Chapter 4 Maintaining Independent Dining Skills

Age-related changes in vision due to cataracts, glau- coma, and changes in the lens of the eye may cause decreased acuity and color discrimination and increased sensitivity to glare (13). These changes can alter the appearance of foods and cause difficulty effectively using utensils. An older adult requires more light than a younger person. Many older adults have difficulty focus- ing between distant and near objects. It may be difficult for them to look at food close up and try to watch the events taking place in the dining room. Adjusting window blinds and overhead lighting can reduce glare. Tablecloths and place mats can also reduce glare and provide increased contrast between the plate and the table. Consistent setup of table setting and presentation of food can help, as persons with low vision often rely on routine and memory to compensate for decreased sensory input.

Rheumatic diseases such as osteoarthritis and rheumatoid arthritis can cause painful joints, weakness, decreased range of motion, and fatigue, all of which can impact independent dining (14).

Movement disorders, including cerebral palsy, multiple sclerosis, Huntington’s chorea, and Parkinson’s disease impact independent dining, as these disorders can include tremor, spasticity, hyperki- nesia and hypokinesia (difficulty with normal speed of movement), and abnormal involuntary movement (15,16). Eating abilities may be affected by these pro- gressive or acute neurological changes. Gross motor and fine motor movements may be impaired, resulting in difficulty bringing food from the plate to the mouth. Grasp strength, proximal and distal control, and regula- tion of speed of movement are required for a smooth movement to occur. Trunk stability is also necessary for effective arm movement.

Adaptive Equipment Often Suggested to Maintain Independence

Adaptive equipment can be very valuable in increasing and maintaining independence with dining; however, some older adults are often provided more adaptive equipment than is necessary, and it is not uncommon for older adults to refuse to use it. Acceptance of adap- tive equipment is influenced by several factors, includ- ing cost, effectiveness, and transparency, as well as the gadget tolerance of the user (17,18). Transparency refers to the degree to which the device calls attention to the person and/or his or her level of disability (17,18). Weighted utensils similar in appearance to standard utensils may be more accept- able to some than large-handle weighted utensils or wrist weights. Inner-lip plates are more transparent than plate guards, scoop bowls, or high-sided plates. Gadget tolerance refers to some people simply not wanting to use special tools to perform activities that

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others do without adaptive equipment (17,18). Gadget tolerance and the perception of transparency are unique to the individual. Proper education on the use of adap- tive equipment and time to practice and increase comfort with the device prior to its use in a public setting such as a dining room can positively influence acceptance. (See Box 4.1.)

Ataxia and tremors can also be addressed by using such items as high-back chairs and footstools to

BOX 4.1 Uses of Adaptive Equipment

Colored plates can provide increased visual contrast between the plate and its contents.

Divided plates and diagramed place mats can assist staff in providing consistent setup.

Built-up handle utensils or cuff utensil holders can accommodate weak or absent grasp.

Swivel spoons can compensate for loss of range of motion.

A high-sided plate, scoop bowl, or inner-lip plate can accommodate for decreased wrist range of motion and decreased coordination by preventing food from slipping off the edge of the plate.

Long- or curved-handle utensils can accommo- date decreased range of motion.

Long straws can eliminate the need to lift heavy cups and can accommodate for decreased coordination.

Two-handle mugs and wide-handle mugs distrib- ute the weight of the mug and/or accommodate for decreased grasp.

Weighted utensils and mugs can dampen tremors.

Nonskid mats under plates or plates with nonskid feet or suction cups can increase independence by increasing stability.

Adjustable-height tables can provide optimal positioning to address decreased range of motion and weakness.

Orthotics such as hand or wrist splints may also be beneficial in supporting weak joints and maximizing available range of motion and strength.

Temperature of the dining room can affect spasticity. Cold can increase tone, resulting in decreased coordination or range of motion.

increase stability. Adaptive techniques such as stabiliz- ing the upper extremities against the body or propping elbows on the table can be utilized. It is also important