Dementia can make everyday tasks more difficult — like dressing and communicating. The cognitive condition can also affect the individual’s ability to eat, leading to weight loss and other comorbidities. Some studies have found that nearly 30% of people living with dementia are malnourished.
The correlation between dementia and malnutrition was something that Jennifer Stelter, Psy.D., CDP, CADDCT, CCTP, DCS, DCSCT quickly observed when she began her career in long-term care over 12 years ago.
“When I took charge as a consultant of the memory care program for a senior living organization, many of the residents within our memory care programs suffered from weight loss and weren’t engaging with food in a pleasurable way. I saw that there was a lot of room for growth,” said Dr. Stelter.
Implementing Intentional Strategies to Increase Food Consumption
In 2016, Dr. Stelter conducted a qualitative study with a group of assisted living residents with varying stages of cognitive impairment. She and her team introduced new dining routines and enhanced the dining experience for residents over three months.
The results of her study, published in her book The Busy Caregiver’s Guide to Advanced Alzheimer Disease, found these dining changes effective. At the end of the study period, Dr. Stelter and her team observed:
- 46% of residents increased their food consumption
- 54% of residents gained or maintained weight
- The use of supplements decreased by 72% (a cost savings of around $9,000)
With more than half of U.S. nursing home residents living with dementia, it’s important for facilities to promote a positive dining experience. As an experienced dementia educator and the founder of the Dementia Connection Institute, Dr. Stelter says facilities can use a few strategies to enhance the dining experience for residents with dementia.
1. Adjust How Food is Presented
Food ingredients are important to all of us, including those living with dementia. Dr. Stelter recommends incorporating the resident’s favorite flavors and textures into their regular diet and elements of the Mediterranean diet to promote brain health.
Aside from the food itself, Dr. Stelter says presentation can have a significant impact too.
“People living with dementia get overwhelmed easily. Sometimes putting multiple food items on one plate can be too much. They need fewer choices,” she notes. “Try serving them one or two items at a time and let them be successful in eating that and then present them a few more items.”
A study from Boston University found colorful plate ware to be beneficial, too. The study revealed that older adults with advanced Alzheimer’s disease who dined from red plates ate 25% more food than those who dined from white plates.
“Red and yellow plate ware can profoundly increase residents’ appetite and sustain their attention,” says Dr. Stelter.
2. Create an Optimal Dining Environment
People living with dementia rely on their senses more than ever. They use their senses to experience the world, so Dr. Stelter says engaging multiple senses within the dining environment is key.
“The colorful plate ware engages them visually. Their sense of smell can be engaged through the food, but also by diffusing citrus essential oils, which can boost their appetite and mood,” she explains. “A Harvard University study also showed that playing music during mealtimes — engaging their auditory sense — is great too.”
The Harvard University study, referenced in Josh Freitas’s book The Dementia Concept, recommends playing:
- Upbeat music with words at breakfast
- Upbeat music without words at lunch
- Calming single-instrument music at dinner
In addition to promoting positive stimuli, removing negative stimuli in the dining environment is just as important. Eliminating loud noises and lowering bright lights may make residents with dementia feel more comfortable and at ease.
3. Involve the Whole Care Team
Meals are a time for socialization. So, Dr. Stelter encourages dining staff and nurses to sit down and eat with residents and converse when possible.
“As caregivers, we are used to providing for the person. But, sitting down and eating with the resident can be so profound,” she notes. “People with dementia are going to mimic you. They watch what you’re doing. It makes sense to sit down with them so they can see you bring your fork to your mouth, how you use your napkin, and how you drink.”
It’s also essential for occupational and speech therapists to be involved in caring for residents with dementia who are struggling at mealtimes.
“Therapists should be observing mealtimes at least once a week. They can look for challenges that residents may have with the mechanics of eating, like using utensils, swallowing, and consuming an adequate amount of food. This allows them to intervene sooner rather than later,” says Dr. Stelter.
Small Dining Changes Can Have a Big Impact on Quality of Life
For care teams who can’t implement multiple dining changes at once, Dr. Stelter says even one or two things can be impactful to counteract malnourishment and promote independence among residents with dementia.
“If your team only has the capacity to change on dining element, I’d recommend switching to colorful plate ware. As the study found, it could boost food consumption by 25% and doesn’t require any extra time from your dining staff,” she says.
Also, adding a diffuser to the dining room with citrus essential oils is a low-cost investment that can deliver excellent results.
“During our study, we found that some residents became more independent when it came to their dining habits,” notes Dr. Stelter. “Once we turned the diffuser on and they smelt the citrus, they began rolling themselves in their wheelchairs to the dining area instead of waiting for staff to move them. Getting to the dining room themselves boosted their independence and incorporated some exercise into their day, which enhanced their quality of life.”