V for Life

Shifting identities: Dementia, mental capacity and the food we eat

Around 70 per cent of people in care homes have dementia. Understanding how we as a society address changes in identity and mental capacity is fundamental to the work of VfL, the UK charity for older vegans and vegetarians. With that in mind, last month we held a panel discussion with three experts to explore the complexities of how diet, and the beliefs behind it, can be respected as people’s mental capacity changes and fluctuates.

Andrea Lavazza, a neuroscientist and moral philosopher based at Pegaso University in Naples, took us through the case of a Swedish man named Oscar, who developed Alzheimer’s disease and was admitted to a specialised facility for severe dementia. In line with his previous habits and at the behest of his wife, Oscar was served vegan meals. One day, however, Oscar was mistakenly given a portion of meatballs in tomato sauce. He liked them very much, while realising for the first time that the dishes he was given were different from those served to other patients. From that moment Oscar refused to eat vegetables. The staff found themselves divided between the desire to please the patient and at the behest of his wife, according to whom the husband wanted to eat vegan and was distorted by his disease.

Lavazza explained how different philosophical perspectives lead us to different conclusions in this dilemma, from following the patient’s perspective as it is in the current moment, so that previous values are no longer applicable; through to beliefs that only desires expressed in full autonomy have ethical relevance. He also presented neurological evidence suggesting that the development of Alzheimer's can undermine individuals’ capacity for moral reasoning. Meanwhile, brain changes may also lead to heightened cravings for protein-rich or iron-containing foods, such as meat.

He concluded that case-by-case decisions may be the most appropriate response over a fixed evaluation. Oscar was served meatballs. But had he made an advanced directive specifying the wish to always be served vegan meals, this would have represented a fully rational and ethical choice that would most likely have changed that decision.

Adding to this message of nuance, Glenda Roberts, Director of Older Peoples Services for the Salvation Army, emphasised the importance of individualising care, supporting people to make their decisions about what they eat in ways that ensure that, as far as possible, they have the right support and information to make that decision. She noted that in their efforts to provide care, staff might unintentionally overlook aspects important to the individual, such as long-standing dietary habits. This neglect can lead to distress and erode the resident’s sense of identity.

Jenny Henderson spoke from her experience of assessing mental capacity as a panel member of the Mental Health Tribunal Scotland, as well as as a practitioner and educator, in saying that capacity is always decision-specific. You may not be able to run the Bank of England, but you can choose what you want to eat or choose what you want to wear. This is backed up by the law in England and Scotland, in each case underpinned by the Human Rights Act. Ultimately, the goal is to act in what in England is called the best interest, and in Scotland of benefit to, the individual. She also emphasised the importance of exploring different methods of communication to ensure that care givers have the best possible chance of understanding the wishes of the person for whom they are caring.

Through questions and discussion, these issues were re-emphasised, and while no firm conclusions were reached, a number of themes emerged. All agreed that this was an area where nuance was required, and that education was vital, with a presumption that most care givers are doing their best most of the time. Discussion returned to protecting and nurturing values of autonomy and respect, with part of this being a recognition that food is often about more than nutrition and calories and can be a carrier of meaning, identity and values.


As an individual, the most important thing we can do for ourselves or our loved ones is to ensure that our wishes are expressed as clearly as possible in advance of any change to mental capacity. With that in mind, VfL has produced a Self-Advocacy Pack, offering practical guidance for ensuring that your wishes are respected in the event that you require care as you get older. Guides for England, Northern Ireland, Scotland and Wales can be downloaded from our website or purchased from our online shop.


You can also view the full panel event, Shifting Identities: Dementia and Mental Capacity, on our YouTube channel.


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