Recently qualified dietitian Debra Nell completed her master’s thesis on meeting the nutrition and hydration needs of residents in dementia care units. As part of her research, she developed a series of recommendations for facilities catering for these special residents.
Residents with dementia can often be underweight and prone to dehydration, unless they are carefully monitored. Because of their dementia, they may also need special consideration at mealtimes. Debra Nell’s research aimed to gain a better understanding of the issues affecting the nutrition of residents with dementia and to provide some useful guidelines for the facilities tasked with ensuring their health and wellbeing.
The study involved asking caregivers from two Specialised Dementia Care Units in Auckland about their perception of issues that might affect residents’ ability to have an optimum diet and adequate hydration. The results of the interviews with the caregivers were sorted into similar themes, and two main themes, each with three sub-themes, were evident. The main themes were environmental factors and individual factors.
Environmental factors fell into three sub-groups – surroundings (the dining environment), social factors, and support (the need for and provision of support with mealtime activities) – the three ‘S’s!
Individual factors affecting food and fluid intake related to appetite, food appeal and functional ability – the three ‘A’s!
All of these factors need to be considered when providing food and nutrition care for these residents. Nell formulated 21 recommendations that should assist dementia care units and their food service providers to address the two main themes, as well as the menu.
- Minimise distractions in the dining room during mealtimes, such as turning off the TV, and setting tables with essential items only.
- Relaxing background music may be beneficial during lunch and dinner, depending on the wishes and behavioural responses of residents.
- Shared dining rooms should be available and residents encouraged to use them. Observational cues from others allow the individual with dementia to mimic appropriate eating behaviours. Seating arrangements should be such that more independent individuals are not distracted by more dependent residents.
- A suitable dining space and staff support should be available for residents requiring time away from the group. Visits from family and friends at mealtimes should be encouraged as appropriate. The dining room environment should be managed to ensure that visitors do not distract other residents from eating.
- Allow the individual with dementia to set his/her own pace for eating and drinking.
- Food should be attractively arranged on the plate, and a plated meal should include a variety of colours.
- A special effort should be made with texture-modified foods to ensure the best possible presentation, with foods visually identifiable, and varied from day to day.
Some foods or menu items create problems:
- Foods that are difficult to pick up with a fork, e.g. peas, rice, salad, may need to be combined with other foods or presented differently when possible to make them easier to manage.
- Meals served on or with toast, e.g. baked beans or savoury mince, may be better served with an alternative carbohydrate food, such as mashed potato.
- Sandwiches may fall apart when made with dry fillings such as lettuce or tomato. Soft, mixed sandwich fillings hold together better.
- Consider presenting suitable foods as either a ‘bite size’ or a ‘finger food’ for individuals preferring this option.
- Mealtime support from caregivers should recognise an individual’s needs and desires, assessing the level of ability or dependence at the time. Interventions involving appropriate encouragement of physical assistance should be provided.
- Meal and snack times should be optimally spaced during the day to ensure individuals have an appetite for each meal.
- Sufficient nutritionally adequate foods should be available at supper, particularly for individuals with a low intake at dinner. Food and drink should be available to residents outside set mealtimes.
- Menu cycles should be of adequate length with sufficient variety for main meals, snacks and drinks (Dietitians NZ recommends cycle menus of at least four weeks in extended care facilities).
- Taste and smell of food should be optimised for older people with reduced taste sensation. Creating flavourful food and opportunities to allow pleasant cooking aromas to enter the lounge or dining room should be utilised.
- Increase the variety of foods by celebrating special occasions with a special meal, introducing occasional events such as barbecues or a weekly ‘happy hour’ or special afternoon tea.
This article was adapted from Dietitians NZ’s “Talk with” series, No 17, February 2015 with permission from Dietitians NZ, Debra Nell and the author, Julian Jensen.