Dementia; The Dining Experience
CONSIDER THE DINING ENVIRONMENT
The dining environment and surroundings can affect how well a person with dementia eats.Helping a person with dementia to eat may take 45 minutes to an hour.
Relaxed and social surroundings can add a sense of security, familiarityand structure to the day for a person with dementia.The following practical ideas may serve as a guide for planning mealtimes for a person with dementia:
HAVE A DEDICATED DINING ROOM
- A room dedicated for eating may help develop familiarity. Going into the dining room may signal that it is mealtime.
- A dining room close to the kitchen allows the smell of food to pass though, encouraging appetite and reminding the person that a mealtime is about to take place.
- If a person feels more comfortable eating in a different room other than a dining room, for example, the living room, go with it. Every person is different.
MEAL PREPARATION IS THE KEY TO SUCCESS
- Allow enough time to prepare the person for the meal.
- A short walk or time outdoors before a meal may encourage appetite.
- Encourage the person to get involved at mealtimes. Helping prepare food or laying the table can remind a person that it is time to eat.
- The smell of food, the sound of cooking of the noise of pots and cutlery can help to stimulate appetite and act as a reminder that it is mealtime.
- Think about the direction the person is facing. Do they eat better when they can see other people eating? Will they be distracted by looking outside the window or the door?
- Encourage the person to sit in the same place at each mealtime to provide familiarity.
- Ensure the person is comfortable, does not need the toilet and is sitting in a good position before a mealtime.
- Make sure the person is ready to eat: glasses on, hearing aids on, dentures are clean, fit well and in place.
- Create a calm, quiet and soothing environment
- The person with dementia may find it difficult to concentrate on meals. The environment should be free from distraction and excessive noise to allow them to concentrate on meals.
- Provide good lighting to help them identify food and cutlery.
- Mirrors in the dining room can create is orientation and it may be useful to cover them or remove them completely from dining rooms.
- Pots and cutlery can help to remind the person that a meal is about to take place, but during the meal it can be distracting.
- Vaccum cleaners and washing machines should not be turned on during meals.
- Turn off the television and radio
- Soothing background music maybe comforting, especially for people individually.
- Meals should be relaxed and unhurried. Try not to become stressed at mealtimes if difficulties arise. Stress can be sensed. If you seem to be in a hurry a person with dementia will be aware of this and may not eat as much. Try to keep food visible or it may be forgotten and left uneaten.
- When eating together at home or in a day-centre, avoid removing plates until everyone is finished. Removing plates early can be seen as a signal to stop eating.
- Avoid interruptions and people entering the room.
- Avoid talking to other people as the person maybe distracted by this.
TABLE SETTING - KEEP IT SIMPLE AND USE CONTRASTING COLOURS
The person with dementia may not always identify their own space at the table and take food belonging to someone else. Use a placement or tray to help the person to recognise their place.
- Keep table settings simple. Minimise the number of items on the table. Remove salt, pepper, condiments, napkin holders and only include essential items as it is not unusual for a person to put salt or pepper into their coffee.
- Flowers and candles may look nice, and can help create a calm environment for some, but for others can be distracting.
- Dementia can make it difficult to see the difference between plates and bowls from the surface they are placed on. Use plain, non-patterned, plates and bowles with a contrasting colour to the table cloth or plate setting, for example white plate on green table cloth can help make it easier to see.
- Pastel colours are difficult to recognise. Use primary colours (red, yellow and blue). Use coloured glasses instead of clear ones.
- Choose a plain tablecloth as the person may try to pick items off a patterned tablecloth
- Avoid the full table setting of a knife, fork and spoon. Only put out what is needed.
- If the person prefers to use a spoon, just put out a spoon. Cutting out choices at mealtimes can help to reduce distress or frustration.
TRY TO EAT WITH THE PERSON
- A person with dementia may eat better in company, as they may copy others and this can help to prompt memory.
- Talk about the smell and taste of the different foods you are offering, so that the person can identify what they are eating.
- Encourage the person to eat independently where possible, even if it is only one bite per meal. Do not comment on the way the person is eating as this could be upsetting.
