Mealtimes for people with Alzheimer’s disease (AD) can be stressful for both the person and the caregiver. Weight loss due to poor nutrition is a common problem for people with AD; especially in the later stages of the disease.¹ A host of physical and environmental factors such as distraction and wandering, decrease in appetite and inability to recognize food can contribute to poor food intake and weight loss. External factors such as the caregiver’s voice and the dining setting are very important in maximizing meal consumption for the person with AD.² In this article, ways to simplify the In-Home dining environment will be discussed.

Tips for Creating an Optimal Dining Environment at Home

Brighten Lighting:

In general, visual acuity decreases with the aging process, requiring the need for brighter lighting. For people with AD, increased caloric intake was found after lighting and contrast interventions were made.² A bright, evenly lit room, will help the person with AD perform the task of eating more successfully.

Create Contrast:

Color contrast on the table can help facilitate eating. A light solid color arrangement; plate, tablecloth, placemats, etc, makes it hard for the person with AD to distinguish the plate from the tablecloth due to the decrease in visual perception, particularly as the disease progresses. The use of colorful high contrast colors such as red and blue appeared to make it easier for those with advanced AD to see food and beverages, leading to increased intake.³ Use solid color bowls or plates that are different in color from the placemat to help the person with AD locate the plate easily. Avoid using patterned items; tableware and mats, as it can lead to confusion.

Simplify the Table Setting:

Place only what is needed on the table. Avoid using a full utensil layout if only one utensil is needed for a meal. Including more than is needed can make it difficult for a person with AD to choose which utensil to use. Plastic utensils should also be avoided as they can break easily.⁴ Remove non-edible items, like wrappers and eggshells, from the table to maintain safety and to avoid confusion.

If a person with AD is having difficulty managing tableware, the use of assistive devices can help maximize independence. Devices, such as plates with suction cups and spoons with large handles make it easier for people with AD to feed themselves for as long as possible.⁴

Simplify the Meal:

Offer food sequentially one item at a time.⁵ Narrowing food choices decreases stress and confusion and allows the person with AD to focus on the process of eating. Serving bite size pieces or finger foods may also be appropriate for some with AD. (Click here to see Fall ’06 Newsletter) These eliminate the need for utensils and can be held in the hand if a person is wandering, or if the person is no longer able to use utensils to feed him/herself. Also, offering food more frequently throughout the day (5-6 times) may work best for someone who eats a little at one time.

Have Patience:

Create a calm and positive meal environment. Eliminate distractions such as the television and loud music, (though soft music can help create a pleasant ambiance), during mealtime. Noise can be agitating and overwhelming, causing a person to eat less or to stop eating abruptly. People with AD may forget how to use utensils and how to feed themselves. Caregivers may need to coach the person with physical and verbal cues to encourage eating.⁶ Breaking down the task into simple steps can help increase intake. For example, remind the person that this is a spoon and here are your potatoes. Then place the utensil in the person’s hand and guide the person to pick up the food and help them to reach their mouth.

Conclusion

Enjoying a meal at home may be challenging for a person with AD and their caregivers, requiring patience and flexibility. Mealtimes are an important social activity which can enhance a person’s emotional, as well as, nutritional well-being.

God’s Love We Deliver, (GLWD), a non-profit agency in NYC, provides meals to men, women & children affected by HIV/AIDS, Cancer, AD and many other serious illnesses who are unable to shop or prepare meals for themselves. The agency’s team of experienced nutritionists also provides nutrition education, information and counseling in individual & group sessions to clients, their caregivers & other service providers.

Patricia Slinger-Harvey is the Director of Nutrition Services at GLWD and Sonia Grant is a staff Nutritionist. For individualized nutrition information, the nutrition department of GLWD can be reached at 212.284.8103/800.747.2023 or by visiting www.godslovewedeliver.org.

References

1 Alzheimer’s Disease and Nutrition.
http://www.answers4families.org/alz/info/nutrition.html
2 Milano, Carol. A New Light on Dining In Patients with Alzheimer’s Disease.
http://www.nasw.org/users/milanocarol/dining.html
3 Dunne, T. E., et al. Clinical Nutrition. 2004. 23: 533-538.
4 Challenging Behaviors from Alzheimer’s Outreach: Challenging Behaviors for the Caregiver.
http://www.zarcrom.com/users/alzheimers/c10aa.html
5 Tips on Eating from Alzheimer’s Outreach: Tips on Eating.
http://www.zarcrom.com/users/alzheimers/47a.html
6 Alzheimer’s disease and other dementias: Just The Facts and More: Nutrition
http://www.answers4families.org/alz;manual/sec5/nutrition.html

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