Mindi Manuel​With approximately 60 percent of assisted living residents experiencing some form of cognitive impairment or dementia, mealtimes can be challenging for both residents and staff alike. Proper nutrition is essential for older adults—especially those with cognitive impairment—to help them stay strong and healthy, while poor nutrition may lead to undesirable weight loss.

Having a holistic culinary and therapeutic hospitality program that addresses difficulties with coordination, restlessness, and problems with remembering the process of eating altogether can make a big difference.

Creating a Supportive Dining Environment
Therapeutic hospitality focuses on providing a calm, supportive dining environment that meets the individual needs of every resident. Through evidence-based design that incorporates the science of aging and dementia, the dining experience becomes an easy to navigate social experience. Focus is placed on simple and efficient layouts, appealing colors, lighting, aromas, safe furniture and flooring, and soft sounds to accommodates changes in the five senses and motor and cognitive skills that residents with dementia may experience. This helps reduce agitation and other behaviors among residents and reduces the potential for slips and falls and other risks. Bright shiny floors, for example, are replaced with darker, more muted colors and surfaces that help with visual perception and promote calmness.  

Tableside choice provides a dignified approach to dining for residents who are no longer able to use a printed menu. This not only empowers residents by allowing them to continue to participate in meal selection, but it also stimulates the senses to signal hunger and increases social engagement. Many residents with dementia have a loss of depth perception which can impact the amount of food consumed.  Use of contrasting plates and tablescapes can provide these residents visual cues that it is a space for dining. Using plate colors that contrast the food items served can increase consumption, with darker foods served on lighter plates and lighter foods served on darker plates. Solid plate colors are preferable to avoid confusion and distraction.

When possible, having an open kitchen environment and providing exhibition cooking are ideal. Open kitchens help stimulate the appetite as appealing aromas spread throughout the dining room. This also helps stimulate the appetite by reminding residents of the joy of cooking while also providing an opportunity for cognitively stimulating social engagement.

Providing Nutritious, Appetizing, and Adaptable Meals
Adaptive wellness culinary focuses on providing healthy meal options that target overall health and wellness. Meals incorporate foods rich in antioxidants, omega-3s, and vitamins and minerals that provide anti-inflammatory and vascular benefits and support cognitive health. Recipes focus on flavors and textures that will appeal to residents and that celebrate the simple pleasures of eating. Choice is essential. These menu items can be plated and served with utensils for those who are able, and prefer, to be seated. But portable, hand-held options are also available for residents who tend to wander during mealtimes. Menu items can also be portioned into bite-sized pieces, for example, for residents who have difficulty using utensils. Healthy, portable snacks are also available for residents who wander at night or may want a snack between meals. Nearly all menu items can be adapted to meet the varying functional abilities of residents.

Educating Staff on Holistic Approaches and Care for Individuals with Dementia
Onsite training helps educate staff on how to enhance the dining experience for persons with dementia. This training recognizes dining staff as an important part of the care team; dining staff are often the first to recognize changes in residents' behaviors and appetites. The training helps dining staff connect the science behind the disease with the “why" of this approach, which allows them to recognize the signs of dementia and how to apply that knowledge to care, emotional support, engagement, and the comforting strategies offered at the end of life. It emphasizes the importance of a calm, therapeutic dining environment, maintaining quality of life for residents, as well as the importance of nutrition and its link to clinical outcomes. Annual training sessions keep staff up to date on best practices in dementia care to support continuous quality improvement. 

​With the aging U.S. population, dementia will become a critical health issue within the next 20 years, emphasizing the need for better prevention and care strategies. By implementing a holistic approach to dementia care, we can deliver more effective, compassionate types of care that meets the needs of the individual. This person-centered approach helps residents age with dignity and maintain their independents as long as possible.

Applying a holistic dementia approach to mealtimes within skilled nursing and assisted living facilities helps shift dining from being a time for feeding to a therapeutic and social activity. It equips staff to nurture residents experiencing sensory changes associated with dementia by using smells, colors, textures, and visual cues. Serving residents at their highest level of function, empowers them to become active participants in their dining experience, prolonging quality of life, and ensuring they will be healthier and better nourished.

During a time of acute staffing challenges, dining and therapeutic hospitality can also ease stress among staff and build job satisfaction and engagement. Staff become equipped to identify and address the changing nutritional and behavioral needs of residents, and the therapeutic setting eases agitation and disruptive behaviors often associated with cognitive decline, making the dining experience better for staff and residents. More importantly, it achieves a higher level of care that residents and deserve.

Mindi Manuel, MS, RD, CSG, LDN, CDP, is the senior manager of clinical support for Sodexo Seniors covering the Pennsylvania market. She is a registered dietitian and a Certified Specialist in Gerontological Nutrition (CSG) and a Certified Dementia Practitioner (CDP).​