Dining with Dignity: The Caregiver’s Guide

How can you create a mealtime environment to support dining with dignity in dementia care? Choosing words and actions carefully at meals and in all aspects of care preserves the dignity of older adults and those living with dementia.

Whether you are caring for a person with dementia at home or in a care facility, providing care with a focus on respect and courtesy makes a difference in the quality of life for all. 

Dementia-Friendly Dining

Preparing a dementia-friendly meal environment is an essential step to supporting dining with dignity and creating an enjoyable experience for each person.  Be sure to consider the following tips with each eating opportunity!

Grooming and Preparation

Attention to detail in appearance helps a person to look and feel their best, which can also improve intake at meals. When possible and allowed by the person, provide the following care prior to mealtime:

• Appropriate dress and hygiene 
• Grooming of hair and makeup
• Dentures and glasses in place as needed
• Comfort and proper positioning
• Restroom break before the meal

For other ways to promote dignity of loved ones and residents during care, check out this article on Preserving the Dignity of Dementia Patients.

Limit Distractions

• Talking & conversations at the table
• Noise from music or television
• Clutter or distracting decor on the table
• Crowded tables or too many people nearby
• Make Meals Colorful and Appetizing

Meal Presentation

Caregivers and care facilities can promote dining with dignity with meal presentation and a focus on food preferences. Enhance the dining experience with the following tips:

• Serve food that looks and tastes good
• Include color variety on the plate – avoid bland, all white meals
• Offer variety, avoid repeating meals and food items
• Consider a brightly colored plate, such as neon green or red

Dining with Dignity: Independence at Meals

In aging and cognitive decline, individuals can experience a decline in independence with self-feeding tasks. It’s important to consider the unique abilities of each person.

When it comes to eating, the ability level will vary from person to person. Some people will maintain the ability to self-feed for the entire meal, while others will require a higher level of assistance in eating.

For those who require more assistance, look for ways to involve them in the care process at meals. Here are a few ways to allow the person to participate as much as possible at mealtime:

Self-Feeding Assistance

• Allow the person to hold on to the cup while drinking through a straw
• Provide assistance only as needed during the meal
• Hand-over-hand technique to bring food and drink to mouth
• Load the utensil for the person & provide cues as necessary

Serve Finger Foods

• Choose foods easy to pick up and hold with one hand
• Avoid overly messy, crumbly foods
• Offer mini versions of menu items

For more tips on dementia-friendly finger foods, check out the Ultimate Guide to Finger Foods.

Adaptive Equipment

Adaptive equipment is specialized dinnerware and utensils designed to support dining with dignity and independence. A few examples of adaptive devices for meals:

• Divided plates
• Scoop plate
• Built-up utensils
• Cups with lids and handles

An evaluation by an Occupational Therapist can help to personalize interventions and find the best product to make eating easier.

Cues & Prompting

It is essential to encourage independence with self-feeding before jumping in to help. A person living with dementia may be easily distracted in larger dining areas may require increased verbal cues and prompting.

Verbal Cues

• ‘Ready for a drink, Miss Linda’?
• ‘Take a bite, John.’
• “Mrs. Wilson, you still have food in your mouth. Keep chewing!”

Visual Cues

• Eat with the person to demonstrate
• Point to your mouth and make a chewing motion

Tactile Cues

• Tap hand gently + verbal cue
• Rubbing back to get attention and open eyes
• Lightly touch the spoon to the mouth

Dining with Dignity: Courtesy and Respect

It’s essential to consider the background and preferences of each unique individual and honor these as much as possible.  Choosing words carefully and speaking in a respectful tone will go a long way to preserve the dignity of a person living with dementia. 

Consider Cultural, Religious, and Familial Backgrounds

• Food preferences
• Mealtime routines
• Customs and traditions
• Rituals around mealtime, like praying or blessing the food
• Past nutrition and diet history and behavior

Choose Words Carefully

Words and phrases are essential to show respect and dignity in aging and dementia. Avoid using language that may come across as childlike or insensitive.

Clothing protectors– protection of clothing can help to preserve dignity and avoid embarrassment for any spills that may happen in self-feeding. Refer to these items as ‘clothing protectors’ instead of ‘bibs’ to show respect and dignity.

Cup with lid and handles – support dignity in self-feeding by referring to adaptive devices in a dignified way. Use the terms ‘cup with a lid’ or ‘mug with handles’ instead of ‘sippy cup’.

Requires assistance – some level of assistance will likely be required for those living with dementia. Using wording such as ‘requires assistance’ or ‘support in eating’ helps to show respect and dignity.

Nicknames – avoid calling a person ‘honey’, ‘sweetie’, or ‘baby’. Call each person by name when speaking to them.

Tone of Voice

• Use a low tone and avoid speaking in a high-pitched voice
• Avoid using ‘baby talk.’ Speak to everyone like any other adult
• Be sure to wear a smile and make eye contact when speaking

Dining with Dignity: Feeding Assistance

Greeting at Mealtime

• Always approach a person from the front
• Make eye contact with all interactions
• Introduce yourself and let them know you’ll be assisting

Feeding Assistance

When providing assistance at mealtime, always sit next to the person at eye level. Call the person by name and get their attention before giving them a bite of food. Always allow sufficient time to eat the meal – never rush!

Give your full attention and engage with the person you are assisting. A conversation about the meal helps to provide more enjoyment and supports dining with dignity. Here are a few examples:

• Describe what is on the plate
• Be positive and share how good it looks or smells
• If feeding, tell the person what they are eating
• “Here are some green beans, Mrs. Margaret”

Mealtime Conversation

Interact with and include the person you are assisting at mealtime. Include them and avoid talking about them as if they are not present.

As much as possible, avoid separate personal conversations with coworkers. Be present and give your full attention to the person you are assisting. Do not use cell phones or other devices when providing care.

Engage the person you are assisting, even if they are unable to fully participate in the conversation. Offer up conversation or statements about the food, surroundings, or something positive about the day.

• “It sure is a pretty day today, Louise”!
• “You look so good in red, Miss Barb”.
• “I think you will really enjoy these pork chops, Mr. Smith”.
• “Oh, these potatoes smell so good, Miss Helen! How do they taste”?

Anticipate Needs

Anticipate and keep an eye out for any needs the person may not be able to verbalize or express. Observe for signs such as: 

• Facial expressions
• Mood
• Fatigue
• Discomfort
• Preferences
• Difficulty with chewing, swallowing or using utensils

Be sure to communicate any observations to other staff and update the individual plan of care.

Key Takeaways: Dining with Dignity in Dementia

Being intentional with words and actions enhances the quality of life and preserves dignity for those living with dementia. Focusing on these tips to uphold dignity as a caregiver, and encouraging others to do the same, brings the comfort, value, and respect everyone deserves.