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Older adults may have difficulty maintaining indepen- dent dining skills because of a variety of conditions. For example, a person with a tremor due to Parkinson’s disease may struggle to manage utensils while trying to avoid spilling food. Weakness from Parkinson’s disease, stroke, or another chronic disease can result in inability to sit upright in a dining room chair. Dementia can lead to cognitive changes such as decreased attention to task or decreased ability to recognize and use once-familiar objects. For older adults living independently, psycho- social factors can impact independence with self-feed- ing. Limited mobility for those living in the community may also create difficulty in shopping for groceries. Difficulty with independent dining is a major concern for older adults in nursing homes and within the community (1,2). One study indicated that nearly 80% of older adults in nursing facilities had deficits in one or more activities of daily living (3). Loss of inde- pendence in self-care skills, including dining, can result in low self-esteem, depression, feelings of hopelessness, helplessness, and infantilism (4,5). Feeding difficulty, often recognized as a common problem for older adults, is associated with weight loss and poor nutrition. The cognitive impairment found in persons with dementia makes it difficult for these individuals to complete the motor and perceptual tasks required for eating and often prevents them from even accepting assistance from caregivers (6). There is often a delicate balance between maintaining independence and meeting nutritional needs. Providing unnecessary assistance can result in increased dependence in as little as two days (7), which increases staff workload. Maintaining independence with dining can “significantly affect both older adult well-being and the financial health of the facility” (5). This chapter will provide an overview of physical and cognitive deficits resultant in decreased indepen- dence with dining for the older adult and interventions to address these deficits.

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Maintaining Independent Dining Skills

DINING EXPERIENCE

One of the first steps in promoting eating independence and maximizing intake for older adults is to evaluate the eating environment. Lifestyle and family changes may affect the client living at home. If eating alone, there is less incentive and greater difficulty in prepar- ing foods for one person. For older adults who have become residents in a nursing facility or assisted-living facility, the dining experience may be very different from what they were accustomed to at home. This rep- resents another major lifestyle change to which the client must become accustomed.

Atmosphere and Environment The food and atmosphere in which it is served impact quality of life (8,9). Dining atmosphere is one of the most crucial aspects of creating a pleasurable dining experience. A pleasant atmosphere consists of attractive physical surroundings and, more importantly, a climate of friendship and respect. Because of the social signifi- cance of mealtime, every effort should be made to ensure each meal is a positive experience. Evaluation of the dining atmosphere includes the following considerations:

● ● comfortable sound levels

atmosphere free from distractions (ie, loud conver- sations, television, and radio)

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attractive setting adequate lighting

comfortable temperature with adequate ventilation ● absence of odors