Do you have special memories around food? Many of us have connections through food that we don’t even realize such as Sunday dinners with our grandparents and holiday feasts with loved ones. For some, even a quiet moment sipping a cup of coffee and enjoying a lite breakfast can be meaningful – a time to reflect, plan, and just take a breath. What about those with dementia, especially if their disease has progressed to the point of residing in a care facility? Do meal times help them connect with others, nourish their spirit and bodies, or give them a moment of calm and reflection? It’s sad to actually ponder these questions as dementia’s hallmark consequence is memory loss: Memory loss so deep that some residents with dementia no longer recognize when it is time for a meal or that they may be hungry. Some residents may react negatively to staff who try to encourage them to sit at the table or to take a spoonful of soup. Three meals plus snacks represent daily intervals to offer and provide nourishment. Overarching goals for a dementia dining program should focus on the following:
- Nourishment: Encourage adequate nutrition and hydration;
- Calm and Serene: Reduce distractions and engage staff;
- Dignity: Promote a culture of respect;
Nourishment
Menu design and recipe refreshes should focus on resident preferences, culinary aromas, and nourishing between-meal-snacks and beverages. Speaking with residents’ friends and families regarding special dishes the resident once prepared or enjoyed is a great way to find new ways to invigorate menu options. A family recipe submission is a fun activity for families to participate while honoring their loved ones. Culinary aromas signal to residents that a meal is approaching. The smell of coffee brewing, soup simmering, or bread baking are unconscious triggers to our brain (and stomachs) leading to the desire to eat or drink. Most can attest to the difficulty of passing up popcorn at a movie theater! The aromas may too unlock some memories related to special occasions and events such as roasting a turkey for Thanksgiving, baking cookies with a parent, or sizzling bacon for a Sunday brunch. Unidine’s signature MemoryFare program incorporates culinary aromas through weekly chef cooking demonstrations, baking in the neighborhood kitchens, and crockpots filled with aromatic ingredients of freshly cut citrus and cinnamon sticks. Every effort is made to create culinary aromas prior to each meal to elicit the best response from the residents.
Calm and Serene
Distractions including noise and visual cues may be overstimulating to those with dementia and result in difficulty to engage and connect with the resident. The resident may even become agitated and restless and thus unable to participate in activities including meals. A top priority is ensuring the living environment is calm and free of unnecessary clutter, noise, movement, etc… to support the overall wellbeing of the resident and ultimately a day with reduced incidence of agitation and anxiety. Beyond the environment, dining initiatives of Breakfast upon Rising, display plates in place of written menus, and service styles can support a peaceful setting. All three strategies promote increased consumption and decreased chance of agitation.
- Accommodate Residents’ Natural Schedules – Breakfast upon Rising is simply that: providing breakfast when the resident naturally awakes. It accounts for individual, internal waking times thus allowing residents to enjoy a full night’s rest and enjoy breakfast during expanded breakfast hours. When left to sleep per one’s natural cycle, observations include residents eat more throughout the day, display less incidence of agitation, and tend to remain alert for all three meals.
- Visual Menus – Visual changes combined with difficulty reading/understanding written words presents a challenge for residents when handed a written menu. Dinner plates displaying the main entrées for the meal are wonderful alternatives to a written menu. Instead of chancing a moment of confusion and anxiousness, residents are shown plated meal options to select from. Beyond verbal confirmation, service staff are trained to identify non-verbal cues related to the resident’s meal preference.
- Serve in Courses – Serving meals in courses versus providing the entire meal at once is another proven strategy to support a calm environment while promoting increased consumption. Often when faced with the entire meal which may include a soup/salad starter, dinner roll, entrée, and dessert along with a full suite of silverware, the residents may automatically feel overwhelmed and thus want to retreat from the table. Instead, Unidine’s MemoryFare program recommends to break the meal into mini segments and provide only the appropriate silverware for the course.
Dignity
Selection of dinnerware and other dining-related items such as clothing protectors should take into account not only function but appearance as well. “Too often, the dishes used in dementia care seem juvenile. There are so many great options available in beautiful, bright colors that look fantastic while also supporting the needs of the residents” indicates Jenny Overly, regional Director of Nutrition of Wellness for Unidine. Keep it simple when choosing plate-ware by avoiding patterns and selecting solid, bright colors such as blue or red. The bright color helps draw the resident’s focus to the plate and creates contrast in the table setting. Appropriate clothing protectors should resemble linen napkins and should never be referred to as bibs. Even more critical to the table appearance is staff engagement with the resident. Mandatory training programs should include dementia training, educating staff about the disease, progression, and how best to interact with residents. One aspect of the MemoryFare program, Companion Dining, supports staff dining with residents. As opposed to traditional models where staff walk around to encourage and cue, the staff member is on the same level as the resident, consumes a small item such as a bowl of soup, and cues and encourages intake while also promoting socialization. The one on one support has been shown to increase oral consumption and improve self-feeding. Families are also encouraged to dine with their loved ones for the same positive impact.
Simple changes in processes along with staff training can make a positive impact related to resident enjoyment of meals and level of nourishment. Three meals and snacks are a significant part of the residents’ day and with thoughtful planning can result in a “good day” for everyone!