Dining areas, kitchens and eating

The smell of freshly baked bread, roast lamb, spaghetti Bolognese or a bowl of phô are inviting smells linked with family and the home kitchen. Home-cooked meals remind people of past times, give sensory pleasure and break down the sense of institutional life.

In residential and respite settings eating is often taken out of its usual social setting and regimented for greater efficiency. Where home-like meals are presented in a dementia-friendly environment, they can lift spirits and remind people of good times. Smells from a nearby kitchen can improve appetite.

Food is a source of pleasure even in late stage dementia when other types of sensory pleasure are reduced.

Changes you can make now

Low cost

• Change the dining room to make it a home-like place to eat and socialise: check the height and stability of chairs, use colourful table cloths contrasting with floor colours and coverings, arrange tables and chairs to promote interaction and personalise the décor.
• Make a cookbook using residents, family members, friends and staff members’ favourite recipes and use it for occasional meals and sweets.
• Have plenty of time for people with dementia to enjoy their meals and for staff to give support and help as needed.
• Increase the number and type of finger foods, snacks and drinks to promote independence.
• Arrange furniture for small groups of diners, for example two person tables.
• Start in-service training on assisted eating, problems people with dementia can have, the kind of communication needed to encourage eating, and ways to increase food intake.

Moderate cost

• Buy moveable screens to create smaller, more private eating areas.
• Buy new dining chairs that are stable and comfortable, have good arm rests and fit under the table.
• Re-paint the dining area in cheery colours to promote good eating, for example, warm-range colours such as coral, soft peach or soft yellow.

High cost

• Use surfaces on ceilings and floors that reduce noise at mealtimes.
• Re-design the working kitchen, turning it into the facility’s social hub: shift appropriate administrative work there so staff are often in the area, and open it out to the dining area so people with dementia can see it, smell food cooking and help themselves to snacks from the counter. Use home-like, cheery décor and put in new technologies to increase safety and efficiency.
• Have an area for people to entertain others, including family members and friends.

Creating a dementia-friendly eating environment

Food preparation and eating and where they take place are important in everyday life and often mark special occasions. Residential and respite settings should offer sound nutrition and a home-like social experience. Think about what constitutes your everyday eating experience.

Do you have a separate dining room at home, kept for special occasions? What about your kitchen?

In many homes the kitchen table is not just where people eat but a social hub. Family and friends gather for a chat and important life events are discussed over a cup of tea. The kitchen table is a place of childhood memories. You may have helped your mother peel the vegetables at the table or listened to your parents talking about the day’s events.

People’s histories and cultural backgrounds help shape the whole food and eating experience, from the garden to washing up. Some people may have grown vegetables, kept chickens or shopped at local markets. Food and eating can tap into people’s life experiences, and be meaningful and joyful times.

Nutrition, eating and drinking are important because they involve:

• social contact
• sensory pleasure
• cultural habits
• religious beliefs
• personal food preferences
• personal life stories.

Example - Café-style dining room

The dining room in the photo is in an aged care residential facility, but has been designed to look like a café. Features include a counter where food and drinks can be served, a menu board on the wall, and small tables with seating for four people. This environment promotes social contact and is comfortable for visitors. The contrasting colour scheme helps with mobility and wayfinding. A simpler carpet pattern and reduced table glare would improve useability.

Expanding the eating experience

A meal begins before food on a table. It includes:

• food preparation
• dining room arrangement and atmosphere
• how people are invited or brought to meals
• greetings and conversation
• other social aspects of an occasion
• taste, colour, aroma, feel and presentation of food
• food wholesomeness, digestibility and nutritional value
• help with eating to uphold dignity and independence
• clearing away dishes and washing up.

Add planning a menu, finding recipes and picking vegetables and you can see there are many different ways to make an eating experience more than a meal.

Dining room essentials

Eating difficulties

In residential and respite settings the dining environment can be difficult for people with dementia and staff, leading to poor food intake and even distress. People with dementia may lose weight and food may become uninteresting. Pressures, from poor décor choices to too much noise, can have negative impacts.

While feeding difficulties are personal, thinking about the social setting of eating and drinking when planning mealtimes can have huge benefits. Delicious smells, inviting presentation of food and a chance to socialise can improve food intake.

When working out how to deal with eating difficulties, ask simple questions:

• What is being served?
• What else is going on in the environment?
• Where does the person sit?
• Is this an ongoing issue?
• Are there issues only at certain times?

Dementia can lead to reduced food and fluid intake because of decreased recognition of hunger and thirst, weakening perception of smell and taste, problems swallowing, inability to make out dining utensils, loss of physical control and depression. Ongoing observation of people at mealtimes is needed to pick up warning signs of eating problems.

Warning signs include problems chewing and swallowing, lack of attentiveness, walking away during mealtimes, poor utensil use and leaving more than 25 per cent of a meal uneaten.

Checklist for positive eating experiences

Hydration

Encouraging and assisting eating

Staff play an important role at mealtimes. They assess feeding difficulties, start new mealtime programs and educate families about ways to get the most out of food intake (DiBartolo, 2006).

Prompting and acknowledging appropriate mealtime responses can produce large changes (Altus et al., 2002). On the other hand, institutional practices like putting people in set seating, food brought to people on trays, and other aspects of old-style institutional food service can provoke disruption and agitation in dining rooms (Moore, 2002).

