Question
What are some ways to modify the environment at mealtime to assist a patient with dementia?
Answer
When assisting a person with dementia during mealtime, numerous modifications to the environment can be made. First, consider the lighting in the room. A low-lit environment, such as a candlelight dinner, is not helpful to patients with dementia. If a person has some visual acuity or visual-perceptual deficits, dark items or shadows may appear to be spiders or insects. If you have a fear of spiders or insects and you have ever awakened in the middle of the night and seen a shadow on the wall that scares you, you have just experienced a little of what your patient with dementia may experience if a meal is provided in a low-lit environment for them. Also, environments with too much glare can be very disturbing for patients with dementia.
Next is place settings. Placemats are important. They help delineate the patients’ individual space. Place cards are helpful for patients who have preserved reading ability but have very poor orientation, and tend to ask, "Where am I supposed to be?" If they have a place card with their name on it, then that designates that area as their spot. Keep in mind that if a patient has their own spot, make sure no other patient takes it or that could cause major problems between the two residents.
Contrasting colors between placemats and plates is useful. For example, a brown table, a brightly colored placemat, and a white plate help facilitate visual perception for the patient because they are all contrasting colors. Single-color plates are also important to use for visual-perceptual issues. A pretty plate with a lot of detail around the outer edge may be perceived by the patient as dirty. We don’t want a patient to think a plate is dirty or there are bugs on the plate, or some type of thought process like that.
Square tables are better than round tables. Round tables just keep going like an infinity symbol. Square tables have sides and corners that help to designate personal space for each patient. No one likes to have someone too close to them while eating. Having those corners helps the person to understand, “This is my space.” If it is a round table and people are sitting too close to one another, that may bother them and cause them to withdraw from eating.
Always keep the eating area clutter-free. You do not want tons of distractions. Having something small, like a flower, in the middle of the table is fine. But you do not want all of your papers, binder, pens as well as the placemats, patients’ napkins and cups all sitting on the table. When there is too much in the environment, it can easily become overwhelming.
Some facilities use the “red napkin program.” That alerts staff to patients who are at an increased risk of poor intake or weight loss. If you see a red napkin in a dining room, know that the patient is at risk and needs to be monitored.
Familiar sounds, smells, and sights help create a welcoming environment. Some facilities have used essential oils or have a bread machine, so there is the smell of baking bread. Those familiar smells, sounds and sights may actually help a patient feel less institutionalized and more welcomed into a home-like environment. It may even improve their appetite.
Be sure to not sit residents who have personality conflicts together, just like you would with any other adult. We all know people that we would probably prefer not to go out to dinner with. We are on our own time and on our own accord, so we do not have to go have dinner with those people. But imagine if you were forced to eat dinner with those people every single night. They may choose to just not eat.
Encourage residents who are highly social to sit with others. Eating can be a very social activity for many patients. For some it may not be, and so those patients may want to be away from others, but with other more social patients, it may benefit them.
Finally, many residents say, "I can't go in there; I don't have any money." They are thinking, “This is not home and I am going in this place. But I don't have any money to pay for my dinner, so I cannot eat.” I have seen patients become very anxious about this. And so in the past we have had “payment” where I give patients some fake money to put in their wallets, and they are then able to pay their certified nursing assistant (CNA) for dinner when the CNA delivers it. You can also provide a meal ticket or receipt, so that the patient feels like he is contributing for that meal.
Please refer to the SpeechPathology.com course, Dysphagia in Patients with Dementia: What's the SLP to Do? - Part 2, for more in-depth information on interventions and suggestions for therapists to improve the quality of life for patients with dementia.
