DMAT stands for the Dementia Mealtime Assessment Tool and has been developed from a paper based audit tool into a software innovation.
The DMAT enables carers to assess people living with dementia at mealtimes, select interventions and generate a person centred care plan to support mealtime eating abilities and meal behaviours.
The DMAT advocates a person centred approach to nutritional care. Assessment of the mealtime is based on retaining the eating and drinking abilities of the persons with dementia.
Implementing evidenced based interventions designed to enhance or support mealtime abilities can help achieve the following health outcomes for people living with dementia:
Increased choices and preferences
Improved support for meal behaviours
Increased nutritional intake
Improved quality of life
Utilising The DMAT to improve the mealtime experience will benefit both the person with dementia and their carer.
Facilitating mealtime care to people with advancing dementia can be stressful for the carer. The DMAT provides access to practical evidenced based assessments and interventions that carers can implement themselves. Therefore helping to empower the carer and reduce the anxiety associated with mealtimes. If you are a carer, or provide nutritional care for someone living with dementia, The DMAT is designed to help you and the person you care for.
Founder of The DMAT
“The mealtime care of people living with later stage dementia is complex”
Lee Martin MSc RD
Lee Martin MSc RD is a Registered Dietitian from the UK. He spent several years working as an NHS (National Health Service) dietitian in community and hospital settings, before moving into a research position at King’s College London. In his NHS role a passion for helping improve the nutritional care for people living with dementia and supporting carers led him to develop The Dementia Mealtime Assessment Tool (The DMAT). Lee’s current dietetic role at University College London Hospital sees him working in Gastroenterology and Neurogastroenterology but he has never lost his passion and interest for dementia care. Over many years Lee has developed The DMAT into an online software innovation and has recently completed his new book entitled ‘Practical Nutrition and Hydration for Dementia Friendly Mealtimes’. The book is available from Jessica Kingsley Publishers and all major book retailers. Read his story below.
My interest in nutrition and dementia started when I was working as a dietitian for the NHS. The hardest part of my job was getting people living with dementia to eat! After trying all the usual approaches I started to observe mealtimes and realised that there were complex interactions with the mealtime environment as well as reductions in many eating abilities and behaviours preventing nutritional intake. Finding simple solutions carers could use to overcome these complex problems lead to the development of The DMAT.
You can read more on my story below including how The DMAT has been researched and developed and the stages it went through over the years.
The DMAT Story
2010: Clinical experience of nutrition care in dementia
When I worked with a 98 bed registered dementia care home I decided to witness a few mealtimes. I observed many mealtime eating difficulties, behavioural and environmental problems associated with the mealtime. I realised that until these practical issues were resolved my dietetic advice may not be as effective as it should be. I needed to find a way to record these mealtime observations!
2011: The DMAT Pilot Project
Audit of Mealtimes in a Dementia Care Home
A quick look at available research showed there was limited information available for recording mealtime eating difficulties. The resources that were available did not cover the sort of observations I had witnessed. I then decided to create my own audit tool to record observations and at the same time suggest interventions to overcome the observed eating difficulties.
This audit tool was originally based on the Caroline Walker Trust practical guidelines ‘Eating Well: Supporting Older People and Older People with Dementia’ (CWT, 2011)
The audit tool also used elements from the Edinburgh Feeding Evaluation in Dementia (Watson, 1996).
I called the audit tool The Dementia Mealtime Assessment Tool (DMAT)
I then completed an audit of mealtime eating difficulties using the DMAT in the 98 bed care home. My colleague and I concluded that the DMAT was very useful in not only identifying common eating difficulties but helping to find interventions to overcome these eating difficulties. Therefore I continued to use the DMAT in dietetic clinical practice mainly in care homes but also in peoples own homes.
You can read the audit report below: ‘A Pilot Project To Assess The Efficacy Of A Dementia Mealtime Assessment Tool (The DMAT) In Identifying Eating Abilities And Behavioural Barriers To Nutritional Intake In A Sample Of Nutritionally At Risk Residents With Dementia At A UK Care Home (July 2011)’
2012: DMAT Research & Development
With my interest in eating difficulties in dementia increasing and most importantly finding practical ways to overcome them I went back to university to complete a Masters in Clinical Research (MRES). Here I researched different ways to measure eating difficulties and what interventions have been shown to improve mealtime eating difficulties in dementia.
