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In addition to conducting a clinical evaluation of a person's swallowing abilities, an environmental assessment of the dining room should be conducted to determine if there are aspects of the environment that could be having a negative impact on the ability to consume meals. Begin by sitting at a table in the dining room during a meal and ask the following questions:
1. Who is the person having the eating problem? What history of preferences, dislikes, ethnicity, and habits does the person bring to this environment? Does the person have any visual deficits or changes in the eye as a result of aging?
2. When are the eating difficulties occurring? Are the problems consistent at each meal or just during a certain meal? Do the difficulties occur throughout the meal or at its beginning and end?
3. What is being served? Examine the consistency of the food items as well as the type of food. Consider food preferences and regional differences among meals. Is the food being served family style, is the person given a choice of food items, and does the food arrive on covered trays?
4. Where does the person sit? Is the person seated next to socially compatible persons or near persons with similar abilities? Is the person seated next to a window with sunlight glaring through it, or in a corner where the light may not be adequate?
5. What is happening in the environment? Consider all of the noise, motion, and other stimuli in the environment. Is the person distracted by the environment? Will the person be more successful in a less noisy environment? In addition, observe the lighting at the table level and the degree of contrast at the table setting. For example, is there light directly overhead that may be causing a glare on the table? Is there contrast between the table and the plate or tray? A dark tablecloth or place mat will make a light plate stand out better to aged eyes.
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