CHAPTER 8 | Maintaining Independent Dining Skills 125
Proper education on the use of adaptive equipment and time to practice and increase comfort with the device before use in a public setting, such as a dining room, can positively influence acceptance. See Box 8.1 for a list of adaptive equipment and its uses.20 Ataxia and tremors can also be addressed by using items such as high-back chairs and footstools to increase stability. Adaptive techniques, such as stabilizing the upper extremities against the body or propping elbows on the table, can be used. It is also important to promote a calm and focused emotional state to maximize independence.4
Cognitive Deficits
Cognitive deficits, such as those resulting from dementia and CVA, can be very challenging and
Box 8.1 Uses of Adaptive Dining Equipment20
Colored plates can provide increased visual contrast between the plate and its contents for individuals with low or limited vision.
Colored cups can provide increased visual contrast between the cup and liquids.
The “clock method” can be used to describe the location of foods on the plate.
Placement of items should be consistent to help those with visual deficits; for example, place the main plate with side dishes, seasonings, and condiments in a semicircle or straight line at the top of the placemat in the same order at each meal.
Divided plates and diagramed placemats can assist staff in providing a consistent setup.
Built-up handled utensils or cuff utensil holders can accommodate weak or absent grasp.
Swivel spoons can compensate for loss of range of motion.
A spork (combines spoon and fork into one) eliminates the need to change from one utensil to another.
A high-sided plate, scoop bowl, or inner-lip plate can accommodate decreased wrist range of motion and decreased coordination by preventing food from slipping off the edge of the plate.
A rocker knife can help cut foods with rocking motion for those with upper extremity weakness.
Long- or curved-handle utensils can accommodate decreased range of motion.
Long straws can eliminate the need to liſt heavy cups and can accommodate decreased coordination.
Two-handle mugs and wide-handle mugs distribute the weight of the mug or accommodate decreased grasp.
Lidded cups and glasses help prevent spills.
Drink mounting devices provide assistance when the resident tires easily or is too weak to independently hold onto a cup.
Nosey cups help with drinking when neck range of motion is limited.
Weighted utensils and mugs may decrease tremors in some cases.
Nonskid mats, damp dish towels placed 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 weakness and decreased range of motion.
Orthotics, such as hand or wrist splints, may also be beneficial in supporting weak joints and maximizing available range of motion and strength.
Feeding robots or electric feeding devices for those with low endurance and fatigue or paralysis have had some success in China.20
Comfortable temperature in the dining room can reduce the effect on spasticity. Cold can increase tone, resulting in decreased coordination or range of motion.
can substantially affect eating abilities. Frequently observed problematic mealtime behaviors associated with cognitive deficits include a slow pace of eating, distractibility, and ineffective use of utensils.6
Individ-
uals with dementia have impaired depth perception (eg, placing a cup on the plate instead of next to it) and spatial orientation. Other problems associated with dementia include ideational apraxia (the inability to use an object properly because the person has lost the ability to discern the object’s purpose) and delayed response to cues and sensory input. Persons with end-stage dementia may have as much as a 90-second response delay.7
Allowing adequate response time and
following a prompt hierarchy (discussed later in this section) can be effective interventions. Older adults with dementia may not recall that they have just eaten a meal. Offering second servings
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