When I was working as a dietitian in the NHS one of my roles was visiting people living with dementia in care homes. The hardest part of my job was getting them to eat! I tried many interventions over several months, talking to the staff and relatives as well as the dementia residents in the care homes. Despite putting dietetic care plans in place many of them continued to lose weight.
I therefore decided to try a new approach and over a few days I simply sat in the dining room and observed some mealtimes. I learnt more in these few hours than I had the last few months working in the care homes. I observed many reductions in eating abilities and meal behaviours as well as environmental problems that were contributing to the person finding it hard to feed themselves and prevent adequate nutritional intake. Since I did these observations I cannot recommend enough the benefits of taking a step back from your normal way of working to simply observe not only the person but the environment the person with dementia finds themselves in. It is a skill rarely used in very busy caring settings nowadays but it is a vital skill in dementia care. I think the article by Beth Britton called ‘Harnessing the power of observation‘ describes the importance of this skill brilliantly and is really worth a read.
I realised that until these unsupportive environmental influences were resolved then the persons with dementia would continue to present with meal behaviours. Additional it seemed there could be simple modification to the meal setting and tableware that would support the person with dementia to remain more independent at the mealtime. Most importantly until all these factors were considered I knew my dietetic advice would not be effective. This became my motivation for creating the first version of the DMAT in 2011. The DMAT works in 3 stages with the first stage being the observational stage. A carer would use the DMAT ‘Initial Measurement Form’ to observe a mealtime and record the current level of mealtime abilities an individual has. It is a strength focused observational assessment helping the carer identify what elements of the mealtime the individual has no issues with and what support is required to help them.