Creating the best dementia dining experience

Richard Woodward, General Manager for apetito Care Homes, takes a look at the future of dementia dining to help care homes create the very best dining experience for their residents who may be living with dementia.

Dementia is an umbrella term that covers a range of different progressive neurological disorders, all triggering a loss of brain function. There are many different types of dementia, although the most common types are Alzheimer’s disease, dementia with Lewy bodies, vascular dementia, frontotemporal dementia, and mixed dementia. Alzheimer’s disease affects around 50-75% of those diagnosed with the condition (1). 

One of the population groups where dementia is the most common is among residents living in a care home. It’s estimated that up to 70 per cent of people living in care homes have dementia or severe memory problems (2), and across the whole UK population, estimations suggest that 850,000 people are living with the condition (3). Being that age is the biggest risk factor for developing dementia, it is little surprise that the condition is so common among those living in a care home, as it is mainly older adults who are residing in residential and nursing care. 

For those living with dementia and their care providers, there are many challenges around food and drink that come with the various types of dementia, particularly as the disease progresses. For example, communication difficulties can lead to someone not being able to express their preferences or needs around food and drink. 

They may also find it difficult to determine or communicate their own levels of hunger, thirst, or satiety. The clear link between dementia and low mood and depression can lead to a lack of interest in food. For those with dementia, depression is common, and can affect 30% of those with Alzheimer’s disease, and 40% of those with dementia related to Parkinson’s or Huntington’s disease (4).  Further challenges with eating and drinking can arise due to agitation, difficulties concentrating on eating and drinking, food refusal, or spitting out food, often without clear cause.   

Furthermore, according to the National Institutes of Health, swallowing problems (otherwise known as dysphagia) occur in about 45% of those who have been diagnosed with Alzheimer’s and other dementias.  The number increases as the disease progresses with some degree of dysphagia found in close to 80% of residents in care that are diagnosed with dementia (5).

There are a number of factors which are important when considering the dining experience and how this can be potentially improved for residents.

Firstly, the environment and by this, we mean the dining room itself.  It’s very important that a care home looks through the eyes of a resident that has dementia.   Many aspects of a dining room that often go unnoticed can have a huge impact on the mealtime experience for residents living with dementia.  No two people will have the same experience, people have different needs – each resident needs ‘person-centred’ care.

Whether a refit, a new build, or simply making some simple changes to an existing dining room, there are some good rules of thumb to bear in mind that can have a positive impact and make a real difference to the dining experience.  

Too many stimulations and distractions can be overwhelming, which prevents an enjoyable dining experience, in turn reducing the opportunity for good nutritional intake.  Minimising noise can be helpful in ensuring it is a calm, relaxing, and non-distracting environment.

Having neutral painted walls with maybe one single ‘feature’ wall is a great way to incorporate colour without being over-stimulating and will also help residents to determine the space of a room because of its obvious contrast compared to the other walls in the room.  

The careful use of artwork and pictures on the wall is another way to gentle add colour and using images of delicious food can also be a stimulation to appetite.

We would recommend that tables are ‘decluttered’, which prevents confusion with how a resident navigates around the table.  Elements such as contrasting plates and tables mats help an individual make a clear distinction between how a table is laid and their food, and seating residents before food service is also helpful with the smell of tempting food helping to stimulate appetite.

Dementia may affect a person’s co-ordination or swallowing and, as a result, their ability to eat and drink. There are a number of practical aids that can help those with dementia to eat independently, such as: cutlery with cushioned handles that are easier to grip, non-spill cups with large handles, one-way straws which do not let liquid travel back down.   There have also been some significant advances in specialist nutrition over the past decade, which can support a resident to dine independently.

A promising and useful nutritional strategy for people living with dementia can be the use of finger foods.  

Eating by hand and using finger foods has been shown to lead to an increased sense of independent as the person living with dementia can freely pick up the food without having to be fed (6).  For those who tend to be quite active and can’t sit down with the other residents at mealtimes, finger food can also be useful as it can be eaten ‘on the go’.

Here at apetito, we have just launched a pioneering range of Finger Food Bites which are entire meals encapsulated in small finger food bites, enabling those living with dementia to pick up and put down their food whilst leaving minimum mess and residue on their fingers.  

Every care home will be familiar with the IDDSI framework of soft and pureed meals.  The IDDSI framework consists of a continuum of 8 levels (0 – 7) where drinks are measured from levels 0 – 4 and foods from levels 3 – 7.  The IDDSI Framework provides a common terminology to describe food textures and drink thickness.

Foods and beverages are defined for individual residents based on their comprehensive clinical assessment.  IDDSI – IDDSI Framework

apetito is a pioneer of texture modified foods which sits within the IDDS Framework.  We help make mealtimes more manageable for those with swallowing difficulties without compromising flavour and appearance enabling them to eat safely and dine with dignity.  Explore Our Range of Care Home Meals | apetito | apetito

As person-centred care plans increase in prominence across many care homes, the quality of dining and nutritional intake is forefront of mind for all carers.  And by taking a few simple steps, there is no doubt that an excellent dining experience can be created that meets the nutritional and needs of residents and aids their enjoyment of mealtimes.

1. Alzheimer’s Society (2021). https://www.alzheimers.org.uk/about-us/news-and-media/facts-media  
2. Alzheimer’s Society (2021). https://www.alzheimers.org.uk/about-us/news-and-media/facts-media
3. Alzheimer’s Research UK, Dementia Statistics Hub. https://www.dementiastatistics.org/statistics/numbers-of-people-in-the-uk/  
4. Depression in dementia – Australian Prescriber (nps.org.au)
5. Caregiver’s Guide to Dysphagia in Dementia | National Foundation of Swallowing Disorders (swallowingdisorderfoundation.com)
6. Using finger foods to promote independence, well-being and good nutrition in people with dementia | Personal website of Christian Ryan (drchristianryan.com).