DementiaThe Importance of Food and Mealtimes in Dementia Care
Dementia is a common term for a series of organic diseases characterized by chronic and irreversible intellectual and mental deterioration. A dementia disease also affects the emotional and voluntary functions (Engedal and Haugen 1996). Dementia causes serious loss of self-care skills and makes the affected person unable to control his or her own life. People who suffer from a dementia illness are likely to become largely dependent on other people for support and care.
About Meal times and Being Together
Many people who suffer from dementia have lost their natural ‘meeting time’ with family and friends. They can no longer take part in social activities as they once did. These social activities reinforced their own identity and standing in the family, their experience of being a good and supportive marital partner, a caring mother or father, a good hostess, friend or colleague. On the contrary, they experience loss of abilities, and they lose the important feedback we all need to make us feel useful and valuable as a person.
Fellowship and belonging
In a ward for persons suffering from dementia, mealtimes are prime opportunities for promotion of the sense of community and belonging How successful we are in achieving these goals, depends entirely on the attitudes of the staff and the forward planning of mealtimes as ‘quality time’. Mealtimes should be a natural and basic part of the care-giving in wards for dementia patients (Kaisa Koskela, in Mary Marshall 2003). Whenwe sit down at the breakfast table, say ‘good morning’ to each other and close the door to the corridor, we have created an opportunity for all to experience the sense of belonging. The patient’s feelings of safety and companionship are dependent on both the physical and the social environment.
Food is more than just nutrition
Food is not only about nutrition. Mealtimes can be an opportunity for caring and thoughtfulness. We show that we care for others by serving up something extra good, and we are happy when our culinary efforts are appreciated. Food is a means of communication (Marshall 2003). The opportunity to join in with meal preparation can give the patient the experience and feeling of giving and doing something for others, of receiving thanks, of being useful. Mealtimes can awaken memories and be a framework for common experiences:
"One day, when we were sitting having a coffee after breakfast, we started reminiscing about the first time we had ever tasted coffee. Petra suddenly remembered the kind of coffee that was available during the Second World War, and she was asked how it was made. She told us about toasted peas as a coffee substitute, and about how her mother made home-made sugar lumps as coffee sugar. Other patients confirmed Petra’s description and also remembered other types of food that were prepared during the War. The younger staff listened attentively and asked the patients questions. They learned things they had never heard before".
Food is vital, but also associated with enjoyment. During the busy daily routine it is easy to overlook the many possibilities to make optimal use of mealtimes.
"In one ward the patients were divided into three groups according to abilities and needs. In the run up to Christmas it was the custom to go out for a special meal. In the group with the most seriously affected patients the staff decided to have the meal in the ward itself. The table was set with tablecloth, napkins, candles and Christmas flowers. Patients and staff were formally dressed. There was ample time set aside. The menu contained Christmas food that was easy to eat. They were served creamed rice porridge with sugar and cinnamon, chocolate pudding with vanilla sauce, caramel pudding with caramel sauce, ice cream and traditional Christmas cookies. The atmosphere was relaxed and non-stressful. The patients and staff thoroughly enjoyed the meal together. They had created a lovely ‘out of the daily routine’ experience in their familiar surroundings".
Mealtimes as the priority event in the daily routine
(This section gives some guidelines for successful mealtimes).
It must be clear who is responsible for the planning of mealtimes, and who should share the mealtimes with the patients. There must be agreement in this forward planning and in how the mealtimes should be organized.
Staff should eat together with patients
Set the table for both staff and patients. Try to make mealtimes as normal and familiar as possible. Staff are models for the patients to look at as they eat. Think of yourself as a guide and a ‘safety guard’ during mealtimes. You do an important job when you influence mealtimes in such a way that patients enjoy their time at the dining table and eat well.
Help should be available when necessary
The person who is responsible for the meal must have the ability to assess the needs of the individual patient. Plan where staff and patients are going to sit at the table. Help those who need assistance. Let patients do as much for themselves as possible. The ratio of staff to patients should reflect the individual needs so that those who need help always have a staff member close by. This will optimize the patients’ feeling of coping with the situation at the table.
Ensure there is sufficient time
We must know that we have enough time for our aims and needs during mealtimes. Dementia patients need more time to eat than other people. When staff are under pressure, this stress will be contagious, and this will cause increased confusion and restlessness among the patients. Dementia patients have problems dealing with several tasks simultaneously. Therefore it is important that we do one thing at a time. Give the patient enough time to put down his coffee cup before you ask him to pass the marmalade.
Proper equipment should be available
Make sure that utensils and food are ready for the mealtime. If possible, there should be extra napkins, cutlery and other things that may be needed at hand to avoid having to leave the table in the middle of a meal.
Ensure everyone is sitting comfortably
Make sure that the patients sit well and close enough to the table. Many need help to position their chair after sitting down. Patients with wheel chairs need help to adjust the seat and the back of their chair so that they sit properly at the table. Many sit leaning so far back in the wheelchair that swallowing can be difficult and hazardous.
The dining room should be quiet and orderly
Agree who should serve andwho should sit with the patients. Switch off the television and radio. Close the dining room door. Put up a sign outside the door, so that there is minimal disturbance during mealtimes. Switch off the dishwasher and other kitchen machinery, so that noise is kept to a minimum. Be aware of how much and to whom you speak.
Ensure the lighting is adequate
Put on the room lights and table lights. Older people need more light than younger people do. Take care that the room lighting or natural lighting does not blind the patients. Many dementia patients do not acknowledge that too bright lighting has blinded them.
Make sure the food looks inviting and tasty
Set the table as you would for your own family at home. The food that is served should whet one’s appetite.
The staff ’s attentionmust be concentrated on the patients. There should be a welcoming and caring attitude. The conversation at the table must include the patients and also promote a feeling of worthwhile contribution by everyone present.
By Grethe Berg in the book "The Importance of Food and Mealtimes in Dementia Care", First published in 2002 in Norwegian as "Til dekket bord", by Nasjonalt kompetansesenter, translated from Norwegian by Margoth Lindsey, Jessica Kingsley Publishers, London and Philadelphia,2006, excerpts from pages 15 to 19. Adapted and illustrated to be posted by Leopoldo Costa.
Hi all,
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