Nutrition & Foodservice Edge Magazine - March/April 2022 - 17

common foods like peanut butter sandwiches and milk, cottage
cheese and fruit, or hard-boiled eggs and crackers. "
5. Create an appealing dining experience.
Take a look at your dining area. Is it comfortable? Is there
adequate light for residents to see their food? Is there enough
contrast between the plate and tablecloth to differentiate food?
Does the menu have enough variety in color, flavor, and texture?
All of these may be useful in setting residents up for a positive
eating experience.
You could also consider a more unconventional experience,
setting up the dining area similar to a restaurant where staff
take and serve orders. While budgets may not allow for this at
every meal, it could be done once a week at dinner for a special
experience.
6. Consider feeding assistance.
Feeding assistance may be comprised of several different types of
interventions:
* Provide finger foods. Conditions like Alzheimer's disease
can make it difficult for patients to remember how to use
utensils. Finger foods allow these patients to self-feed while
maintaining dignity.
* Consult with occupational therapy, who may be able to
provide adaptive equipment to help residents maintain their
ability to self-feed.
* Provide verbal cues to residents during mealtimes to remind
and encourage them to eat.
* Have staff trained to provide " handfeeding " techniques for
residents with dementia. This could include " direct hand, "
where the caregiver is feeding them with the utensil and
no involvement of the patient, or " under hand, " where the
caregiver places their hand under the resident's hand to help
guide them. Research suggests both methods increase caloric
intake.
According to Jennifer Makin, RD, LD, feeding assistance
" allows those with advanced dementia to respond with action
to cues such as, " let's use this spoon, " or " doesn't this ice cream
look great? " The subtle assistance provided allows for preserved
dignity. "
7. Ask about liberalized diets when needed.
Some long-term care residents are put on restrictive diets due
to chronic health conditions like hypertension or diabetes.
However, when diets are less restrictive and provide more
food choices, residents may be more likely to maintain
nutritional intake.
Dodd explains: " It's important to liberalize diets of those in
LTC to prevent the occurrence of malnutrition. Many older
adults experience poor appetite, decrease in the ability to
taste, and just don't eat as much as they used to. Providing
therapeutic diets that aren't appealing to an older adult can
lead to decreased intake and unintended weight loss. Taking
an older adult off therapeutic diets can help ensure they get
the nutrition they need to thrive. "
Andrews echoed these sentiments: " Advocate for the patient
and talk to their doctor about a more liberal diet. It doesn't
make sense to restrict someone's diet then have to add an oral
supplement because they're not eating. "
The position paper from the Academy of Nutrition and
Dietetics on Individualized Nutrition Approaches for Older
Adults: Long-Term Care, Post-Acute Care, and Other Settings,
drives home this point in their summary: " Given that many
older individuals are at risk for malnutrition and may have
different therapeutic targets for blood pressure, blood glucose,
and cholesterol than younger adults, a regular or liberalized
diet that allows for resident choice is most often the preferred
initial choice. "
As a CDM, CFPP, you can consult with the doctor or
dietitian to voice any concerns. You are often on the front-line
during mealtime, seeing the resident's true intake and hearing
their feedback about their diet. If you see or hear things that
may put the resident at risk for malnutrition, it's valuable
information to communicate to the patient care team.
8. Try fortifying foods.
In a study of Canadian hospital foodservice directors, only
49 percent noted practices for fortifying foods and beverages.
Yet this can be an impactful way of combatting malnutrition
when planned with the dietitian.
Dodd explains: " When appetite is poor, it is helpful to
maximize the amount of calories in the same volume of food.
Adding high-calorie foods to what they are already eating can
be a beneficial way to combat malnutrition. For example, you
can add butter or olive oil to vegetables or grains, or add dry
milk powder to milk, shakes, and soups. "
Continued on page 18
NUTRITION & FOODSERVICE EDGE | March-April 2022
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Nutrition & Foodservice Edge Magazine - March/April 2022

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