve jam sandwiches. I found out that she liked custard and ice cream and another staff member discovered she liked stewed fruit. A breakthrough came when an evening meal included quiche and Pamela ate it all! Pamela gradually chose a variety of meals.

I gained Pamela’s trust and encouraged her to talk about her home in England. Pamela began to vent many negative issues and discussed a variety of positive topics. I felt joyful to see her smile at her great grandson’s picture and reminisce about her childhood exploits.

This marked the end of Pamela’s jam sandwiches. I am now happy to see her eating a variety of small meals and she even enjoys broccoli. Other changes in her care plan helped Pamela during this change of diet. She gained a female roommate and her medications changed to include oral vitamins and iron. There have been no further serious bowel impactions.

It has taken about six months to achieve these positive, healthy dietary changes with Pamela with the support of the staff. We achieved it through teamwork and mealtimes are now a helpful and happy experience.


*Please note that names have been changed to protect privacy.