If a person needs help with eating, think about what help is best for improving independence:

• Ask the person what they like to eat.
• Use verbal prompts to encourage eating.
• Serve one course at a time to promote concentration.
• Think about using finger foods.
• Remind people to swallow (Brush et al., 2003).

Defining an eating area can be important for encouraging eating. It can be defined verbally and non-verbally, and by using different items. Staff may find it useful to:

• explain the purpose of the dining room
• explain what mealtime it is
• name the food (Grealy et al., 2004).

The staff member’s sitting position, verbal communication and non-verbal actions should focus on the person. Think about different methods for different people to help with eating.

Do's and don'ts for assisted eating

Finger food

Eating problems in late stage dementia

Eating problems can come with the final stages of dementia. Some people have problems chewing and swallowing, and food can be swallowed the wrong way. Others may no longer understand how to feed themselves or have no interest in food.

Look at problems to see what steps to take. Think about a person’s beliefs and previously stated wishes about end of life care.

In late stage dementia have appropriately prepared food and simplify the setting as much as possible so the person can concentrate on eating. Do not force a person to eat more than they want to.

Advance care planning

Eating in late stage dementia

The physical environment of eating

Changes to the physical environment do not have to involve major building changes. Small, inexpensive changes can have positive results, improving eating, nutritional intake and the social experience of mealtimes.

Simple physical changes in dining areas and kitchens involve:

• choice and arrangement of furniture
• lighting
• signage
• colours and materials
• home-like decoration.

Example - an inviting dining room

The photo is of a dining area that has tables to seat four people. Plenty of space between tables and different coloured tablecloths help with mobility and wayfinding. Small dining tables are home-like and promote social interaction. Drapes can be drawn to reduce glare and distractions. The clock is clearly visible.

Dining room essentials

New residential facilities

Eating, dining areas and kitchens

Kitchens

Many researchers see the kitchen as the central hub of a residential facility. Well-located kitchens can support services and benefits, including supporting the dining area, promoting a home-like feel and being used for staff events.

Some dementia-friendly facility designs place the kitchen centrally, with the dining room an extension of the kitchen and the living room or sitting area nearby. Kitchens that visibly open directly onto dining areas encourage people to join in informal kitchen activities. In cluster designs, people’s rooms are often directly off a central public area, making the kitchen a replacement for old style nursing stations (Calkins, 2005).

Kitchens can have most appliances, cupboards and work surfaces found in home kitchens, giving a sense of familiarity for people with dementia, staff and visitors. One new facility design using the kitchen as a key feature of everyday living is The Green House Project®. Universal staff prepare meals in an open, central kitchen, easily accessible to people with dementia and visitors. People with dementia, family members and friends can join in all activities relating to food preparation and eating. They are thought of as social activities, and this is written into the facility’s policies. Food-related activities take many forms:

• cookbooks based on recipes of people with dementia and their families
• meals planned around local seasonal produce, according to resident preferences
• staff and people with dementia eating together, with family and other visitors invited to join in
• active involvement of people with dementia in physical activity and social contact during mealtimes.

Creative approaches around meals include:

• only partly setting dining tables, leaving the rest of the cutlery at the end of the table for people with dementia to complete the task
• talking about the day’s menu with residents each morning to see what might be cooked using their recipes
• encouraging people to help themselves to snacks from the kitchen counter, such as fruit or biscuits, to share with others (Bartoldus, 2005).

Example - a comfortable and welcoming kitchen

The photo shows an open plan kitchen with benches around the perimeter, including an island bench with chairs outside the kitchen area for people to sit and participate in activities or eat at the bench. There are many features of the kitchen that enable participation by people with dementia:

• ambient and task lighting
• open plan kitchen area to allow food preparation aromas and noises to reach other areas
• under bench seating and wheel chair access for watching and participating in kitchen activities
• colour contrast to highlight features for different functions.
  
  

Safety

Good design and planning can support safety in the kitchen, including in the absence of staff. Store dangerous items in locked cabinets or use hidden switches and control lockouts. Smart stoves are a useful innovation. Smart stoves turn themselves off and cool down instantly.

Assistive technology

Issues to consider

• Not knowing people’s food and eating preferences
• Not understanding eating as a social experience
• Insufficient lighting in kitchen and dining areas
• High noise levels in dining areas
• Unsuitable or inadequate levels of help

Lived experience

How I hate this food!

My name is Angela. I’m 86 and I grew up on the farm. I was called a tomboy, and my jobs included collecting eggs, feeding animals (chooks, pigs and my lamb Anny), and picking ripe fruit and vegetables from the orchard and vegetable garden. When I arrived here, staff filled in a form with my daughter’s help. They have followed it ever since. Meals follow a routine I could set my clock to. No freshly baked bread now, just that thin sliced stuff. I’m sure it’s good for you but it’s just not the same. I will get lukewarm tea in a minute so I can drink it fast and they can get me into bed. My daughter said I liked black tea when they filled in that form, but after two years of drinking it warm from a plastic mug I would love a hot black coffee in a proper cup. I sit here in a track suit, and that box in the corner talks and smiles, but I can’t really hear what they say. It looks like staff are enjoying it as they chat and laugh with each other, but they don’t smile like that at me or see the longing in my eyes. They seem so busy and it must be hard with so many of us to feed.