Smell and Taste and
the Art of Fine Dining
The literature on dementia’s effect on taste and smell is minimal. We do know that taste is diminished when there is an inability to smell, and appetite for food can be affected. There are safety risks to anyone that has diminished smell or taste. One may not be able to tell if food is rancid or spoiled, and telltale odors of a gas leak or fire may not be interpreted. Odors may be strongly linked to memories and emotions, as the olfactory lobe is the first sense to develop. Indirectly, smells can affect consumption either positively or negatively. In any case, a diminished capacity in taste or smell warrants a complete check of medications. Many drugs can cause dry mouth and some medications change the taste of food itself. Metallic taste can be counteracted with beans or dairy (protein), and water can be adapted with lemon, mint, cucumber, or fruit. There are many flavored water choices available, too.
One of the most often overlooked adaptations that can be utilized in dementia is sensory input. Although there is little evidence to confirm, it appears that some senses are diminished by dementia while others appear to be enhanced. Taste changes in dementia patients typically involve a strong inclination toward sweets and diminished desire for protein, which is often bland. This makes sense from a scientific viewpoint as carbohydrates fuel sensory input (glucose) which in turn provides a ‘boost’ of endorphins in the brain. Protein is needed and desired less by a body physically limited in activity. Textures might be an additional factor in protein distaste. Chewing protein can be assisted by providing bites smaller than half the width of a fork.
Presentation of new flavors and combinations of spices are encouraged as tastes change. Previously disliked foods can be tried and welcomed by the client. Flavors can be enhanced by adding seasoned salts to meats or flavored extracts to milk, oatmeal, etc. Temperature of food and drink is important, too. Check the food temperature before serving. A straw can be an incentive to drink more fluids. Conventionally, the fork is placed on the left side of the plate. For dementia patients, place it on the diner’s dominant side (left side of plate if left-handed). It will be seen easily and more likely utilized if it is readily available. Do the same with liquids. We want our clients to drink fluids as much as possible. They should be placed on the dominant side of the client for accessibility and visibility.
There has been some research indicating that red plates, cups, and utensils may stimulate eating and drinking in geriatric patients. It may simply be the contrast of the food from the plate and/or table covering. This demarcation may assist the elderly in seeing the food, which in turn makes it easier to find and eat (Van Itterson and Wansink, 2012 and Hanslits, n.d.). Food should be served in a visually attractive way to encourage its consumption. Isn’t this what we do in our own lives, particularly when we entertain?
An excellent protocol developed for use in nursing homes and assisted living environments is the Cognitive Rehabilitation Dining Program from Select Medical Rehabilitation Services. This program provides strategies based on the cognitive level of the individual and has excellent suggestions for addressing weight loss, eating too fast or too slow, refusal to go to the dining area, etc. Several of the interventions in this program can be used for clients at home. For those that have difficulty pacing their food consumption, finger foods should be offered for eating ‘on the go’, offer food whenever resident is awake rather than at scheduled mealtimes, serve soup in a cup with a handle, etc. Examples of strategies for forgetfulness or disorientation during eating would be to use a different colored placemat to define the eating space, eliminate choices if unable to choose, minimize noise and other distractions including centerpieces, and use plain silverware that contrasts in color from the table. Plaid or busy table coverings should be avoided. Serving one food or beverage at a time can simplify the meal.
For those that become combative or agitated during mealtimes, try to identify the factor(s) triggering the behavior. Stand or sit at the non-dominant side of the client. Have the client face the wall when seated at the table rather than other residents or offer meals in a quiet, private area. Background music might be appropriate. Avoid conversation that tries to evoke a response so the individual can focus on eating. Minimize caffeine --it can cause restlessness. A stimulating activity just before mealtime can increase alertness during a meal. Try to match previous and preferred eating schedules, if possible, especially since the patient may not remember when or if he/she ate.
If a client appears fearful about eating foods, use a separate utensil for each. The caregiver might try a sample of each food to “prove” it is safe. Do not give medication with meals in this case. Foods can be served in closed containers. Do not argue with the client about their concerns; this provokes agitation and, in many cases, additional suspicion about the food.
For those choosing not to eat, offer flexibility in mealtimes, the type of food (i.e., breakfast foods can be served all day) and enhanced lighting during meals. (Koss and Gilmore in Vellas and Fitten, 1998). Food should be served in small bites with smaller portions on the plate. Serving one item at a time might also limit confusion to choose what to eat next. Softer food should be provided to assist with chewing and swallowing, which may be an unverbalized issue. High calorie finger foods can be offered to replace lost calories, and protein drinks can be utilized to help with missing nutrients.
If dining out is an option, plan to go to a quiet, less stimulating restaurant at the time of day when your loved one is feeling best and not too tired. Pick a place where the food is well-liked and where staff can prepare the order fairly quickly. Bring special eating utensils, bathroom items, and a sweater to keep them comfortable. If possible, allow the IWD to choose from pictures on the menu or from one or two items you suggest. Most importantly, dining should be a social time and unrushed. An hour or more to finish eating is not unusual.
Sources:
Cognitive Rehabilitation Dining Program [n.d.] Select Medical Corporation. Retrieved on April 1, 2017 from https://www.selectmedical.com/.)
Hanslits K. Do red plates for dementia really help people eat more? Retrieved September 25, 2019 from http://www.homesweethomecareinc.com.)
Koss E, Gilmore GC. Environmental interventions and functional ability of AD patients. In: Vellas B, Fitten LJ, eds. Research and Practice in Alzheimer’s Disease. Paris, France: Serdi Publishers; 1998:185-192.