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Time for dinner: the communal dining room in care homes and its impact on nutritional outcomes

Several years ago, we described the differential impact of the nature and size of care home settings on dementia-related outcomes (Leroi et al., 2006). For example, the rates of challenging behaviors and the profile of cognitive diagnoses among residents depended, in part, on the physical environment of the care home, such as its size. Following the same theme, in this issue, Slaughter et al. (2020) shine a spotlight on the physical nature of a very specific area of the care home, the dining room. They investigate how care home dining rooms impact on nutrition-based outcomes in older care home residents. In “Short History of the Dining Room,” internet food blogger Christine Baumgarthuber (2015) describes several intriguing aspects of historical dining rooms in private homes. Ancient Roman “triclinia” were lavish, open dining spaces designed to delight and entertain. In contrast, furniturecongested Victorian dining rooms were intense spaces designed to showcase material wealth and status and, at the same time, to provide a secure space with rules of behavior for families to nurture their identities. But outside the domestic sphere, communal dining has also evolved, molding to the changing priorities of mealtimes. Here, through Slaughter et al.’s careful dissection of care home mealtimes and eating environments, the changing nature of communal dining for older people, including those with dementia, can be explored. Based on data from the “Making the Most of Mealtimes (M3)” study (Keller et al., 2014), Slaughter et al.’s analysis of 82 dining rooms in Canadian care homes found that on general care units, the physical and functional aspects of the dining environment had a direct effect on resident energy intake. This effect wasmoderated by the social and person-centered aspects of the dining environment. In contrast, the environment on dementia care units did not significantly impact on resident energy intake nor on “challenging eating behaviours.”Thus, with design principles for long-term care at the core of their investigation, the authors support the case for improving the dining environment for people who, by virtue of their frailty and vulnerability, experience daily communal dining. This topic of enquiry underscores the need to look more closely at the concept of “social health” when considering the impact of interventions, or in this, case, the care setting, on the lives of people with dementia (Dröes et al., 2017), and those in need of care. Social health can be encapsulated by three dimensions, which are personal, disease-related, and the social and physical environment. This third dimension, relating also to social relationships and meaningful activities, is heavily influenced by the design and accessibility of living and personal environments. Slaughter et al.’s study slots neatly into this space, starting to fill the gap in understanding and appreciation of the aspects of social health. The parent “M3” study, designed to quantitatively explore factors influencing nutritional intake of care home residents with and without dementia (Keller et al., 2017), was based on the conceptual framework of “Model of Place” (Weisman et al., 2000). In this study, the definitions of the mealtime experience, meal quality, and meal access were operationalized, and the authors argued that ascertaining key covariates impacting on nutritional intake is important in improving outcomes for care home residents. TheModel of Place describes the complex interdependency among the physical environment, social context/people, and organizational program. Meaningful, and indeed effective, interventions, or, in this case, mealtimes, in a care home setting need to address each of these components. Recently, we undertook an extensive scoping study with people livingwith dementia and their care partners regarding “meaningful” outcomes for dementia-related nonpharmacological interventions (Reilly et al., in press). Consensus was attained for the inclusion of 13 outcome items across four domains, which were: friendly neighborhood and home; independence; self-managing dementia symptoms; and quality of life. Here, the authors address three of these four domains by assessing the physical and psychosocial aspects of the dining room environments through functional ability of the residents, orientation, safety and security, familiarity and “homelikeness,” social interaction and privacy, personal control, and optimal sensory stimulation. Tools used tomeasure these domains were the Mealtime Scan (MTS) tool and the Dining Environment Audit Protocol (DEAP; Chaudhury et al., 2017). The MTS includes International Psychogeriatrics (2020), 32:7, 803–805 © International Psychogeriatric Association 2020