2013: DMAT Trial & Project in the Hospital Setting
While completing my MRES I managed to obtain funding to test the DMAT in a hospital setting. The trial concluded that the DMAT took an average 7 minutes to administer, required no training, could be used by volunteers, carers or staff and helped identify the most common mealtime difficulties on the ward setting. Strategically the DMAT also helped to identify organisational changes for the mealtime provision, such as new cutlery, equipment and foods to make mealtimes easier for people living with dementia in hospital.
You can read the audit report below: ‘The Dementia Mealtime Assessment Tool (DMAT) in Acute & Rehab Settings (October 2013)’
2014: DMAT Presentations and feedback
The work in my locality on the DMAT attracted wider attention and I presented the DMAT at Nutrition and Hydration Week (NHW) 2014, the international nutrition campaign organised by NHS England. Unfortunately you can no longer watch a recording of the DMAT webinar on the NHW website. However I have uploaded my presentation from the day which is linked below.
Following the NHW event I was invited to present the DMAT at the Caroline Walker Trusts (CWT) 25th Anniversary lecture. You can obtain a copy of my presentation from the CWT event via the link below. Discussions with the CWT board after the presentation led to me being invited to become a trustee of the CWT, a position I am held until 2016.
2015: DMAT trials continue
I continued to develop the DMAT and collaborated with NHS and private organisations so the DMAT can be tested in real life clinical practice to aid further development. The outcomes of these pilot projects, if available, are linked with the organisations logos below.
Personal feedback from the Catering lead at a Dementia Care Home:
” The DMAT verified that the standard of the assisted feed was very good and the care staff followed good practice i.e. touching the residents lip with the spoon and exaggerating mimicked mouth movements to encourage the resident to open their mouth. The DMAT Observation Form is very user friendly and seems to cover all obstacles or behaviours that may occur over a meal service within the service, it was interesting to see the behaviours in action and the intervention techniques used by the care staff.”
Gathering feedback from all these previous experiences I realised the DMAT needs to become more accessible to everyone and I started to design a software concept so everyone has access to the DMAT. With the help of JB Cole Ltd who built and further designed the DMAT software, towards the beginning of 2016 the DMAT system was created!
2016 – The DMAT System Launches
The DMAT system allowed me to expand the paper version of the DMAT into a complete care package for the mealtime care of people with dementia accessible to everyone.
To find out exactly what the DMAT system is and how it can help improve the nutritional care of people living with dementia you care for create a free account
The DMAT has now completed several pilot projects and undergone years of research and development. The DMAT is aimed at all carers, meaning anyone who cares for people living with dementia. Whether you are a health professional or unpaid carer you can now find evidenced based ways to improve the support you provide to people living with dementia at mealtimes.
2016 to 2018 – Developing The DMAT System
During 2016 to 2018 The DMAT Observation Form and mealtime nutrition interventions found within the DMAT system continued to be updated, based on the available research literature and best practice guidelines. The body of the evidence from this research has also been produced into an essential book for those caring for people with dementia at mealtimes.
2019 – Book Publication
In 2019 I authored a book entitled ‘Practical Nutrition & Hydration for Dementia Friendly Mealtimes’ available from Jessica Kingsley Publishers.
This book offers guidance on ensuring that individuals with dementia can maintain a high standard of nutritional intake alongside increased independence at mealtimes. It explains how dementia impacts on mealtime abilities, with practical guidance on how to enhance these abilities and interventions for overcoming common issues.
Disclaimer The information contained in The DMAT is designed to provide information and ideas for dealing with mealtime eating problems in people living with dementia. The DMAT accepts that not all ideas will be applicable or appropriate to every individual. The information provided is based on research evidence and best practice guidelines which were up-to-date and accurate at the time of publication. The DMAT is not a substitute for good clinical care and does not replace the advice of a healthcare professional. It is important to never delay a referral to a healthcare professional if you have concerns about an individual. We suggest The DMAT is used in conjunction with screening tools for malnutrition and swallowing difficulties as these medical conditions are common in elderly dementia and form part of good clinical practice. The DMAT accepts no responsibility for any loss, damage or negative consequence that may result from using the information supplied throughout The DMAT.