Eating, dining areas and kitchens
Creating a dementia-friendly eating environment | Expanding the eating experience | Eating difficulties | Encouraging and assisting eating | Eating problems in late stage dementia | The physical environment of eating | Changes you can make now
- Promote mealtimes as pleasant and enjoyable
- Understand people’s food and social likes
- Find out personal eating and nutritional issues
- Involve people in tasks linked to food and eating
- Encourage eating and social involvement through physical design and décor
- Reduce too much background noise
The smell of freshly baked bread, roast lamb, spaghetti Bolognese or a bowl of phô are inviting smells linked with family and the home kitchen. Home-cooked meals remind people of past times, give sensory pleasure and break down the sense of institutional life.
In residential and respite settings eating is often taken out of its usual social setting and regimented for greater efficiency. Where home-like meals are presented in a dementia-friendly environment, they can lift spirits and remind people of good times. Smells from a nearby kitchen can improve appetite.
Food is a source of pleasure even in late stage dementia when other types of sensory pleasure are reduced.
Food preparation and eating and where they take place are important in everyday life and often mark special occasions. Residential and respite settings should offer sound nutrition and a home-like social experience. Think about what constitutes your everyday eating experience.
Do you have a separate dining room at home, kept for special occasions? What about your kitchen?
In many homes the kitchen table is not just where people eat but a social hub. Family and friends gather for a chat and important life events are discussed over a cup of tea. The kitchen table is a place of childhood memories. You may have helped your mother peel the vegetables at the table or listened to your parents talking about the day’s events.
People’s histories and cultural backgrounds help shape the whole food and eating experience, from the garden to washing up. Some people may have grown vegetables, kept chooks or shopped at local markets. Food and eating can tap into people’s life experiences, and be meaningful and joyful times.
Nutrition, eating and drinking are important because they involve:
- social contact
- sensory pleasure
- cultural habits
- religious beliefs
- personal food preferences
- personal life stories.
Food is a major part of our sensory stimulation and can continue to bring satisfaction and pleasure when other sensory pleasures reduce.
- Not knowing people’s food and eating likes
- Not understanding eating as a social experience
- Insufficient lighting in kitchen and dining areas
- High noise levels in dining areas
- unsuitable or inadequate levels of help
How I hate this food!
My name is Angela; I’m 86 and I grew up on the farm. I was called a tomboy and my jobs included collecting eggs, feeding animals (chooks, pigs and my lamb Anny), and picking ripe fruit and vegetables from the orchard and vegetable garden.
When I arrived here, staff filled in a form with my daughter’s help. They have followed it ever since. Meals follow a routine I could set my clock to. No freshly baked bread now, just that thin sliced stuff. I’m sure it’s good for you but it’s just not the same. I will get luke-warm tea in a minute so I can drink it fast and they can get me into bed. My daughter said I liked black tea when they filled in that form, but after two years of drinking it warm from a plastic mug I would love a hot black coffee in a proper cup.
I sit here in a track suit and that box in the corner talks and smiles but I can’t really hear what they say. It looks like staff are enjoying it as they chat and laugh with each other, but they don’t smile like that at me or see the longing in my eyes. They seem so busy and it must be hard with so many of us to feed.
What is more familiar than the sights, sounds, aromas and actions associated with meals? These are the cues to which people have learned to respond over a lifetime.Zgola and Bordillon 2001
A meal begins before food on a table. It includes:
- food preparation
- dining room arrangement and atmosphere
- how people are invited or brought to meals
- greetings and conversation
- other social aspects of an occasion
- taste, colour, aroma, feel and presentation of food
- food wholesomeness, digestibility and nutritional value
- help with eating to uphold dignity and independence
- clearing away dishes and washing up.
Add planning a menu, finding recipes and picking vegetables and you can see there are many different ways to make an eating experience more than a meal.
Habitual patterns … such as cooking, serving, being served, sharing and clearing … have been established over the years’. Cognitively impaired people can still call upon them to experience ‘wonderful feelings of competence and productivity Zgola and Bordillon 2001.
In residential and respite settings the dining environment can be difficult for people with dementia and staff, leading to poor food intake and even distress. People with dementia may lose weight and food may become uninteresting. Pressures, from poor décor choices to too much noise, can have negative impacts.
While feeding difficulties are personal, thinking about the social setting of eating and drinking when planning mealtimes can have huge benefits. Delicious smells, inviting presentation of food and a chance to socialise can improve food intake.
When working out how to deal with eating difficulties, ask simple questions:
- What is being served?
- What else is going on in the environment?
- Where does the person sit?
- Is this an ongoing issue?
- Are there issues only at certain times?
Dementia can lead to reduced food and fluid intake because of decreased recognition of hunger and thirst, weakening perception of smell and taste, problems swallowing, inability to make out dining utensils, loss of physical control and depression. Ongoing observation of people at mealtimes is needed to pick up warning signs of eating problems.
