Table 2.
Major Mealtime Barriers and Strategies—Participant Quotes
| Domain | Construct | Quote |
|---|---|---|
| Barriers | ||
| People with dementia | Functional status | “I see a lot of clients who are just limited in their range of motion, so—especially with their shoulders, being able to lift their shoulders up to get things out of their kitchen cupboards is a challenge” (119, care coordinator). |
| People with dementia | Cognitive status | “Well, I think what we mentioned earlier is that they don’t know cognitively how to take the plastic off the tray. They don’t equate that tray with their food necessarily. Problem solving how to eat that lunch can be a problem … this person never ate food like that. They ate it on a plate, or they ate it in a carry out container, but they’ve never seen a container like this” (218, occupational therapist). |
| Caregiver | Skills and knowledge | “Caregivers are given a ton of overwhelming information at diagnosis or during various healthcare visits or online with the Alzheimer’s Association” (110, occupational therapist). |
| Living environment | Safety and security | “In my experience with people with dementia living alone, they often have rotten food in the refrigerator or food left on counters that’s rotten. Are they properly washing and cleaning their utensils and plates and things? Those are things that I’ve seen that concerned me when I was working on conservatorship with older adults that had dementia” (117, occupational therapist). |
| Strategies | ||
| People with dementia | Functional status | “I think about finding utensils … and they might have difficulty using utensils. They do so much better with finger foods. I love the finger foods. It’s such a simple intervention, but people forget about it” (113, registered nurse). |
| People with dementia | Cognitive status | “Putting signs or post-it notes on the microwave because, even now, microwaves have all these buttons and most of us still only use a few of them” (217, nutrition program provider). |
| Caregiver | Skills and knowledge | “As dementia progresses, it’s necessary to provide care partner education and just tell them it’s going to be very hard for them to sit down and have their structured 30 to 60-minute meal that maybe they’re used to, and they’re going to have to just be okay with giving finger foods or other types of pouches or whatever they can so they’re getting the adequate nutrition and still move around their house in a safe way” (110, occupational therapist). |
| Living environment | Safety and security | “I think for just any older adult, the fall risk assessment—I think that’s got to be included. Doing a home environment assessment and finding out if there are some tripping hazards or fall hazards would be good for any older adult, but especially one with dementia” (219, registered dietitian). |
Note: Domain and construct terminology drawn from Gitlin and Hodgson’s (2018) Socio-Ecological Model for Developing and Implementing Comprehensive Dementia Care.