Dining Information...

Adequate nutritional intake for a person with Alzheimer's or a related dementia requires a comprehensive approach. The ability to feed ourselves is the first activity of daily living we master and the last to be lost in our later years.

     There are many reasons for decreased eating in the elderly. Some of these include vision loss, depression, social isolation, a swallowing problem, and effect of medication and terminal illness. Pain, fatigue and gastrointestinal problems may make food less desirable.

     At Long View Nursing Home, we have developed a therapeutic nutritional and hydration program to promote adequate intake. The resident with Alzeimer's or deficits related dementia may have cognitive deficits that further impair their ability to eat. Two of these deficits are amnesia and agnosia. Amnesia causes short-term memory loss. When presented with food, the person may think they just ate, even though four hours have passed since their last meal. Agnosia is an inability to receive and understand sensory input. This can result in an inability to recognize food and to know it's to be eaten.

     The challenges of adequate nutritional intake in the elderly, complicated by Alzheimer's disease, require specialized programming.

The therapeutic nutritional and hydration program has four elements. The program is designed to:

• Maintain physical and emotional health with adequate intake of nutrients.
• Observe the social components of meals including mealtime rituals.
• Maintain functional ability at the highest practical level.
• Provide quality of care and life as indicated in the quality of mealtime.

     One way of providing these elements is to serve meals family style. This type of dining is provided on the specialized unit to those who are functionally able to participate. Mealtime begins with some form of aromatherapy. This sensory input increases appetite. The aroma is provided through a variety of methods. Essential oil of vanilla, cinnamon or apple pie spice may be infused into the dining area. Other times food items prepared and cooked on the unit provide the aroma, such as, baked bread or vegetable soup. The activity program is designed to cook foods or make items near mealtimes that stimulate the appetite. The environment and ritual of mealtime is supportd by the use of tablecloths, china plates, napkins and silverware. Dinner music is played softly in the background to help create a calm atmosphere.

     Before the meal starts, staff and residents say a prayer. This acknowledges a meal time ritual while creating a sense of togetherness.

     Residents take pride in the foods they cook and their table settings. This process maintains their functional level. The residents pass food in serving containers. The highly functional residents even help those who have less ability.

     Family style dining promotes socialization among residents which further serves to increase intake.

     One goal is to maintain independent feeding. When this ability decreases the next progression is the use of finger foods. The environment and family style setting are maintained. Each resident has assistance if needed, but independence is strongly encouraged. The results have proven successful. The intake of food and socialization has increased with the implementation of this program.

     Food related activities that provide aroma or use of essential oils reminiscent of "cooking smells" stimulate the appetite. The tasks require residents to speak to one another when passing food or when asking for seconds. Conversation reguarding the food is a natural occurrence. The process of table setting, passing food and self-serving has increased functional ability at mealtime for some residents. Those at a high functional level maintained their skills and increased self worth by assisting those in need. The quality of life at mealtime is supported by the environment pleasant background music, table mates with similar abilities and a set table rather than tray service, set the environment. Setting the table, prayer before meal and family style serving support the rituals of this generation.

     The success of the therapeutic nutritional and hydration program requires the effort of several facility departments; nursing, dietary and activities; working as a team. This group effort has proven successful in meeting the four goals of the program.

Caregivers in the home setting can apply these same approaches to achieve similar success:

• Let the person participate in meal preperation. If unable to actively participate, let them observe the preperation.
• Plan to eat in an area where the food is cooked so the aroma stimulates appetite. If not cooking, try putting a small pot on the stove with water and a variety of items that remind us of food, such as, orange/lemon peel, cinnamon sticks, cloves, nutmeg, vanilla extract, etc. Gently simmer (careful not to let the pot run out of water!)
• Have the person assist, as able, in part or all of the table setting.
• Turn off or reduce distractions at mealtime, i.e., turn off the T.V./Telephone.
• Try playing soft music in the background.
• Serve food in bowls and platters, encourage the person to pass food and to serve themselves.
• Allow the person to feed themselves: If spills are a problem try an apron for women or an extra shirt for a man; place plastic under the chair or on the chair seat; if grip ability has diminished try slipping a foam curler on the end of the utensil; straws with cup lids or sip cups may decrease spills but maintain independence.