Yvonne Roberts: Meals for the elderly are not just about nutrition

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The Independent Online

My dad, aged 88, has Alzheimer's Disease (AD). He can no longer speak except with his eyes – and they still occasionally show the humour that is the stamp of his locked away former self. He is one of the more fortunate sufferers because for three years he has lived in a closed ward in a psychiatric hospital, not a private care home. His condition is recognised as an illness rather than the inevitable path of old age.

He is lucky because the quality of nursing is high. He is treated as an individual with quirks and likes and dislikes, many of them manifested by what he chooses to have on his plate (basically, yes to anything with jam and custard). Now, the British Society of Gastroenterology tells us, many care homes across the country are making it a condition of residence that people like my dad have to have a tube fitted into their abdomen, to make feeding easier for staff.

The report says that such a procedure, known as a gastronomy, is often unnecessary and potentially dangerous. With time and patience, elderly people with swallowing difficulties can be helped to eat and drink normally. This widespread and growing use of tube-feeding shows just how corrupted the concept of "care" has become when applied to older and very vulnerable people.

Mealtimes – even for those with dementia – are never just about nutrition. For my dad, they are also episodes in an often monotonous routine in which he is gently encouraged to exercise choice, to socialise and to make a connection with the carer who feeds him and who finds ways of communicating with him, beyond words. He is John, not a confused old man with a tube.

In many of the private care homes I've visited, people with dementia sit with trays untouched, starving emotionally and physically, in a room full of strangers, probably lonelier than they've ever been before in their lives, and not just because of the isolation that dementia may trigger. Is a feeding tube more preferable? Or is the answer properly subsidised care within the NHS; decent wages for staff; an improved carer-patient ratio and a much more imaginative view of the kind of stimulation a life with dementia requires?

On occasions artificial feeding may be unavoidable but even here there is room for debate. My aunt, in her 90s, has very advanced AD, and has been fed via a tube for months. This is in part because her daughters, daily visitors for years, find it hard to say good-bye. The report calls for agreement between the patient, relatives and healthcare professionals about the aims of artificial feeding. But before agreement, there has to be an acknowledgement that the rights of the patient come first. If my aunt had been on a life support machine, it would have been switched off many, many weeks ago.

So where, if any, is the good news in all this? Perhaps, paradoxically, it's to be found in the sheer weight of numbers. It's beginning to feel as if everyone knows someone who is trying to negotiate a life for their elderly relative with dementia – a life that, ideally, is far removed from the stamp of the Victorian workhouse and which increases rather than reduces the opportunities for an individual to experience empathy, enjoyment, compassion, understanding and laughter.

As the numbers grow, so the gap between the ideal and the sometimes horrific reality that a diagnosis of dementia can bring, becomes ever more visible. And that surely has to count for something?

Look good, Sadie's way

Sadie Frost, mother of four, bears all, untouched, in Grazia magazine, and declares herself free from any temptation to go under the surgeon's knife, generally chuffed about something she calls, "Size You". "Just be proud of who you are," she says sagely.

But look at what it takes for Sadie to be her natural eight stone self. Eight stone, as she tells us. Twice. Frozen water treatment (shared by half of the population now the pipes have turned to ice); acupuncture facial work; body brushing; exercise; no booze and fags; facials and regularly swinging on a circus trapeze. Sadie pronounces: "This decade should be about sisterhood, natural health, caring for ourselves and loving who we really are."

Sisterhood? With a friend who tells her that she needs to get the bags under eyes removed? Loving who we really are is fine, as far as it goes, but arguably loving what we do is so much more productive and interesting. If Sadie wants to be a fortysomething role model then she should don a dress and tell us about other areas of her life: her business acumen; her design ability; her entrepreneurial streak, the books she's read; adventures she plans. Anything other than look at me, myself and I.

"Size you?" Sadly, more like size yawn.

The secret of happiness?

Marriage is back in vogue. At least, it is for the politicians. David Cameron (possibly) promises tax breaks for married couples – while Labour's soon to be published green paper on "Family and Relationships" (can you have one without the other?) is likely to suggest matrimony is not such a bad idea. But at a time when it has never been less popular, how do you encourage more to take the orange blossom route?

The biggest incentive to tie the knot, some studies say, is plain old-fashioned prospects – a job, qualifications, a roof over your head, savings, all of which are in short supply right now. But much of the chemistry that makes an unbreakable union remains a mystery.

In The Strangest Man by Graham Farmelo, winner of the Costa Biography Award this week, Farmelo describes the marriage of Paul Dirac, said to be Einstein's equal, and divorcee Manci Balazs. How did they handle arguments? Criticism? Jealousy? Lost libido? The in-laws? Very simply (for a genius) it seems.

Mr Durac stayed mute for weeks at a time while Mrs Durac never stopped talking. And they lived very happily ever after for 50 years.