For many people with dementia and the caregivers who help them stay at home, mealtime is no picnic.

The home environment can pose challenges for both patients and caregivers — the confusion and functional problems associated with dementia and the lack of caregiver support for friends and family members involved in the role. A few names.

A new study led by Ohio State University researchers lays the groundwork for a future intervention to help caregivers establish a safe and workable mealtime routine for people with dementia living at home. is designed to provide

In addition to describing various barriers to patients’ participation at mealtimes, interviews with a range of health professionals for the study identified strategies to make meals go more smoothly. Among them: reducing distractions and eliminating clutter, using written prompts, and taking advantage of the support that can come from community-based nutrition programs such as Meals-on-Wheels.

“It comes down to keeping things simple. How do we keep that environment as simple as possible so that people’s eyes and ears don’t wander and they don’t get distracted from their food?” said Lisa Juckett, assistant professor of occupational therapy at The Ohio State University School of Health and Rehabilitation Sciences.

“For people with dementia, it’s just ‘I forget to eat and that’s why I’m at risk of malnutrition’, which some people might think. It’s a combination of all these other factors that really come into play. Come on, here’s why. Food is complicated — it’s more than just putting a fork in your mouth.”

The study was recently published in the journal Gerontologist.

According to the Centers for Disease Control and Prevention, more than 80 percent of people with dementia in the United States live at home. An estimated 60% of homebound patients are unable to eat normally or prepare their own meals.

“We know that the older adult population is growing and that older adults are living longer, but that doesn’t mean they’re living healthier and disease-free lives,” Jackett said. “Alzheimer’s and related dementias are expected to increase over the next several decades, and it is estimated that the health care system will no longer be able to meet the needs of people with dementia. It places a greater burden on those who are not paid to do so but want their loved ones to stay at home, because that’s where most people want to age — at home and of their own choosing. in the communities of.”

While organizations hold training sessions or support groups and offer educational resources about caring for dementia patients at home, a stressed and overwhelmed caregiver may not be able to take this route or Don’t want to, Jackett said.

“We wanted to give caregivers actionable steps and strategies to try with their loved ones at home because they already have so much going on,” she said.

Jackett interviewed 20 professionals whose work involves providing community-based care to people with dementia, including registered nurses, speech-language pathologists, social workers, occupational therapists, counselors and registered dietitians. Plus the staff at the largest Meals on Wheels provider. In Ohio, Life Care Alliance.

The sessions identified key challenges to mealtime participation at home. For people with dementia, cognitive impairment can mean they forget to eat, don’t recognize unsafe food, and become distracted during preparation and eating. Some also lack the functional ability to open packages and operate the microwave. A cluttered home threatens to collapse, radio and TV noises can be distracting, and even a patterned tablecloth can cause visual confusion. On top of these factors, caregiver training typically does not cover the complexities surrounding mealtime at home.

The strategy proposed in the study takes these constraints into account. Professionals are recommended to:

  • Minimizing auditory and visual distractions.
  • Eliminating household clutter, clearing pathways and improving lighting.
  • Providing written instructions to guide patients’ mealtime activities.

Establishing a connection between the table and food can improve routine, but for people with dementia who prefer to eat on the couch, making sure they are sitting up straight can help keep them safe when they swallow. can be found

Caregivers are also advised to sign up for a clinical assessment of the home environment to receive individualized guidance. If that’s not possible, Jackett said, that’s where the Meals on Wheels program can help — staff and volunteers who monitor food recipients daily or weekly for behavioral or household cues. See which referral or coordination services are in order.

“Meals on wheels can be powerful for meeting the needs of people living with dementia, but it can also provide some relief and ease the burden for the caregiver,” Jackett said. Is.”

Jackett has begun conducting interviews with caregivers and people with dementia to gain insight into their caregiving and how their experiences match those of health professionals. From there, the work will proceed to develop core components of an intervention focused on mealtimes at home and to test its effectiveness.

“We don’t want to make recommendations that add to the burden on caregivers,” he said. “It’s often unrecognized how much work goes into maintenance.”

This work was supported by the National Institute on Aging IMbedded Pragmatic Alzheimer’s disease and Related Dementias Clinical Trials (IMPACT) Collaborative.

Co-authors included Michael Howard, Shannon Jarrett and Lorraine Mayon of Ohio State, Beth Fields of the University of Wisconsin-Madison and Callie Thomas of Brown University.