Mealtime can often be one of the most difficult times for both individuals with dementia and their caregivers. Due to the disease process of dementia, and the behaviors that often accompany the declines in functional ability, meals can often provoke a great deal of anxiety and frustration. To ensure that individuals with dementia eat during mealtimes, as well as to reduce the occurrence of behavior problems, caregivers must create an environment during the mealtime that provides a structured, homelike atmosphere, while still allowing for individual mood and behavior changes. If not handled appropriately, mood and behavioral changes will affect appetite and intake. Moreover, since weight loss is an almost inevitable part of the later stages of Alzheimer's dementia, we must maximize the individuals' intake during early and middle stages of the disease. By shifting the way we deliver care from a task (or outcome) oriented approach to a process oriented approach, we can help to maintain the abilities of the individual with dementia and decrease the potential for intake-related weight loss.
To follow, are useful ideas which caregivers and families may utilize during mealtime with individuals with dementia.
- To develop effective mealtime delivery requires an awareness of the characteristics of individuals with dementia. Individuals with dementia typically will have an impaired ability to concentrate and an extremely short attention span. These individuals may also experience psychomotor agitation and become easily overwhelmed by external stimulation. Due in part to these factors, catastrophic reactions often occur during meals. Given the short attention span of those with dementia, three large meals each day may not be as effective as multiple small meals throughout the day. This is especially important for those who tend to wander about, and then return to their meal after a few moments.
- Avoid trying to encourage individuals with dementia to return to their meal and excessive redirecting . There is no law that requires an individual to complete his/her meal, nor any reason an individual needs to remain seated throughout the meal.
- Avoid power struggles during mealtime. When power struggles occur, there are no winners. When staff or family try to convince an individual with dementia to return to his/her meal, frustration levels rise. The higher the level of frustration with the staff or family member, the more agitated and aggressive the individual with dementia will become. Although the individual may have dementia, he or she will still be able to sense the aggravation in the voice of the caregiver. Appetite will probably be diminished due to the stress. The caregiver will then have to deal not only with an immediate behavioral issue, but also a possible weight loss as well.
- Within a nursing home, the dining room power struggle may also cause stress and distraction for other residents. Allowing residents to wander around during mealtime is necessary. After the resident has wandered around for a few minutes, a staff member could re-approach the resident and offer the meal once again. In most instances, the wandering will calm the resident who will then readily comply with the request to eat. Meals may take longer, but they will be less stressful and more productive for all involved.
- Some nursing facilities have found that serving small meals throughout the day can have positive results for the residents. Since individuals with dementia do not have the ability to concentrate for sustained periods of time, providing shorter, more frequent meals served in smaller portions can be effective. The meal can also be staggered to allow the resident to eat one type of food, wander to another activity, and then return to eat another course.
- Smaller portions - and offering fewer choices is important since individuals with dementia are easily overwhelmed by three or four food choices on a single plate. This is especially important given the reduced appetite of many older adults. Consider serving food in small containers. A full meal could be served, one bowl or plate at a time over an extended period of time.
- Finger foods are also ideal since they enable individuals with dementia greater amounts of freedom and independence. Finger foods are especially appropriate for individuals who find manipulating utensils difficult.
- Whenever possible, encourage individuals with dementia to take part in the preparation of the meal. Since this is a normal lifetime routine, it should remain a part of the individual's life. Remember to always supervise an individual with dementia when working in the kitchen around a hot stove or with sharp kitchen utensils. Normalizing daily events helps the individual with dementia to maintain his/her normal routine and is strongly tied into feelings of self-worth and accomplishment. When possible, encourage participation in setting the table, putting ice in glasses, preparing the food and cleaning up after the meal. Although this may lengthen the time required to prepare a meal, it is important to create opportunities for the individual with dementia to continue to utilize lifelong abilities. In fact, the more that individuals with dementia follow established lifelong routines, the less rapid the decline in functional abilities.
- Encourage families and friends to eat at the same time as the individual with dementia. When caregivers eat at the same time, individuals with dementia will maintain concentration on the meal for longer, and eat more. Individuals with dementia often become self conscious when visitors simply sit and watch the individual with dementia eat. Also, since the visitor will most likely be younger, the individual with dementia may feel responsible for this younger person and will not eat when they are not eating.
- With mealtimes, and all other activities of daily living, it is important to create opportunities for the individual with dementia to have as much control over his/her situation as possible. When many other issues are beyond the control of the individual with dementia, caregivers must be attentive to providing safe opportunities for autonomy.
Mealtimes may either be a time of stress or pleasure for individuals with dementia and their caregivers. By shifting the way we deliver care from a task (or outcome) oriented approach to a process oriented approach, we can help to maintain the abilities of the individual with dementia and create a positive dining experience for all involved. By implementing some of the strategies identified above, caregivers should observe increased intake during mealtimes, and decreased frustration on the part of both the individual with dementia and the caregiver.
Source: Susan Love, MSW., Keith S. Savell, Ph.D., CTRS Geriatric Healthcare Consultants
|
