Dementia dining: A model
Suzanne Hensley, long time administrator of Fair Haven Home in Bostic, NC, sat in the dining room and watched Ruth*,who has dementia. Ruth was not eating or drinking well, made a mess with her food, was confused about what to do with silverware, and had trouble seeing the food that was placed right in front of her. Ruth struggled with grasping her cup and raising her drink to her mouth due to muscle weakness.
Suzanne began to think, “I wonder if there is anything more we can do to help Ruth be more successful at mealtimes." She researched dining options for dementia patients and found little online about it other than the importance of color, contrast, and placement of food due to poor or declining vision. She discovered that lime green is the last color clearly seen by dementia patients.
What other information would help her to help Ruth?
It dawned on Suzanne that a good resource was just down the hall working in the Activities Department. Donna Eades was working as one of her activity aides. Donna had a 25-year career in Retail Management and had followed her heart several years back, changing her profession to healthcare. She became a certified nursing assistant and a Nationally Certified Activity Director with a Specialization in Memory Care/Dementia. Some of her training was learned traveling to the Alzheimer's Resource Center in Connecticut, which is a cutting edge, state of the art facility.
Suzanne and Donna put their heads together and came up with an innovative and transformational approach to dining for dementia residents at Fair Haven Home that is making some big differences.
They first identified their goals:
1. Nutrition and hydration needs met and exceeded
Dementia residents often forget to drink and eat which can cause more serious health issues.
2. Individual dignity and respect
By allowing more attainable independence and choices, morale and self esteem improves.
By providing a feel-good interactive environment, friendships are formed, self isolation decreases, and overall attitudes improve, which lessens negative behaviors.
How it Works: A dining atmosphere of calm and caring is provided
A quiet dining space is provided with minimal distractions and noise. There is no TV, soft instrumental music plays, and lighting is non-glare. Temperature is controlled. It is common for dementia patients to say they are cold, so sweaters or wraps are provided as needed. Any staff member who works in the dining area is trained in techniques to assist with a “helping hands” approach. The conversational tone is kept positive, involving all residents if possible.
Topics include reminiscing, childhood, food and cooking, happy thoughts. It's like a nice, big family gathering. There is no joking or teasing since diners may take words literally or be confused.
Color contrast needs are met.
Lime green table cloths are layered next to darker burgundy plates. Lighter toned plates are provided for darker toned food items. Dark-colored chair cushions are used against a lighter toned floor.
Dignity and respect are honored.
Dignity for the dementia patient is often found in choices. A choice among attractive dining scarves is provided. They look like vests without the sides attached. They are sewn with seasonal fabrics with both masculine and feminine patterns. Some patients like to wear them out after the meal because they like them so much!
Individual needs are met.
Some residents are still able to use silverware and some are not. Finger food items are commonplace to accommodate this without embarrassment. Foods are also cut into smaller pieces before serving them. Lighter weight cups are also available for some whose muscle tone has weakened. Straws are only given to those who can use them. The pace of the meal is slow – sometimes up to two hours. Cueing (reminding or prompting) is common. Each individual's consumption is charted by staff.
Simple, one step tasks are apparent.
Tea or water is served first. Next a half-filled mug of soup is served. As the soup is finished, the plates are brought with defined separation of food items. Larger food items are cut into bite size. Smaller portions are less overwhelming. Sandwiches are cut into quarters as this is more manageable. Sandwiches are always offered as an addition to the meal as well as an alternate. Dessert is served separately after the main meal is removed. Drinks are refilled throughout mealtime.
Outcomes and Benefits
After just four months, dementia dining benefits are already apparent to Suzanne and Donna. The diners are more independent eaters, are better hydrated, and are experiencing measurable weight gains. They also appear to be more contented, less isolated with better social integration, and express fewer complaints in general.
“We want to incorporate these ideas into some of our staff training in the future,” said Hensley. “And we want caregivers to be made aware of how these ideas can help their loved ones.”
*Names or residents have been changed to protect their privacy.
Pat Snyder is the author of Treasures in the Darkness: Extending the Early Stage of Lewy Body Disease, Alzheimer's, and Parkinson's and a number of articles about caregiving.