Joel August had a problem with mealtimes. As a chef at a residential home for seniors with Alzheimer’s disease or dementia, he was saddened when food plates came back with only a few bites missing. August was concerned about resident health — dehydration, malnutrition and weight loss can result from poor appetite, few hunger cues and forgetting to eat. Malnutrition, in turn, can reduce mobility, impair posture and weaken the immune system.
He also understood that when enabled to perform everyday independent tasks such as eating, older people maintain confidence, dignity and normalcy.
So, August set to work. Experience with fine dining and catering taught him how overall dining presentation influences appetite. “Everyone eats with their eyes regardless of their mental state or age,” he says.
August ushered in a more restaurant-like atmosphere for dining. Food should be well-presented, he told staff — not just scooped onto a plate. Quiet music plays in the background, and ample natural light enters through windows. Residents indulge in the elegance of at-table hot towel service before dining on vibrant plates.
August also played with the color, shape and varieties of fare leaving the kitchen. As older people may have issues with swallowing and chewing, modifying texture can help people with dementia and dysphagia eat more. This dining challenge is met by an innovative approach used at Koelsch Communities – Purees With Purpose.
It’s no surprise that residents soon joined the clean-plate club.
Satisfying changing appetites
Currently, August works as the director of culinary services at Koelsch Communities, where he mentors and trains chefs nationwide for Koelsch’s facilities.
Adapting to resident needs led to some of August’s most rewarding challenges (and creative solutions). While most residents are on a regular diet, some may be prescribed a modified diet due to dysphagia or the difficulty or inability to move nourishment from the mouth to the stomach.
According to the International Dysphagia Diet Standardisation Initiative, dysphagia affects an estimated 8% of the world’s population but is primarily found in older people. Common causes include dementia and Alzheimer’s disease, but dysphagia can also result from incidents such as strokes, multiple sclerosis or spinal cord injuries.
In general, residents in a care community all sit down to the same meal, which provides social stimulation along with nutrition. While it’s possible to just throw tonight’s pizza into the blender for those who need softened textures, the result is rarely appealing. To increase edibility, August directs staff to apply creative techniques.
Purées With Purpose: A softer approach to dining
To make puréed and softened meals more attractive and realistic, August uses a variety of approaches, including molds, piping bags and separation. A burger bun is soaked in broth to soften it, then filled with puréed, seasoned beef and cheese, and plated with a side of puréed potatoes hand-piped into French fry-like ribbons. Premade molds can help shape chicken purée into a chicken breast with fake grill marks. Peas and carrots can be re-created, as well.
“If you’re in a restaurant and a dinner looks like it was plated in a hurry or lackluster, it’s not going to taste as good,” he says. “But if it comes out looking great, you’ll have an appetite and feel more excited about eating.”
Purées can be brightened naturally by adding natural colors from small amounts of real, nutrient-rich foods — blue hues of blueberries, yellow from butternut squash. If steamed and puréed green beans lose their vibrant color, a little spinach can punch up the green. The final product is then piped onto the plate in bean-like thick strings.
Contrast and color play a role, too. Sauces and condiments such as sweet honey mustard, rich balsamic glaze and peppery ranch dressing add color — along with necessary calories. In the kitchen, chefs taste their handiwork and may add cream cheese, chicken stock, salt, white pepper, or other seasonings to entice residents.
“We want chefs to put themselves in resident shoes and ask, ‘Do I want to eat this?’ ”
As for August, he’s excited to meet older people where they’re at, and provide what’s necessary to survive and thrive. “I’ve always had an affinity for the elderly,” August says. “I was fascinated by the seniors in my family. They were so wise and had the best stories.” Thanks to food innovations for our older family, friends, and loved ones, many more stories will be shared.
Koelsch Communities is a third-generation, family-owned and -operated senior living provider. For over 60 years, Koelsch Communities has led the industry in independent and assisted living and memory care. Koelsch believes in innovative programs that make aging well possible. Learn more: koelschseniorcommunities.com/communities