clinical focus
Food for thought
What do people with dementia
and their family members think
about meals in residential care?
By Rachel Milte
M
alnutrition 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), 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. n
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. Sh