For most of us, meal times are pleasurable experiences, whether we crave comfort foods, new cuisine or self-prepared creations. In the nursing home and long-term care settings, facilities work hard to ensure that residents meet their nutritional requirements while enjoying communal sharing in a friendly dining environment. For the person with dementia, however, meal times can be frustrating, confusing and extremely stressful, with the potential of reduced appetite, weight loss and even malnutrition. It is not unusual for residents to resist eating at such times, often resulting in additional stress between residents and their caregivers or family members, who are trying hard to persuade them to eat.
In addition to any physical problems or medication issues that may affect appetite and eating ability, people with dementia may forget whether they have eaten, be unable to recognize some foods or to use cutlery, have difficulty chewing or swallowing, be easily distracted while eating and/or be unable to communicate their food likes and dislikes. They may prefer only a few foods, or certain types of foods—for example, ice cream, or cookies, cake or chocolate candy.
Although there are a number of challenges to be faced, there are steps that can be taken to maximize both food intake and more pleasure in eating, while helping to maintain your relative’s independence and dignity:
- Ask to speak with the dietitian. Provide as much information as you can about your friend or relative’s past working and family life, eating and drinking patterns (including meal times, how often they ate, whether they snacked, etc.), habits and food preferences.
- Most nursing home residents do not need special diets and restricting food options can increase the risk of weight loss. Work with the dietitian and the physician to come up with a satisfactory meal plan for your relative.
- Observe whether your relative is comfortable when seated for meals, i.e., fully awake, sitting upright with necessary aids in place (glasses, hearing aid, dentures), and whether the food is positioned so that it can be easily seen. If not, work with staff in the dining room to make appropriate adjustments.
- Observe whether plates contrast with the color of the tablecloths or placemats. Contrast helps the resident to see where the edge of the plate is. The plate shouldn’t be overcrowded, and too many choices can be confusing. Sometimes offering only one course at a time can be helpful (as opposed to a tray loaded with soup, bread, main course, dessert, etc.).
- The dining area should be quiet and calm. Noise and other distractions can interfere with attention span. Soothing music may help.
- Residents should never be forced to eat. It is also important not to take food away too quickly, as many residents will eat if given enough time.
- If a resident doesn’t seem willing to eat at mealtimes, they may respond to being offered snacks throughout the day (a piece of fruit, a cookie, some pudding, a peanut butter and jelly sandwich). It is preferable that residents eat food they enjoy, rather than relying on supplements, which are rarely if ever as satisfying.
If it’s possible, you may wish to schedule your visit at meal times. When you share a meal with your friend or relative, try to eat a similar food to encourage positive feelings of comfort and familiarity. For most people, food is a source of pleasure. For the person with dementia, it is one of the few pleasures still available to them, so it makes all the more sense that meals be a priority.
Focus on Finger Foods
One of the key solutions to dealing with eating problems in persons with dementia has been the use of finger foods. Many people with advanced dementia, who can no longer use utensils, are able to feed themselves if they have finger food they like, presented to them in an encouraging way by staff or family members. While not everyone is able to benefit from finger food, those who can often take more interest in eating.
There are some clear advantages: Finger foods can be eaten on the run if the person stands up or wanders; it requires less assistance, preserving independence longer and making more efficient use of staff time with the resident, and it can be given in smaller amounts several times a day in keeping with the person’s preference.
Ariane Stein, a dietitian in France specializing in Alzheimer’s and gerontology, has done some interesting research on the use of finger foods and gave us some ideas about how to make them more appealing. Mrs. Stein experimented with taking traditional French dishes such as casserole of beef, veal, stew, pork with lentils, even rice pudding, and preparing them as finger food. There are few things as comforting as familiar foods and tastes, so imagine macaroni and cheese, lasagna, your favorite chicken dish, or pumpkin pie as finger food!
Ms. Stein did her research in a nursing home in the Dordogne region of France, Le Verger Des Balans, with support from Dr. Genevieve Demoures. The purpose of the study was to show that nutritionally balanced, visually appealing, easy to pick up food could provide residents with Alzheimer’s the ability to feed themselves and be more independent. Her results were extremely positive, with all 20 of the residents she worked with improving to the point where they needed less help. This is consistent with what has become good practice for many years. What is new here is Mrs. Stein’s creation of recipes that are interesting, comforting and familiar to residents, as well as nutritionally balanced.
As you can see, food choices are open to creativity and imagination—most foods can be prepared as finger food when approached the right way. Think wraps, meatballs, mini quiches, scones, crackers with cream cheese, fruit slices, French toast, cooked carrot sticks, potato wedges, sandwiches with soft fillings, cheese melts, fishcakes—the possibilities are endless.
One thing to keep in mind is that this is not a “one size fits all” approach, and plans should be customized in consultation with the dietitian and staff to accommodate preference and comfort.