By Caitlyn Rose, OTR/L
Occupational Therapist
NJ Central 1

So many of our older adult patients are concerned with going out to restaurants. From being able to put on their jacket independently to cutting their own food, there are a lot of challenges for them that we may not realize at first. How can occupational therapists assist our patients in achieving their goals?

Let’s consider the patient’s physical abilities, the environment, and the activity of self-feeding.

7 OT Considerations for Older Patients When Dining Out

What specific concerns does your patient have? Some common complaints include balance, fine motor skills, and activity tolerance.

Does your patient have a history of falling? Can they easily leave their home and transfer into their car? Do they have difficulty donning their jacket or shoes?

What about the act of eating? Does your patient have a hard time reaching, grasping, or manipulating? Are they embarrassed because they need help cutting food, or because they spill food? Is your patient afraid of choking? What about needing to use the bathroom in public?

1. Balance

Assure your patient that balance is a skill that can be improved and their confidence can be increased. Train them on posture, implement balance training, and practice activities such as donning a jacket, exiting the home, stair climbing, and transfers from various surfaces such as car, chair, and toilet.

2. Vision

Consider a vision assessment. Would a high contrast setup be useful? A direct, bright light? Are there impairments such as depth perception or visual perception? Can your patient read the menu? Would they benefit from a magnifier with light?

3. Fine Motor Control

Educate your patient on the importance of positioning, posture, shoulder stability, upper body flexibility, upper body support, and grip strength to facilitate fine motor control. Implement a home exercise program including exercises using an adjustable hand gripper, putty, table slides, wall walks, and wall push-ups, resistance training especially for the wrist and stretches for the chest, shoulders, elbows, forearms, wrist, and digits.

Does your patient have arthritis causing pain or stiffness? Do they complain of difficulty feeling? Could they benefit from pain management, tendon gliding, hand active range of motion?

4. Activity Tolerance

Educate your patient on the importance of cardiovascular stamina and proper dosage. Encourage them to implement moderate physical activity most days of the week with a goal of 10-minutes of consecutive activity up to 3 times a day.

Consider energy conservation principles: plan, prioritize, positioning, and pacing. What kind of DME does your patient use outside of the home? Can your patient benefit from a rollator to allow for sitting and support from sit-to-stand?

5. Environment

Consider the time of day, the day of the week, and the setting of the restaurant your patient is possibly considering for his or her return to eating out. Are they open to a quiet time of day, a less popular day of the week? Could they go to a familiar location with limited family or friends with whom they’re already familiar and comfortable around, who may already be sensitive and supportive of the situation that limits their ability to eat out at a restaurant?

Consider seating. Booths versus free-standing chairs, chairs with and without armrests, is the chair on a smooth or textured floor surface? When does your patient have the most energy and least amount of pain? What kind of shoes do they typically wear?

6. Adaptive Equipment

If your patient still has a difficult time manipulating a fork and knife, it may be time to consider adaptive equipment. Some common equipment includes rocker knives, built-up handles, weighted utensils, angled utensils, swiveling utensils, a universal cuff, straws, cups with open handles to allow for an open-palm grip that supports the use of both hands or nosey cups for patients who cannot tilt their head back due to impairments such as cervical stenosis.

Recommend cups with lids for those who may be likely to spill, if not to keep clothing from being soiled, to keep them safe when consuming hot beverages such as coffee or tea. If your patient is concerned about car transfers, adaptive equipment considerations include a swivel sweat, such as this one, and a car handle. If they have a difficult time reaching for the seat belt, consider a seat belt handle.

For dressing, button hooks, sock aid, (long) shoehorns, adaptive pull tabs, or modification of fasteners to replace buttons, zippers, snaps with Velcro, or elastic laces for certain shoes. Perhaps a cushion to facilitate a better position at the table might be appropriate.

7. The Occupation of Self-Feeding

Set the scene for a mock trial at home and practice, practice, practice. Start small and build your way up. Start with food that is easy to pierce and cut. Consider food that is a consistent, soft texture such as foods that are already in a pureed form, such as mashed potatoes. Educate your patient to be more cautious about ordering mixed textured foods such as soups with solids or a “tough steak.” If need be, consider finger-friendly foods such as sandwiches, chicken tenders, or pizza.

How Occupational Therapists Can Help Older Patients Return to the Restaurants They Love

Recommend that your patient prepare for his or her outing by implementing pain management strategies as needed, such as applying moist heat prior to dining out as well as doing a gentle range of motion exercise for maximum soft tissue mobility and comfort. You can also suggest packing any useful adaptive equipment (perhaps labeled with name and phone number in case anything is left behind!) and bringing equipment such as a rollator to facilitate sitting for rest breaks or sit to stand transfers from chairs or toilets.

Go at a time that will result in the least amount of stress, a situation that is as familiar as possible, and at a time of day when they have the most energy and least amount of pain, if possible. Make sure they do not have any other obligations to ensure no need to rush in case more time is needed for the outing than previously anticipated. Returning to a restaurant in and of itself will be stressful enough, but with proper planning and practice, you can ensure a successful return to eating out in restaurants again!