Chapter 4 Maintaining Independent Dining Skills POSITIONING

Positioning provides the key for maximizing eating independence and is the framework on which other interventions may be added to promote independence in eating and to make the client more comfortable during mealtimes.

The ideal eating position begins with the use of a standard dining room chair with armrests for support. While in the chair, the older adult can get close to the table by sliding the chair arms under the table. Being close to the table is a key element in eating inde- pendently. The ideal position places the person’s mouth approximately 12 inches from the plate. Body alignment should be maintained so that weight is evenly distrib- uted. Pillows, trunk supports, lap boards, or chair arms may be useful to assist in maintaining posture so the person can concentrate on chewing and swallowing. (See Figure 4.1 for correct positioning.)

Figure 4.1 Correct Position

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maintaining this position require careful analysis to determine appropriate interventions (12). Occupational or physical therapy intervention to address seating and positioning is advised. Persons who have had a hip replacement may have restrictions against hip flexion greater than 90 degrees (27). Although proper positioning of a hemiplegic arm forward on the table can assist in maintaining symmet- rical upright posture and increase awareness of the affected arm (24), improper table height or improper relation of the height of the seating surface to the height of the table can compromise alignment of the shoulder joint and cause pain.

Older adults are often brought to the table in wheelchairs, presenting several obstacles to proper positioning. As the body ages, tightening of tendons and muscles can occur. As frequency of walking decreases, older adults can develop tightness in their hamstrings. When feet are placed on wheelchair foot- rests, tight hamstring muscles will pull the pelvis into a posterior tilt, which results in a slumped posture and sliding forward on the seat. This slouched posture may cause abdominal compression, which affects digestion and respiration. Placing the feet on a footstool posi- tioned under the wheelchair can accommodate short hamstrings. Additional posterior pelvic support can assist with sacral sitting. The appropriate wheelchair cushion can increase comfort and postural stability. Proper positioning in the wheelchair is very important and should comply with the following:

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The table may need to be elevated, to allow the wheelchair to roll under the edge.

● The client must be within 12 inches of the plate. ●

The wheelchair must be locked into position, with the resident’s abdomen close to the table and the hips at a 90-degree angle.

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Solid support for the seat and back of the wheel- chair should be provided.

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Many older adults have difficulty achieving and maintaining an ideal posture when seated for meals. An ideal position for optimal performance with indepen- dent dining includes a symmetrical posture with normal alignment of the head, neck, trunk, and pelvis with equal weight bearing on both ischial tuberosities. The older adult should be seated on a firm surface with feet flat on the floor, knees bent to approximately 90 degrees, trunk flexed slightly forward with approxi- mately 90 to 100 degrees of hip flexion (if not contra- indicated), back straight, both arms forward on the table, and with the head erect in midline with a slight chin tuck. Older adults with difficulty achieving or

The resident should be positioned to promote normal dining room conversation.

Older adults able to transfer, who do not require addi- tional postural support, may benefit from being seated in a dining room chair. Not only does this address posi- tion change and pressure management, but the dining room chair can also serve as an external cue for meal- time. Older adults with shorter stature may require a footrest for greater stability and comfort, and those with postural changes such as thoracic kyphosis or sco- liosis may require a lower table to achieve optimal positioning.