Dementia care – Dining with dignity

September 29, 2017

Photo credit Matthias Zomer

Most would agree that food and mealtimes are deeply social experiences, which are embedded at the core of many religions and belief systems. They are part of our daily living and we simply couldn’t survive without them.

Dementia is one of many degenerative neurological conditions that can affect the ease at which someone is able to enjoy or partake in a meal. This can be due to the physiological changes in swallowing, and also to the cognitive changes affecting the ability to perform the tasks that are usually required during mealtimes . This can negatively affect an individual’s wellbeing, including their physical (taha tinana), spiritual (taha wairua), family (taha whaanau), and mental health (taha hinengaro) (Durie, 1998).   

In the first instance whanau and carers must always encourage independence during mealtimes. This not only maintains dignity, but also increases swallow safety. A speech-language therapist (SLT) can help guide carers and whanau with the best way to safely achieve maximum independence.  If it is deemed necessary by a SLT to provide full or partial assistance during meals here are some tips to ensure that it can remain a positive experience and that dignity is maintained:

  • Always use the residents’ name to get their attention.
  • Acknowledge, respect, and consider any cultural differences.
  • Make eye contact when communicating with the resident.
  • Use a gentle tone of voice.
  • Tell the resident who you are and what you are going to help them with.
  • Make allowances for hearing and visual deficits (speak to their ‘good’ ear, sit where they can see you, with light on your face).
  • Ensure that the resident’s dentures are in place before the meal.
  • Sit facing the resident when feeding them.
  • Some residents may benefit from sitting near others in order to model appropriate feeding behaviours.
  • Ensure sensory aids are accessible, in situ, and turned on.
  • Serve one course at a time.
  • Pay attention to facial expressions and gestures.
  • Avoid rushing the resident to eat. Use a calm approach.
  • Residents may need prompts to: Start, continue and finish off their meal, chew their food, take another mouthful, swallow
  • Encourage the resident to use any remaining physical skills.
  • During assisted feeding, bring the spoon up where the resident can see it.
  • Tell the resident what is on each spoonful.
  • Don’t do anything to a resident’s plate without asking them first.
  • Do not mix foods together.
  • Never scrape the food off teeth or gums.
  • During mealtimes, avoid conversations among staff that do not include the residents.
  • Be aware of food temperatures. Due to decreased tactile sensations, residents may not be able to judge when food is too hot or cold.
  • Keep in mind the resident’s past diet history. Their feeding and eating behaviours may be normal for them (e.g. they may have always had a small appetite prior to the onset of dementia).
  • Record strategies and ideas for other carers that help a resident to eat and drink their meals (LaTrobe University, 2009).

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