Observing people with dementia at mealtimes

When I was working as a dietitian in the NHS one of my roles was visiting people living with dementia in care homes. The hardest part of my job was getting them to eat! I tried many interventions over several months, talking to the staff and relatives as well as the dementia residents in the care homes. Despite putting dietetic care plans in place many of them continued to lose weight.

I therefore decided to try a new approach and over a few days I simply sat in the dining room and observed some mealtimes. I learnt more in these few hours than I had the last few months working in the care homes. I observed many reductions in eating abilities and meal behaviours as well as environmental problems that were contributing to the person finding it hard to feed themselves and prevent adequate nutritional intake. Since I did these observations I cannot recommend enough the benefits of taking a step back from your normal way of working to simply observe not only the person but the environment the person with dementia finds themselves in. It is a skill rarely used in very busy caring settings nowadays but it is a vital skill in dementia care. I think the article by Beth Britton called Harnessing the power of observation describes the importance of this skill brilliantly and is really worth a read.    

I realised that until these unsupportive environmental influences were resolved then the persons with dementia would continue to present with meal behaviours. Additional it seemed there could be simple modification to the meal setting and tableware that would support the person with dementia to remain more independent at the mealtime. Most importantly until all these factors were considered I knew my dietetic advice would not be effective. This became my motivation for creating the first version of the DMAT in 2011.

Using The DMAT at Mealtimes

The DMAT works in 3 stages with the first stage being the observational stage. A carer would use the DMAT ‘Observation Form’ (see below) to observe a mealtime and record the current level of mealtime abilities an individual has. It is a strength focused observational assessment helping the carer identify what elements of the mealtime the individual has no issues with and what support is required to help them.

The DMAT Observation Form is free to download. Please take a look and share with those involved in the nutritional care of people living with dementia

The DMAT Observation Form helps carers to identify which mealtime abilities are reduced and therefore are preventing the individual from consuming their food. The DMAT has not undergone psychometric evaluation for validity or reliability but provides a much needed resource to quickly and easily capture the most common mealtime abilities an individual with dementia may present with. Feedback from pilot projects of the DMAT suggest it takes 7 minutes to observe someone at a mealtime and record all the mealtime abilities.

Once the carer has gathered this initial observational information they enter the results into the online DMAT system which will automatically provide a range of interventions to choose from.  The carer can simply tick the box of the interventions they wish to implement and the DMAT system will generate a care plan based on this. The care plan will show which mealtime abilities have been identified and what interventions are to be implemented to support these abilities. Everyone caring for the individual will then have a care plan sheet explaining how to help make that persons mealtime more dementia friendly.

The aim of the DMAT is to enhance mealtime abilities and improve the independence of the person at mealtimes. This can help the person feed themselves for longer and maintain their nutritional status therefore improving their quality of life.

*The DMAT is not a substitute for good clinical care*

The DMAT does not try to replace the advice from a healthcare professional. Nothing can better the personal advice from an expert tailored to the individual. Instead the DMAT provides carers with a simple platform to access practical evidenced based assessment and interventions for improving the mealtime experience and health related outcomes.