Creating a Good Meal Time for Residents with Dementia- Aged Care Case Study

Background

Unintentional weight loss and malnutrition are common in older adults living in residential aged care facilities (RACFs). Those with dementia are at particular high risk due to a range of behaviours which can impact on optimal oral intake, such as memory, confusion and inappropriate behaviours, including wandering at meal times.

Staff at a home in Sunbury were reporting meal time difficulties for residents with dementia.

Strategy

Issues were identified by staff and were addressed with the site Dietitian during a regular Nutrition and Hydration meeting.

Staggered meal times were introduced in the evenings to allow residents who required additional time for meals (e.g those requiring full staff assistance) and those on smooth pureed meals, to begin their meals half an hour earlier (at 5:00pm).

Lifestyle staff and/or Management were also involved with the serving of meals to allow carers greater time and focus to assist and interact with residents during meal times.

A finger food menu was devised by the Dietitian and trialled for a number of weeks and education was provided to kitchen and care/clinical staff covering texture modified diets, meal time assistance and the use of finger foods.

Outcome

Through a number of simple changes to the meal time, the site was able to create an environment which was conducive to optimising oral intake.

The staggered meal times and assistance from lifestyle and other staff has been a continued success.

While the finger food menu had some success, particularly in the first few weeks, residents were found to fluctuate in their ability to manage this diet and some residents again required full staff assistance with meals. Overall the finger food menu did not appear to reduce the need for staff to assist residents and provide mealtime supervision. A finger food menu therefore may be more successful as a short term adjunct to the regular facility menu for residents whose dexterity and function have deteriorated, butbefore requiring full staff assistance, and for residents who wander at meal times.

The key is to encourage staff to be proactive in identifying issues which may impact upon a resident’s ability to consume adequate amounts of food and fluids, and to regular communicate with the site Dietitian. While not all strategies trialled may succeed, if only one does, it may be enough to make a significant improvement to the resident’s dietary intake, their reliance on oral nutrition support and their quality of life!