The Importance of Food and Mealtimes in Dementia Care

The Table is Set

Grethe Berg

• Publisher: Jessica Kingsley Publishers
• Year: 2006
• ISBN:
  9781846425165
• Topic: Social Sciences
• Subtopic: Gerontology
• Index: Social Sciences

Mealtimes are about much more than just re-fuelling, and the importance of mealtimes in the care of people with dementia cannot be overestimated. Using her extensive experience of working with older people with dementia, Grethe Berg explains how mealtimes can be used as natural opportunities for meaningful interaction, socialising and reminiscing, and useful forums for taking part in familiar tasks.

The book considers the social significance of mealtimes and their role in maintaining patients' feelings of social attachment and well-being as well as the impact of the symptoms of dementia on food and mealtimes. It also explores different types of residential care and how they can make mealtimes a focus of activity for patients. Finally, the author discusses practical implementation strategies, considering variables such as building design, interdisciplinary collaboration, organization of staff and residents, and staff participation and conduct at mealtimes.

This book provides much-needed help and practical strategies for care managers and carers to reclaim mealtimes as positive experiences for people with dementia.

CHAPTER 1

About Mealtimes and Being Together

Mealtimes give us important opportunities to interact with others. They accompany major events in life and are meeting points in both the daily routine and especially in celebrations (Notaker 1987). Mealtimes place people physically together, around a common table, sharing the enjoyment of food. To eat together promotes companionship, for example a birthday celebration with cake and candles with family and friends, or the coming together for a meal after a funeral (Thorsen 1993).

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).

When we 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.

The work in connection with mealtimes should be a priority for each day

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 wheelchairs 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 and who 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 patients should be the focus of attention

The staff ‘s attention must 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.

CHAPTER 2

Dementia

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. Investigations have shown that more than 70 per cent of residents in Norwegian nursing homes suffer from a dementia illness and that only 14 per cent of the nursing home places are adapted for people with dementia (Eek and Nygård 1999). This provides great challenges for the staff who are responsible for the daily treatment and care of nursing home residents. Managers who have responsibility for planning and organizing the caring service in the municipality have an obligation to consider the consequences of a dementia disease. The organizing of staff and residents and the provision of the proper physical surroundings and facilities are important. This will provide good care and effective arrangements in order to maintain the remaining skills and resources of residents suffering from dementia.

The following is a definition of dementia in old age:

Dementia is an acquired organic brain disease affecting an elderly person. The disease affects the brain by loss of mental capacity and leads to weakness in the psychological processes such as speech, learning, memory and thinking. The disease is chronic, incurable, and deteriorates over time. (Engedal and Haugen 1996)

Loss of function and practical consequences for persons with a dementia illness

A dementia illness leads to serious loss of the ability to take care of oneself, generally speaking. Here we will consider some of the most common skills that are affected and the possible consequences for those who are affected.

Deteriorating memory and loss of ability to learn

Memory problems are an important sign of dementia.

Petra constantly asked if anyone had seen her husband. She had forgotten the answer she received five minutes earlier, and that her husband had been dead for two years.

Anna accused her fellow residents and the staff of stealing her bag. She forgot that she had put it under her pillow half an hour earlier.

Memory is a complicated function, an...

Table of contents

• Cover
• Of Related Interest
• Title Page
• Copyright
• Contents
• Foreword by Aase-Marit Nygård
• Preface
• Introduction
• 1 About Mealtimes and Being Together
• 2 Dementia
• 3 Mealtimes Used as a Purposeful Activity
• 4 The Relationship between Ideals and Practical Reality
• Conclusion
• References