People with a diagnosis of dementia can struggle to distinguish items due to the lack of colour contrast – think the white diet on a white plate. It’s everywhere in aged care, and with diminished vision and decreasing cognitive ability, it makes it hard to see what’s what.
Depression, restlessness and responses to people with dementia’s living environment can also result in decreased appetite and a reduction in the consumption of both food and drink, which can lead to significant weight loss, dehydration, constipation, acute delirium and worst of all – death.
Studies in clinical nutrition have shown a significant increase in both food and liquid intake when using tableware that offers a high colour contrast (when compared to the table or the food).
Multiple peer-reviewed studies have now shown that the colour red and blue can increase eating by 25 percent and drinking by 84 percent (Dune et al, 2004, Brighter colours, 2004, NHS, 2018).
Those are some impressive numbers! But there’s a bit more to it of course!
But what else can we do to increase our resident’s intake?
- The use of coloured crockery or place mats for visual contrast.
- Use larger dinnerware to serve meals. Larger plates make it seem like there is less food on the plate and encourages people to finish.
- Adaptive table wear – such as cups with internals cones or cutlery, assess what each individual needs to empower their eating experience.
- Offering once course at a time – too many dishes at once leads to overwhelm and disinterest. Think 1960’s Sunday lunch – entrée, main and then dessert.
- Set the table properly – this is such an important part. Take the time to train your staff, people eat differently in different cultures so this is not a given.
- High nutrient foods including fresh veggies and protein.
- Add fats to food, stir double cream into potatoes, add custard to ice cream.
- Check the resident is on the right diet – I can’t stress this enough. Read your care plans and notes frequently, identify any gaps or lags in the documentation and correct with the kitchen asap.
- Smaller dining areas – break you areas down into more intimate areas – no one wants to eat in a school hall.
- High calories snack and finger food in places people can access– so residents can snack 24/7. Did you know its a human rights violation to not have access to food?
- Consider a clear fridge in your common areas – with food and snacks added daily.
- Essential oils like peppermint, ginger, citrus in the air using a diffuser half an hour before meals can help stimulate appetite
- Bake a loaf of fresh bread half an hour before a meal and let the aroma infuse into the dining area.
- Extended and flexible meal times -people should be able to eat when THEY want.
- Shared plates of food on the table, make the process enjoyable
- Offer staff free meals and encourage to sit, talk and eat at the tables with the people that live there.
- Regular dental checks – every 6 months or at any sign of discomfort, including loose or broken dentures. Brush teeth dentures twice a day!
- Regular diet reviews with speech pathologist or dietician, especially after someone returns from hospital and changes may have been made.
Get people engaged meaningfully – with growing food, preparing food, setting tables, picking flowers for the table, serving or clearing away.
- Throw a random milkshake party or high tea as often as possible – load it with all the good stuff.
- Ambience – keep dining room excess noise-free while eating, no kitchen staff dropping cutlery into buckets and clearing noisily as it will make some residents lose interest in the meal or become agitated. More lost calories.
- Frequent care plan reviews – no less than every 2 months and each time a person comes back from the hospital. A lot can happen in that short amount of time.
- Weigh your residents – as per policy if weight is at a healthy range, but more if required. Talk to your care manager or refer to a dietitian (or speech path too) if concerned about the numbers.
- Person-focused care – hire and train staff who are emotionally intelligent and can identify when people are losing interest in meals, or the environment around them needs correcting – engaging with people meaningfully at mealtimes is the KEY to enjoyable eating experiences and stable weights.
References
Air impressions. How scents can help memory care patients regain appetite (2017) https://aromaimpressions.com/scent-can-help-memory-care-patients-regain-appetite/
Brighter colours help dementia (2004). Toronto Star, F03. ISSN 03190781.
Dunne, Neargarder, Cipolloni, & Cronin-Golomb. (2004). Visual contrast enhances food and liquid intake in advanced Alzheimer’s disease. Clinical Nutrition, 23(4), 533-538.
NHS (2018). Blue plates to be trialled for dementia. Retrieved https://www.westlondon.nhs.uk/news-events/blue-plates-trialled-dementia-patients/
Creating caring communities for people with dementia and their loved ones! Raising the standards of agency nursing, trying to make aged care better!
If you have dementia or are caring for someone please drop me a line anytime if you would like any information.
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