Coping with “taste” and smell loss
Imagine a life without being able to smell your favourite food or “taste” the delicious flavours of your favourite dish. Sadly, this is the reality for a large number of people with brain injuries, as smell loss (and to a lesser extent, taste loss) is quite common after this type of injury. The more serious the brain injury, the more a person’s sense of smell tends to be affected. “Olfactory dysfunction” (defined as a reduced or absent sense of smell) is reported in 20-44% of “mild” brain injuries, 37-68% of “moderate” brain injuries and 33-61% of “severe” brain injuries.1 This “dysfunction” can be a result of direct trauma to the olfactory region (eg. facial fractures), tearing of the nerve filaments and/or damage to the olfactory region of the brain.2 In contrast, a reduced sense of taste has only been found in 0.4% of clients with head injuries.3
Even though it’s generally a person’s sense of smell which is affected, what you will often hear people saying is that “food has no taste” or “food doesn’t taste like it used to.” Most people have difficulty distinguishing between the sensory information transmitted by their tongue and the information transmitted by their nose. The characteristic flavour of food actually comes primarily from the smell molecules in the food going up the back of your throat into your nasal passage. Most people use the terms “taste” and “flavour” interchangeably, but they are two completely different things. “Flavour” relates to a combination of the taste, smell and texture of food, whereas “taste” only refers to the information transmitted by your taste buds about whether a food is sweet, salty, sour, bitter or has a meaty (umami) flavour. Being able to distinguish between whether a sweet flavour comes from a strawberry or a peach is completely down to your sense of smell. If you want to test this, pinch your nose closed while you eat something.
A reduced sense of smell (or taste) can have a huge, negative impact on someone’s quality of life.2 If you suspect your client has an altered sense of smell or taste, what should you do?
Ensure that changes to smell and taste are investigated thoroughly.
While a reduced or absent sense of smell can be caused by a brain injury, it can also be due to treatable conditions such as: medication, swelling (eg. due to facial trauma), upper respiratory tract infection (“colds”), allergies, rhinosinusitis and nasal obstruction.2 A reduced or absent sense of taste can be due to: medication, a zinc deficiency, low thyroid function or liver or kidney disorders.4 There are five clinics in the UK which specialise in assessing and treating taste and smell disorders – James Paget University Hospital in Norfolk, Freeman Hospital in Newcastle, Royal Surrey County Hospital, Queen Elizabeth Hospital in Birmingham and Guys Hospital in London. These clinics are the best places to assess whether anything can be done to treat the problem.
Encourage clients to join Fifth Sense or Abscent.
The charities Fifth Sense and Abscent are dedicated to helping people who suffer from smell and taste disorders. They stay abreast of all the current research in this area and hold regular educational events throughout the country.
Suggest alterations to food choices.
Eating is a multi-sensory experience. If one sense has been reduced, it is important to dial up the other senses so the person still gets some level of stimulation from their food. Unfortunately, most people try to compensate for an altered sense of smell or taste by adding more salt or sugar to their food. This can lead to long term health problems such as high blood pressure or diabetes. Instead, more effort needs to be made to ensure food looks colourful and appetising. Meals should be planned to include foods of various temperatures – for example, hot, room temperature, cold or freezing food and drink can be alternated during the eating process. Recipes can be altered so that every mouthful includes multiple textures – smooth, crunchy, crisp, chewy — for more sensory stimulation (eg. chopped apple and raisins can be added to porridge). Additional ingredients can also be added to food to make the tongue “tingle” – such as mustard, vinegar, horseradish, hot chillis, or menthol.
Encourage clients to eat mindfully.
Eating in front of the TV or while otherwise distracted means people are much less able to register the sensory information that they are still getting from their food. Family members and support workers can help clients really focus on the appearance, taste, temperature, texture and tingling sensation of food by directing conversations around these topics at mealtimes.
Conduct risk assessments.
A reduced sense of smell means clients are at very high risk of injury from not being able to detect smoke, volatile agents/gases or even spoiled food.1 It can also have huge implications for personal and home hygiene. Risk assessments and care plans need to be put in place to mitigate these risks.
For additional suggestions and ideas on how to improve the pleasure derived from food when smell or taste have been affected, please get in touch at: 0121 384 7087 or firstname.lastname@example.org. If you enjoyed this article and would like to receive more articles like this direct to your inbox, please sign up for my newsletter below.