■ Create a consistent meal schedule with others. Mealtimes are a “temporal anchor.” They mark the time of day—morning, noon, and evening—create familiarity, provide a reminder to eat, and improve on the feeling of being safe. In addition, meals provide an opportunity to connect with others.
■ Tie food to memories through food choices and social interactions. “A positive social environment can promote the ability of residents to eat and drink” (alz.org). The use of family-style dining, where bowls are passed and individuals can take what they would like, is one method used to tie eating to memories for some, while for others, restaurant-style dining may be what they were accustomed to.
■ Have a liberalized diet. Eating is a complex process, and for the individual with dementia, it can be confusing and embarrassing. Do not limit foods when it’s not medically beneficial. Also, be careful not to impose your own food preferences.
■ Have finger foods and other adaptations available if needed. Finger foods are important for the individual who paces or has trouble sitting to finish a meal. These do not have to be specially purchased items. Straining vegetables such as green beans, putting soup in a cup, or removing meat from the sauce and using the sauce in a bowl for dipping are all acceptable solutions. Foods may need to be placed in separate bowls to decrease the distraction on the plate.
■ Have food around at all times. When the individual has eaten but does not remember doing so, provide simple nutritious items such as fruit, yogurt, and cereal. (Do not try to convince her she has eaten. You will fail and cause frustration.)
■ Provide the proper environment, such as good indirect lighting to see the food, and limit noise.
■ Provide color contrast between the plate and the table, and make sure the food does not blend in with the color on the plate.
■ Provide one-step instructions.
■ Have caregivers assist where needed, but encourage independence. Caregivers can assist by eating at the same time, which helps to provide visual cueing. Physically putting hand over hand to assist the beginning of the eating process is another common tool used.
■ Have consistent individuals in their life: the same family members, nurse, certified nurse assistant, and
physician.
Resources
■ “Descending Into Dignity,” by Sandra Burrows and Cheryl Lacy, 2004
■ Weight increase in patients with dementia, and alteration in meal routines and meal environment after integrity promoting care, by Mamhidir, AG, Karlsson, I, Norberg, A, Mona, K, Journal of Clinical Nursing, 16: 987-996, 2007