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Food for thought: people with dementia on dining in aged care

Malnutrition is common in aged care settings and is associated with an increased risk of ill health and a decline in the physical health, function and wellbeing of residents.

Studies consistently identify that more than half the people living in residential aged care are malnourished.

For people with dementia (a significant proportion of aged care residents), problems with eating – such as difficulty chewing and swallowing, loss of appetite, and distraction during meals – can worsen as dementia progresses, resulting in an even greater risk of poor dietary intake and ultimately malnutrition.

Despite this, there are very few studies that engage people with dementia and their family members to find out what they think about the issue, its impact on their wellbeing, and potential solutions.

Recent research undertaken by Flinders University asked people with dementia and their family members for their opinions on how mealtimes and food in residential care can support or impact upon their quality of life. The aim was to identify what they thought contributed to a good or poor experience at meal times, and to identify practical ways to improve mealtimes.

Residents said they want more flexibility in the timing and size of meals. For people with dysphagia (difficulty swallowing) who require texture-modified meals (e.g. minced or pureed meals), residents feel they have minimal choice with regard to meals, compared to those who can manage a full diet. They also perceive that there is a ‘one-size-fits all’ approach to the level of modification that was recommended, with those on soft diets often being offered the same as those on puree diets.

Poor presentation of meals does not go unnoticed and plays a role in people refusing meals. Some residents and their families feel hesitant to speak up and ask for changes to the menu or practices, although others described situations where they have achieved successful improvements through asking for change.

Previous research shows that residents in aged care facilities value interactions with staff, a welcoming and home-like dining environment, and flexible approaches that cater to individual needs.

Together with this recent study, it is clear that the mealtimes in residential care can provide much more for residents than nutrition alone. Meal times are associated with memory, social occasional, emotions and providing a source of enjoyment during the day (J Gerontol Nurs 2005 Feb; 31(2):11-17).

While residents and their families acknowledged the constraints of the environment, they felt that more could be done to provide individualised and person-centred nutrition and mealtime care. Flexibility and individualisation were considered critical to ensure that people with dementia maintain a sense of control and dignity.

With the ultimate goal to improve nutritional status, quality of life and wellbeing for residents, particularly for those with cognitive impairment, future work could further explore how to provide food and dining experiences in residential aged care settings within the practical constraints that exist. Individual facilities could even consider what changes are possible now.

The current study suggests it is critical to involve residents and family member carers in this process. Engagement should include acknowledgement of the different ways residents and family members may want to be involved. For some, participation in a formal advisory group may be preferred, however this study indicates many may find this method a barrier to participation.

In addition, the presentation of texture-modified foods is a key area needing improvement. A popular new technique involves using moulds to form food into familiar shapes. While this requires some outlay in terms of buying moulds and training staff, this would be worthwhile when compared to the cost of wasted and uneaten food returned to the kitchen.

Lastly, individualised assessment of the need for a texture-modified diet, and the level required, should be carried out by a trained professional (e.g. a speech pathologist). This enables a more structured approach to implementing texture-modified diets for individuals.

Accredited practising dietitians and speech pathologists can assist with this, and can provide advice or education and resources for staff.

To find a local accredited practising dietitian who can provide support to aged care facilities in their food service department and to individual patients, click ‘Find an APD’ on the DAA website www.daa.asn.au and choose ‘Aged Care’ under ‘Area of Practice’ or free call 1800 812 942.

To find a speech pathologist, go to www.speechpathologyaustralia.org.au.

To find more information about this study, see the following article: Arch Gerontol Geriatr 2017 Sep;72:52-58.

Dr Rachel Milte is an accredited practising dietitian and a research fellow at the University of South Australia. She worked on this project in a team with Dr Wendy Shulver, Dr Maggie Killington, Dr Clare Bradley, Professor Michelle Miller and Professor Maria Crotty of Flinders University, Adelaide.

This project was undertaken as part of the National Health and Medical Research Council Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People (grant no. GNT9100000).

Reference: Evans, BC, Crogan, NL & Shultz, JA 2005, ‘The meaning of mealtimes: connection to the social world of the nursing home’, Journal of Gerontological Nursing, vol. 31, no. 2, p. 11.

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