The smell of freshly baked bread, roast lamb, spaghetti Bolognese or a bowl of phô are inviting smells linked with family and the home kitchen. Home-cooked meals remind people of past times, give sensory pleasure and break down the sense of institutional life. Show
In residential and respite settings eating is often taken out of its usual social setting and regimented for greater efficiency. Where home-like meals are presented in a dementia-friendly environment, they can lift spirits and remind people of good times. Smells from a nearby kitchen can improve appetite. Food is a source of pleasure even in late stage dementia when other types of sensory pleasure are reduced. Changes you can make nowLow cost
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Creating a dementia-friendly eating environmentFood preparation and eating and where they take place are important in everyday life and often mark special occasions. Residential and respite settings should offer sound nutrition and a home-like social experience. Think about what constitutes your everyday eating experience. Do you have a separate dining room at home, kept for special occasions? What about your kitchen? In many homes the kitchen table is not just where people eat but a social hub. Family and friends gather for a chat and important life events are discussed over a cup of tea. The kitchen table is a place of childhood memories. You may have helped your mother peel the vegetables at the table or listened to your parents talking about the day’s events. People’s histories and cultural backgrounds help shape the whole food and eating experience, from the garden to washing up. Some people may have grown vegetables, kept chickens or shopped at local markets. Food and eating can tap into people’s life experiences, and be meaningful and joyful times. Nutrition, eating and drinking are important because they involve:
Example - Café-style dining roomThe dining room in the photo is in an aged care residential facility, but has been designed to look like a café. Features include a counter where food and drinks can be served, a menu board on the wall, and small tables with seating for four people. This environment promotes social contact and is comfortable for visitors. The contrasting colour scheme helps with mobility and wayfinding. A simpler carpet pattern and reduced table glare would improve useability.Expanding the eating experienceA meal begins before food on a table. It includes:
Add planning a menu, finding recipes and picking vegetables and you can see there are many different ways to make an eating experience more than a meal. Dining room essentials Eating difficultiesIn residential and respite settings the dining environment can be difficult for people with dementia and staff, leading to poor food intake and even distress. People with dementia may lose weight and food may become uninteresting. Pressures, from poor décor choices to too much noise, can have negative impacts. While feeding difficulties are personal, thinking about the social setting of eating and drinking when planning mealtimes can have huge benefits. Delicious smells, inviting presentation of food and a chance to socialise can improve food intake. When working out how to deal with eating difficulties, ask simple questions:
Dementia can lead to reduced food and fluid intake because of decreased recognition of hunger and thirst, weakening perception of smell and taste, problems swallowing, inability to make out dining utensils, loss of physical control and depression. Ongoing observation of people at mealtimes is needed to pick up warning signs of eating problems. Warning signs include problems chewing and swallowing, lack of attentiveness, walking away during mealtimes, poor utensil use and leaving more than 25 per cent of a meal uneaten. Checklist for positive eating experiences Hydration Encouraging and assisting eatingStaff play an important role at mealtimes. They assess feeding difficulties, start new mealtime programs and educate families about ways to get the most out of food intake (DiBartolo, 2006). Prompting and acknowledging appropriate mealtime responses can produce large changes (Altus et al., 2002). On the other hand, institutional practices like putting people in set seating, food brought to people on trays, and other aspects of old-style institutional food service can provoke disruption and agitation in dining rooms (Moore, 2002). If a person needs help with eating, think about what help is best for improving independence:
Defining an eating area can be important for encouraging eating. It can be defined verbally and non-verbally, and by using different items. Staff may find it useful to:
The staff member’s sitting position, verbal communication and non-verbal actions should focus on the person. Think about different methods for different people to help with eating. Do's and don'ts for assisted eating Finger food Eating problems in late stage dementiaEating problems can come with the final stages of dementia. Some people have problems chewing and swallowing, and food can be swallowed the wrong way. Others may no longer understand how to feed themselves or have no interest in food. Look at problems to see what steps to take. Think about a person’s beliefs and previously stated wishes about end of life care. In late stage dementia have appropriately prepared food and simplify the setting as much as possible so the person can concentrate on eating. Do not force a person to eat more than they want to. Advance care planning Eating in late stage dementia The physical environment of eatingChanges to the physical environment do not have to involve major building changes. Small, inexpensive changes can have positive results, improving eating, nutritional intake and the social experience of mealtimes. Simple physical changes in dining areas and kitchens involve:
Example - an inviting dining roomThe photo is of a dining area that has tables to seat four people. Plenty of space between tables and different coloured tablecloths help with mobility and wayfinding. Small dining tables are home-like and promote social interaction. Drapes can be drawn to reduce glare and distractions. The clock is clearly visible. Dining room essentials New residential facilities Eating, dining areas and kitchens KitchensMany researchers see the kitchen as the central hub of a residential facility. Well-located kitchens can support services and benefits, including supporting the dining area, promoting a home-like feel and being used for staff events. Some dementia-friendly facility designs place the kitchen centrally, with the dining room an extension of the kitchen and the living room or sitting area nearby. Kitchens that visibly open directly onto dining areas encourage people to join in informal kitchen activities. In cluster designs, people’s rooms are often directly off a central public area, making the kitchen a replacement for old style nursing stations (Calkins, 2005). Kitchens can have most appliances, cupboards and work surfaces found in home kitchens, giving a sense of familiarity for people with dementia, staff and visitors. One new facility design using the kitchen as a key feature of everyday living is The Green House Project®. Universal staff prepare meals in an open, central kitchen, easily accessible to people with dementia and visitors. People with dementia, family members and friends can join in all activities relating to food preparation and eating. They are thought of as social activities, and this is written into the facility’s policies. Food-related activities take many forms:
Creative approaches around meals include:
Example - a comfortable and welcoming kitchenThe photo shows an open plan kitchen with benches around the perimeter, including an island bench with chairs outside the kitchen area for people to sit and participate in activities or eat at the bench. There are many features of the kitchen that enable participation by people with dementia:
SafetyGood design and planning can support safety in the kitchen, including in the absence of staff. Store dangerous items in locked cabinets or use hidden switches and control lockouts. Smart stoves are a useful innovation. Smart stoves turn themselves off and cool down instantly. Assistive technology
Lived experienceHow I hate this food!My name is Angela. I’m 86 and I grew up on the farm. I was called a tomboy, and my jobs included collecting eggs, feeding animals (chooks, pigs and my lamb Anny), and picking ripe fruit and vegetables from the orchard and vegetable garden. When I arrived here, staff filled in a form with my daughter’s help. They have followed it ever since. Meals follow a routine I could set my clock to. No freshly baked bread now, just that thin sliced stuff. I’m sure it’s good for you but it’s just not the same. I will get lukewarm tea in a minute so I can drink it fast and they can get me into bed. My daughter said I liked black tea when they filled in that form, but after two years of drinking it warm from a plastic mug I would love a hot black coffee in a proper cup. I sit here in a track suit, and that box in the corner talks and smiles, but I can’t really hear what they say. It looks like staff are enjoying it as they chat and laugh with each other, but they don’t smile like that at me or see the longing in my eyes. They seem so busy and it must be hard with so many of us to feed. |