Warning signs include problems chewing and swallowing, lack of attentiveness, walking away during mealtimes, poor utensil use and leaving more than 25 per cent of a meal uneaten.
Staff play an important role at mealtimes. They assess feeding difficulties, start new mealtime programs and educate families about ways to get the most out of food intake DiBartolo 2006.
Prompting and acknowledging appropriate mealtime responses can produce large changes Altus et al. 2002. On the other hand, institutional practices like putting people in set seating, food brought to people on trays, and other aspects of old-style institutional food service can provoke disruption and agitation in dining rooms Moore 2002.
If a person needs help with eating, think about what help is best for improving independence:
- Ask the person what they like to eat.
- Use verbal prompts to encourage eating.
- Serve one course at a time to promote concentration.
- Think about using finger foods.
- Remind people to swallow Brush et al 2003.
Defining an eating area can be important for encouraging eating. It can be defined verbally and non-verbally, and by using different items. Staff may find it useful to:
- explain the purpose of the dining room.
- explain what mealtime it is.
- name the food Grealy et al. 2004.
The staff member’s sitting position, verbal communication and non-verbal actions should focus on the person. Think about different methods for different people to help with eating.
Eating problems can come with the final stages of dementia. Some people have problems chewing and swallowing, and food can be swallowed the wrong way. Others may no longer understand how to feed themselves or have no interest in food.
Look at problems to see what steps to take. Think about a person’s beliefs and previously stated wishes about end of life care.
In late stage dementia have appropriately prepared food and simplify the setting as much as possible so the person can concentrate on eating. Do not force a person to eat more than they want to.
Dining can be distracted because of environment, from décor through to too much noise.
Changes to the physical environment do not have to involve major building changes. Small, inexpensive changes can have positive results, improving eating, nutritional intake and the social experience of mealtimes.
Simple physical changes in dining areas and kitchens involve:
- choice and arrangement of furniture
- colours and materials
- home-like decoration.
Many researchers see the kitchen as the central hub of a residential facility. Well-located kitchens can support services and benefits, including supporting the dining area, promoting a home-like feel and being used for staff events.
Some dementia-friendly facility designs place the kitchen centrally, with the dining room an extension of the kitchen and the living room or sitting area nearby. Kitchens that visibly open directly onto dining areas encourage people to join in informal kitchen activities. In cluster designs, people’s rooms are often directly off a central public area, making the kitchen a replacement for old style nursing stations Calkins. 2005.
Kitchens can have most appliances, cupboards and work surfaces found in home kitchens, giving a sense of familiarity for people with dementia, staff and visitors.
One new facility design using the kitchen as a key feature of everyday living is The Green House Project®. Universal staff prepare meals in an open, central kitchen, easily accessible to people with dementia and visitors. People with dementia, family members and friends can join in all activities relating to food preparation and eating. They are thought of as social activities, and this is written into the facility’s policies. Food-related activities take many forms:
- cookbooks based on recipes of people with dementia and their families
- meals planned around local seasonal produce, according to resident likes
- staff and people with dementia eating together, with family and other visitors invited to join in
- active involvement of people with dementia in physical activity and social contact during mealtimes.
Creative approaches around meals include:
- only partly setting dining tables, leaving the rest of the cutlery at the end of the table for people with dementia to complete the task
- talking about the day’s menu with residents each morning to see what might be cooked using their recipes
- encouraging people to help themselves to snacks from the kitchen counter, such as fruit or biscuits, to share with others Bartoldus 2005.
Good design and planning can support safety in the kitchen, including in the absence of staff. Store dangerous items in locked cabinets or use hidden switches and control lockouts. Smart stoves are a useful innovation. Smart stoves turn themselves off and cool down instantly.
- Change the dining room to make it a home-like place to eat and socialise: check the height and stability of chairs, use colourful table cloths contrasting with floor colours and coverings, arrange tables and chairs to promote interaction and personalise the décor.
- Make a cookbook using residents, family members, friends and staff members’ favourite recipes and use it for occasional meals and sweets.
- Have plenty of time for people with dementia to enjoy their meals and for staff to give support and help as needed.
- Increase the number and type of finger foods, snacks and drinks to promote independence.
- Arrange furniture for small groups of diners, for example two person tables.
- Start in-service training on assisted eating, problems people with dementia can have, the kind of communication needed to encourage eating, and ways to increase food intake.
- Buy moveable screens to create smaller, more private eating areas.
- Buy new dining chairs that are stable and comfortable, have good arm rests and fit under the table.
- Re-paint the dining area in cheery colours to promote good eating, for example, warm-range colours such as coral, soft peach or soft yellow.
- Use surfaces on ceilings and floors that reduce noise at mealtimes.
- Re-design the working kitchen, turning it into the facility’s social hub: shift appropriate administrative work there so staff are often in the area, and open it out to the dining area so people with dementia can see it, smell food cooking and help themselves to snacks from the counter. Use home-like, cheery décor and put in new technologies to increase safety and efficiency.
- Have an area for people to entertain others, including family members and friends.