Dining Practices for Residents with Dementia: First Impressions from a European Research Tour
Four European nursing homes are using person-centered dining practices to ensure good nutrition and foster independence among their residents with dementia.
Two LeadingAge researchers examined those dining practices during a recent 8-day tour of communities in Belgium, France and Italy.
Sodexo Institute for Quality of Daily Life, a research partner of the International Association of Homes and Services for the Ageing (IAHSA), is funding the project. IAHSA is collaborating with the LeadingAge Center for Applied Research to conduct the project.
Visiting 4 Nursing Homes in 3 Countries
The research team consisted of Natasha Bryant and Alisha Sanders, senior research associates at the LeadingAge Center for Applied Research. From Nov. 12-20, 2012, the 2 researchers visited 4 nursing homes that are taking steps to improve the dining and nutritional experience of residents with dementia:
- Sint Vincentius, a 96-bed community in Meulebeke, Belgium, which serves approximately 40-50 residents with dementia.
- De Wingerd nursing home in Leuven, Belgium, where 137 residents live in small-scale housing units.
Bryant and Sanders are still sifting through extensive materials and notes they collected during their visits, which included interviews with staff, residents and family members at each community. But they recently shared some preliminary impressions of their trip. The center will release a collection of descriptive papers about the dining programs in early 2013.
All of the nursing homes Bryant and Sanders visited were striving to provide person-centered care in their dining rooms. Nursing home staff members observed closely each resident’s need for assistance.
Then, they provided assistance based on each resident’s specific needs and abilities. The goal of programs was to make sure residents did as much on their own as possible, says Bryant.
This was not always an easy process, observes Sanders.
“These nursing homes are dealing with the same questions as nursing homes in America in terms of trying to do more person-centered care within older, more traditional settings,” she says. “They also talked about staffing challenges and the fact that person-centered models are very time-intensive. Just like providers in America, they were trying to figure out how to provide the most person-centered care possible with the staff that is available.”
The European nursing homes employed a variety of strategies to address these challenges, according to Bryant. These included working hard to engage staff in the dining experience, tapping nontraditional workers to ease staff shortages, and tailoring menus to improve outcomes.
Engaging Staff in the Dining Experience
The full-time medical director at Emile Gerard in France initiated the development of a nutrition program to address malnutrition and advocate for the need for residents to eat better. He has worked hard to help aides understand the important role nutrition plays in a resident’s wellbeing. As a result, these aides better understand that by helping residents improve their eating habits, they are also helping residents improve their health.
Other nursing homes are encouraging aides to develop personal relationships with residents so they can more easily identify when it is necessary to modify the resident’s dining experience. Those modifications might include providing assistive devices like special utensils or dishware, cutting food into bite-sized pieces, offering finger foods or pureeing foods that a resident has trouble swallowing.
“These aides were an integral part of many of the committees that discussed how to change the dining program, identified what foods residents wanted to eat, or devised solutions for individual residents,” says Bryant. “There was also a formal process that aides could use to report when residents had lost weight or if there were other changes in their dining behavior.”
Tapping Nontraditional Workers
Volunteers at De Wingerd in Belgium played a major role in heating and serving meals and assisting residents who could not feed themselves. Two nursing homes enlisted the help of their housekeeping staff to assist during meals. This change occurred at one community after residents complained to the residents’ council about staffing shortages at the lunch mealtime.
Tailoring Menus to Improve Outcomes
Opera Pia AE Cerino Zejna in Italy changed its menu with the goal of helping residents with dementia sleep better with fewer medications and to help with digestion. Prior to the change, residents with dementia ate a combination of carbohydrates and protein at each meal.
The new menu calls for an all-carbohydrate mid-day meal and a mostly-protein dinner. In addition, residents receive an after-dinner snack accompanied by milk.
Sodexo Institute for Quality of Daily Life
"We strongly believe that Improving Quality of Life contributes to the progress of individuals and to the performance of organizations,” said Michel Landel, chief executive officer of Sodexo SA.
The Institute for Quality of Daily Life is dedicated to the capture and exchange of knowledge, and experience, related to the improvement of quality of daily life. The aim of the institute is to qualify, quantify, and measure, wherever possible, how services provided by Sodexo improve quality of daily life and consequently positively impacts the progress of individuals and the performance of organizations.