When Bill Warren, an executive at Walt Disney World in Orlando, Fla., was diagnosed with early-onset Alzheimer’s at age 55, his wife, Lisa, took care of him at home for as long as possible. Until he died, at 68, in March, she tried to keep up a routine as much as possible, including going out to eat.
For some people who have dementia, a restaurant can be a triggering experience—loud music, crowded rooms and unfamiliar faces. But the Warrens went to The Meatball Stoppe, part of a dementia-friendly dining initiative based in Orlando. No music, a quiet space, limited menus with pictures of the dishes and servers trained and attuned to the needs of people with dementia.
“It was a nice little Italian restaurant, and we ended up going there so often they put a picture of us up on the wall,” says Lisa Warren, now 63. Although the restaurant is now closed, “we ended up going there even when it wasn't dementia-friendly dining time, because we knew the staff, they recognized us, and treated us with kid gloves.”
Alzheimer’s disease is the most common form of dementia, typically affecting people over age 65. The number of people affected in the U.S. is growing — from seven million today up to an expected 13 million by 2050, according to the Alzheimer’s Association. The dementia-friendly dining option in Florida is just one of an increasing number of initiatives addressing the needs of caretakers and people with dementia.
Other dementia-friendly services
From dedicated grocery store check-outs to dementia-friendly travel consultants to the national “Memory Café” series, which combines a social hour, support network and caretaker education sessions, the goal is to increase support for caregivers and improve the social lives of people with dementia, who are often isolated.
Heather Keller, a professor specializing in nutrition and aging at the University of Waterloo in Ontario, Canada, says little things make a big difference in how much patients eat — a key concern in a disease where studies show that about 30% of sufferers experience significant weight loss.
“If it's chaotic or noisy, or people are not seated with their friends, all that would impact food intake,” she says. In her 2020 study, for example, researchers compared how much people ate when using white plates versus blue plates. About 25% ate more with the blue plates — probably a result of visual and perception changes, where seeing white mashed potatoes on a white plate can be difficult, she says.
The challenge is finding what works for each person, says Keller. “We can't make blanket statements that everybody with dementia will benefit — one person with dementia is just one person with dementia,” she says. “Different interventions that might work for one person may not work for another.”
Dementia-trained servers learn to look people in the eye, not down at their pad, serve from the front, not the side, and be patient and flexible, program coordinators say. For example, when Bill Warren, the Disney World executive, ordered iced tea, he would forget what he ordered, and then get confused, insisting that he’d asked for coffee. Rather than argue, servers would just bring the new item, Lisa Warren says.
In some cities, dementia-friendly efforts extend well beyond the dining rooms. St. Albans, a city of about 10,000 in West Virginia, was proclaimed a “dementia-friendly city” in 2022, says Walter Hall, a member of the West Virginia House of Delegates representing the city. The effort started in 2016, when Hall was a city council member, and now several restaurants participate with dementia-friendly hours and trained servers. The grocery store and pharmacy also have special hours with a dedicated check-out and trained cashiers.
Experiencing dementia
St. Albans has an older population, and many people have loved ones with Alzheimer’s or dementia, says Hall, who heads a taskforce to address dementia needs across the state. The city also has education programs, and recently purchased a trailer that offers visitors the ability to discover what it’s like to have dementia — wearing gloves that make the hands numb, for example, and goggles that skew vision.
“The program is designed to help those with dementia do such things as go to the bank, go to the store, go to a restaurant,” Hall says. “We want them to continue to engage in the community; we can't let them sit at home and be idle because that is detrimental to their health, not only physically, but emotionally.”
Dennis Dulniak, 73, heard about the West Virginia effort from his son. At the time, the Orlando man, a former registrar at the University of Central Florida, was taking care of his wife, Nancy, who had been diagnosed with Alzheimer’s when she was 62. (She died at age 69 in 2021.) They had enjoyed going out to eat before the disease struck, and he tried to keep that tradition going. But if there were too many people at their favorite omelet bar, she would become uncomfortable. She often struggled to wait if there was a line at their frozen custard place.
At the time, Dulniak had started a support group for men who were taking care of parents or partners with dementia, and heard similar stories. In 2020, he, along with Toni Gitles, a caregiver consultant, started reaching out to local restaurants to see if they would be open to creating dementia-friendly hours.
“We go in and sit in the location that they would like to have designated for dementia-friendly dining, and they’ve got to turn the music off,” says Dulniak. This includes making tables available, rather than booths to facilitate serving from the front to encourage eye contact.
Chris Cremen is the chief operating officer at Hollerbach’s, a German restaurant in Sanford, Florida, which offers dementia dining hours three days a week from 3-5 p.m., typically drawing a couple of people. The 600-seat restaurant has a special section that’s a little separated where it’s quieter and the music can be turned off. About 15 interested members of the staff received a 20-minute training, he says. The restaurant was provided with large purple placemats for those diners, to alert servers. Now Cremen says he’s reaching out to senior homes and trying to get the word out.
Coffee, snacks, performances
Megan Kalafsky, associate director of social programs at the University of Pennsylvania Memory Center, helps run the monthly Memory Café at a church near the Liberty Bell in Philadelphia. Similar gatherings are held nationally, offering support groups and social interaction for caregivers and those with dementia.
Attendance ranges from 7 to 20 people at the Penn gathering, depending on the discussion, she says. The goal is to provide a chance to socialize, with 30 minutes of coffee and snacks, followed by an hour-long presentation, such as a recent performance from a cappella singers.
“As silly as it might sound, fun is important; it’s good for us and improves our quality of life,” she says. “In a secondary way, for people with dementia, it provides mental stimulation and engagement, which may help in slowing the disease progression in some way, shape or form.”
Some people take that element of fun a step further, hoping to take their loved one with dementia on vacation. There are some dementia-friendly cruises, but often, it’s a matter of planning ahead and paying attention to details, says Carol Sargeant. After taking care of her mother, who had vascular dementia, she created “Mind For You,” a vacation program for people with dementia. She is now a dementia-friendly travel consultant based in England.
“You can have a routine for every minute of the day, but I don’t think that’s really what somebody with dementia wants,” she says. “I think routine is often easier for the individual who's providing the support than it is for the person who's receiving it.”
She suggests going somewhere nearby at first, and reaching out to local Alzheimer’s groups for information in case medical care is needed. If traveling far, sometimes plane travel is best despite the crowds and lines, simply because it’s much shorter.
Although it’s not necessary or beneficial to plan every minute of every day while on vacation, it is a good idea to bring little moments of the familiar to a new place, she says. It could be having a nap at the same time, or watching television after dinner with a favorite blanket or bringing along the kind of candy they always eat. It’s also important to notice when someone is becoming uncomfortable and be willing to pick up and leave. But it’s necessary to at least try, she says.
“If you discourage any human being from going outside their own home, their own four walls, and go outside their own front door, and experience new things, are they really living?” she says. “To me, life is about experiencing new things, and some things we'll like, some things we won't.”
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