Creative Mealtime Strategies for Alzheimer Patients

Faced with the ongoing challenge of ensuring patients with dementia receive enough nutrition, healthcare foodservice personnel are turning to innovative programs to encourage food intake. The problem is critical: A recent study by the Alzheimer’s Association found that people with dementia in residential care/assisted living facilities and nursing homes often suffer from inadequate food and fluid intake.

The causes are varied and frustrating to caregivers: residents may become distracted, lose the ability to recognize food, or suffer from depression or anxiety that interferes with their dining abilities. The Alzheimer’s Association states that nearly 50% of all people 85 or older have the condition, and with 35 million baby boomers well on their way to senior citizen status, the trend is poised to increase.

With this in mind Cura Hospitality launched its Connections, Memory Support Dining program in August 2012. The program, which recognizes the importance of food and hospitality to the Alzheimer resident, for both social and caloric nourishment, offers specific methodologies to help foodservice personnel meet the mealtime challenge.

In addition to the tools described below, Connections also includes Walking Food, a nutritional finger food program, and Musical Memories, which takes advantage of music’s positive impact during mealtimes.

Dining scarves: A glimpse inside the dining room at Hearthlands, the 27-bed memory support unit of St Andrew’s Village, a continuing care retirement community in Indiana, Pa., reveals residents are wearing handmade, colorful and multi-patterned “dining scarves,” a dressier replacement to the institutional looking dining bibs more typical in this setting.

The dining scarves made their appearance thanks to Emily Greenhill, R.D., director of dining services. In 2011, she learned about the concept through the Alzheimer’s Research Center in St. Paul, Minn., and sent letters to community groups and local churches asking volunteers to make the scarves, which resemble vests rather than bibs. Greenhill even provided the sewing pattern. The scarves are made of two long pieces of fabric, fastened in the front with Velcro.

“We want the residents to be independent and eat independently but that increases messiness,” Greenhill says. “The scarves keep their clothes clean and preserve their dignity,” she adds.

The designs for women might be floral and feminine; those for men include the Pittsburgh Steelers logo. The scarves serve as conversation starters between the staff and the residents and amongst the residents themselves.

“People are talking because the scarves are all different. The residents are more light-hearted and engaged,” says Greenhill, and, as a result, they’re more comfortable eating in the dining room.

It can be difficult to coax dementia patients out of their rooms into the dining area, but the scarves provide an incentive for the residents to enjoy their meals together and socialize. More residents are coming to the dining room, sitting with others and stimulating each other to eat, Greenhill says.

When the cooks come out to chat with residents, they compliment their scarves and at the same time inquire about the food and the residents’ food preferences, even encouraging them to take just one more bite.

“Residents don’t have a lot of choices to make,” says Audra Palmo, administrator of the healthcare center. When they select their scarves, she adds, “these are smaller choices but still something they get to decide for themselves.”

Kitchen connections: Cooking in front of residents helps encourage eating at Woodside, the dementia neighborhood in Longwood at Oakmont, a retirement community in Oakmont, Pa. Since January, Patti Stolar-Demharter, recreational assistant, has spent one day a week introducing smells, textures and tastes to the 16 residents by preparing foods right in front of them.

Using simple recipes for cakes and housemade soups, and letting the residents touch and smell and even help prepare the ingredients, Stolar-Demharter is stirring up more than food—she’s stirring up memories. “Even if they can’t remember the word for cinnamon, they recognize the smell,” she says.

When the food is served, Stolar-Demharter reminds residents, “’This is the soup we made this morning. Do you see the carrots? Do you remember touching them?’ “It stimulates an interest in the food at mealtime,” Stolar-Demharter says.

“Everything centers around the kitchen in our homes. I want to recreate that in the neighborhood,” she adds. “While the food is cooking or baking, the smell permeates the entire neighborhood,” she says.

Though relatively new, the program seems to be working. “We had a lot of residents in Woodside losing weight,” says Misse Tomko, director of recreational services. “We haven’t seen a lot since the program started.”

Stolar-Demharter is even including family members in the program, asking them resident’s favorite recipes. Sometimes the residents will read the recipes themselves, check off ingredients, mix and add spices; and sometimes just holding the card is enough to warrant a smile.

Often the residents’ recollections go back to baking with a parent or grandparent in their childhood kitchens and not to their more recent memories as adults. Either way, “I’m trying to recreate those warm feelings from when they cooked, to help them find an interest in eating,” Stolar-Demharter says.

Conversation starters: In the memory care unit of Menno Haven Retirement Communities in Chambersburg, Pa., Jeremy Frye, general manager, has found a way to improve interaction between staff members and the 32 residents, with the ultimate goal of getting residents to eat.

Using a series of 5-by-8-inch index cards of full-color nostalgic pictures on one side and questions on the other, staff members have a tool to engage residents as they enter the dining room and wait to begin their meals. Topics evoke memories from the residents’ era, and range from vacations to trains or lemonade stands.

“The staff members want to interact but don’t always know how. The cards help them get a conversation going better than a simple, ‘how are you today?’” Frye says.

The television card bears a likeness to an old floor model TV, which gets residents talking about the first television they owned or the first show they watched in black and white.

“Memory-loss residents can’t remember what they ate yesterday, but they remember the first show they watched and what it meant for their families,” says Frye.

When there’s comfortable conversation, the residents enjoy mealtime more and they’re apt to eat more as well, Frye explains. “Our overall goal is resident satisfaction. If they’re happy, I think they’ll eat more.”