- Prompt the person to eat by placing cutlery or a cup in their hand if they have forgotten what to do at mealtimes.
- Keep a good level of eye contact if the person with dementia is holding eye contact and it doesn’t appear to be causing distress.
- As the dementia progresses it may be necessary to help the person at mealtimes. Always treat the person with dignity. Never treat them like a child.
- Use an apron if necessary to protect clothes
- Ask if the food is too hot or cold, and tell the person which food or drink you are serving with each bite or sip of fluid.
DOES THE PERSON WITH DEMENTIA HAVE A BEST TIME OF DAY FOR EATING?
- Appetite can vary at certain times in the day. Some people eat more as the day goes on or some people may eat more in the morning. If you notice that there are times in the day when person with dementia eats better, change your meal time to suit the person rather than trying to make them fit in with your routine.
- Serve one course at a time to keep food warm and to help avoid confusion with foods.
- Serve half portions and keep the rest of the food warm until the first portion is finished. Insulated plates may be useful.
- Offer drinks after the meal instead of at the same time, or offer small amounts during the meal. Drinks can be filling and they may put someone with dementia off their meal.
- Allow the person plenty of time for eating. A person may not be finished, even if they have stopped eating.
- Have a large, easy seen clock on the wall with a sign showing the times of breakfast, lunch and dinner.
WOULD YOU EAT THE SAME MEAL?
- Colourful foods are more appealing.
- Watch food temperatures. The person may not be able to tell if a food or drink is too hot.
- Serve foods that the person previously liked. Don’t worry if the person wants to eat the same meal twice in a row. Tastes may change so try to be flexible. Do not feel the need to prepare fancy meals but rather concentrate on the person eating and enjoying the meal.
- Expect the unexpected. People may enjoy unusual combinations of food. Some people with dementia, who previously preferred savoury foods, may develop a taste for sweet foods and other people may develop a taste for hot and spicy foods.
- Avoid serving meals of the same colour, for example chicken, cauliflower and potato on a white plate. Dark – coloured plates highlight light-coloured food well. Does the colour of the food stand out against the background of the plate? It is hard to see a poached egg or mashed potato on a white plate.
- Avoid food garnishes which can be distracting
- Do not overload the plate with too much food.
- Adapted cutlery and crockery can help promote independence and can help with poor coordination.
- Try plate warmers or insulated cups to keep food and drinks warm for longer.
- Use non-slip placements or dinnerware with suction pads to prevent dishes from sliding.
- Use a large lipped bowl rather than a plate.
- Use cups with 2 handles and a spout or cups which tip without spilling
- Try lightweight, coloured, adapted cutlery (the occupational therapist can advise).
- Use a familiar mug/china cup/plate as this may help to orientate the person.
- Using matching cups and plates may help the person to recognise which cup or plate is theirs.
- When it is obvious that the person can no longer use a spoon or fork, continue to encourage them to feed themselves but introduce finger foods. See section on finder foods for more information.
- Avoid plastic eating utensils and Styrofoam cups because the person may try to eat them which can increase the likelihood of choking.
USEFUL LINKS FOR PEOPLE WITH DEMENTIA AND THEIR CARERS (IRELAND)
- The Alzheimer society of Ireland (www.alzheimers.ie)
- The dementia services information and development centres (www.dementia.ie)
- Alzheimer café (www.alzheimercafe.ie)
- Living well with dementia (www.livingwellwithdementia.ie)
- Irish National Dementia Strategy (www.health.gov.ie/blog/publications/the-irish-national-dementia-strategy/)
- Sonas (sonasaps.ie)
- Dementia Friendly Communities (www.alzheimer.ie/get-involved/dementia-friendly-communities.aspx)
- The crystal project (www.crystalproject.ie)
- Irish Nutrition and Dietetic Institute (www.indi.ie)
Updated by members of the Older Person and Dementia Interest Group May 2016.
Review date: May 2019
© 2016 Irish Nutrition and Dietetics Institute, INDI. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a dietitian. It is intended for educational and informational purposes only.
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