Dementia-friendly dining

Senior living dining has been through many design phases lately—including the bistro, the casual café, the fine dining setting and even the wine bar. Now, senior residences are fine-tuning the dining experience of a growing population—those with cognitive decline.

While the latest dining settings have tended to target the appetites of younger and more mobile residents, dining options for those living in memory care settings have not been as robust. Some say it’s because certain food forms are simply easier when serving those with dementia, but others say it’s just because the industry hasn’t thought beyond the status quo.

“Too often, the rest of the senior community gets a traditional, wholesome meal, while the memory care residents get fish sticks,” says Chef Sarah Gorham, co-founder of Atlanta-based Grind Dining. “Why should that be? Just because someone has trouble chewing or using utensils doesn’t mean they don’t deserve a healthy, flavorful meal.”

Traditional spaghetti dinner (left) becomes Grind Dining's hand-held version (right).

Grind Dining’s baliwick is rethinking the shape and presentation of foods to make them easier to hold, bite or chew, while preserving the fresh flavors and textures of the ingredients. Gooey cheeseburgers become stuffed miniburgers on lollipop sticks. Wraps, tarts, crepes and tortillas all become containers for breakfast frittata, pork fried rice or sautéed vegetables. They’ve even figured out how to bake spaghetti in wedges.

“It’s the same food you’re feeding the rest of the community,” adds co-founder Chef Stone Morris. “It’s the same menu, just in a different shape. It retains the textures that are such important memory triggers and creates a sense of inclusion.”

The effects of color

At meal times, different colors of dinnerware can encourage appetite or slow appetite, depending on what each resident needs, says Joshua J. Freitas, M.Ed, CADDCT, CAEd, corporate director of memory care and resident engagement at LCB Senior Living, who presented on the subject at the recent Memory Care Forum in Philadelphia. The maturing eye sees colors differently than in younger years, and when dementia is added to the mix, encouraging a healthy level of eating and hydration can become a big challenge.

LCB Senior Living has done several pilots in dementia-friendly dining and has learned dark blue and bright yellow plates can stimulate appetite, while white plates tend to reduce eating, especially if white foods (like white-bread sandwiches or mashed potatoes) are placed on them.

Other tips:

• Use colored placements to help the eye differentiate between the linen and the plate
• Table decorations can be distracting—keep the focus on the plate
• Serve in courses—too much food presented at once can be overwhelming to someone with dementia
• Prepare as many foods as you can near the dining room so the smells can entice appetite: Coffee, soup, rolls, French toast

In all cases, Freitas suggests, avoid the “all-white nightmare” of light-colored foods on white plates upon a white tablecloth with white or clear utensils.

Operation: flexibility

Dementia-friendly dining also means being willing to accept flexible meal times, says Jenny Overly, director of senior health nutrition and wellness at Boston-based Unidine, which launched a memory care-focused dining program earlier this year. “In the senior living arena, many people design their dining programs around what’s convenient for the staff,” she says. “If you look at it only from an operational standpoint it’s a lot easier to have breakfast only from 8 to 9 a.m. versus having an extended timeframe from 6:30 to 10 a.m. I think that now we’re seeing people taking a very fresh look at it and saying, ‘This isn’t about our staff. It’s really about the resident and how they best interact with food.’”

Unidine's program uses traditional foods in new shapes, like these breakfest nests.

Incorporating family recipes is another way to engage residents with dementia. “It’s not just about knowing that a resident likes a certain food. Let’s try to get their family’s recipe and put it on the menu,” Overly says. “Maybe that food will be a conversation starter, getting residents talking about what’s on the menu today.”

Food format is a tricky subject. It’s key that the food format matches the resident’s dining skills and isn’t based on the employee’s convenience instead, she says. But if a resident is no longer able to use utensils, then it’s far better to serve the food in a form where the resident can still eat it themselves, rather than being fed by a caregiver, Overly says.

Unidine has worked on hand-held models of the most challenging foods, including eggplant parmesan, fruit pie and chocolate mousse. The trick is to develop an easy-to-handle form without losing the texture and individual flavors of the meal’s elements, she says. Thin slices of eggplant can be rolled around ricotta and dipped in marinara sauce. Fruit pie can be baked in tartlets, and mousse can be piped into a cookie cone.

“Plenty has been done in this industry around finger foods, like French toast cut into strips and chicken fingers. But dignity is No. 1, and from a dignity standpoint, they should have the variety of foods that we can serve any other group of people. Why should an individual who needs finger foods never get to eat lasagna again?”

Dignity at the table

Assess the dining skills of each resident individually and frequently, says Juliet Holt Klinger, senior director of dementia care and programs at Brookdale Senior Living. Her goal is to keep capable residents at the dining table as long as possible, including the use of familiar tableware and the social comfort of a group setting. “Keep them using utensils as long as you can,” she says, “and get them out of bed. Keep them in the familiar setting of eating around a table.”

Brookdale uses “dining scarves”—made from attractive fabrics to resemble clothing—to serve as bibs while preserving the resident’s dignity in being “dressed for dinner.” Experiments with flexible meal times, made-to-order models and other pilots have shown a deep need to focus on individual strategies for each resident. “But we’ve learned we need to employ the most flexibility at breakfast,” she says.

Close teamwork among dining services, memory care directors and clinical supervisors all help to create dementia-friendly menus that encourage healthy eating of foods in their traditional form, yet avoids the messy pitfalls of spilled food and food elements that may frustrate residents with eating challenges. It’s not that difficult, Holt Klinger says: Serve the shrimp with the tail shells removed and the cocktail sauce in a container that allows easy dipping. Peel the orange-segment garnishes. Serve grapes off the stem.

Above all, don’t change the format of the food if it isn’t necessary for that resident, Holt Klinger says. “The quality of the food matters, and there’s a lot of value in serving recognizable and familiar foods,” she says. “It’s about choice and voice. It’s not just about what foods they like, but maintaining an understanding of their ongoing relationship with food.”

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.