Transcript Introducing the new identity

DEM 302: Understand and meet the
nutritional requirements of individuals
with dementia
Sheena Helyer
Learning Outcomes
1. Understand the nutritional needs that are unique to
individuals with dementia
2. Understand the effect that mealtime environments can have
on an individual with dementia
3. Support an individual with dementia to enjoy good nutrition
DEM 302
CQC Essential Standards of Quality and Safety
Outcome 5
• Reduce the risk of poor nutrition and dehydration by
encouraging and supporting people to receive adequate
nutrition and hydration
• Provide choices of food and drink for people to meet their
diverse needs, making sure the food and drink they provide
is nutritionally balanced and supports their health
DEM 302
What is nutrition and hydration?
• Nutrition and hydration means eating the right foods and
drinking the right fluids to live well and be healthy
• Good nutrition and hydration levels are essential for health;
inadequate nutrition or hydration can lead to ill health
• Malnutrition has been on the increase in the elderly in recent
years
• An estimated 3 million people in the UK are either
malnourished or at risk of being malnourished
• The majority of these (97%) are in the community
• Malnutrition costs the NHS an estimated £13 billion annually
• People who have dementia are at higher risk of malnutrition
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Effects of Malnutrition on Elderly People
• Increased risk of infection
• Low energy levels
• Weakness
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Muscle wasting
Lower blood pressure
Slower pulse
Increased risk of falls
• Poor wound healing
• Anaemia
• Lethargy/Apathy/ Depression
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Nutritional content of a
Well balanced diet
Functions of the body
Carbohydrates
(330g daily)
Protein
(100g daily)
Fat
(75g daily)
Water
(2000g daily)
Vitamins
(<300mg daily)
Minerals
(5-10g daily)
Main source of energy
Fibre is good for health
Growth and repair
Energy, storage, synthesis
Repair of cell parts
Solvent, lubricant, medium
for transfer, temp control
Enable chemical reactions
in the body
Aid enzyme functions,
electrical balance, nerves
Preserving the health giving properties of food
• Eat food fresh
• Eat food raw
• Store in the fridge
• Do not boil vegetables for long periods
• Do not over cook
• Frozen while still fresh
• Tinned food and food with high levels of salt or
preservatives is not so healthy
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Food types: Protein, fat and carbohydrate
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Vitamins and minerals
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A healthy balanced diet
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Brain functions involved in eating and drinking
COGNITION
• Sensation of hunger
• Recognising food
• Choosing what to eat
• Memory of how to eat
FUNCTION
• Taste and smell
• Motor skills to handle utensils
• Communication skills
• Chewing and swallowing
EMOTION
• Eating and drinking gives sensation of pleasure or dislike
• Elation or depression may affect appetite
• Calm / agitation/ anxiety
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How can you encourage the person with
dementia to plan a healthy diet?
• The person may want familiar food with recognisable brand
names
• They may find it difficult to plan ahead for meals and need
help to write a list
• They may need prompting to make healthy choices
• Their food needs to be attractive and culturally appropriate
DEM 302
How can you help the person with dementia to
shop for food and drinks?
• The person with dementia may need help to find their way
around shops
• They may become more easily distracted and need reminding
why they are there
• They may only have the energy for a short trip
• They may need help to manage money/cards /chip and pin
• Pictures could be used to guide their choices if shopping on
line
DEM 302
How can you help the person with dementia to
store their food safely?
• Help them to store food where it is easily accessible and
where the person with dementia can find it.
• Pictures or labels on the cupboard doors make it easier to
find things. Transparent jars and glass doors in cookers and
cupboards may help.
• The person may need prompting to get rid of expired food
or food in the fridge which is not fresh
DEM 302
How can you help the person with dementia to
prepare food?
• Encourage the person to purchase food in packaging which is
easy to open
• Cook recipes together so that help can be given
• The person may need a reminder that it is mealtime e.g.
telephone call or recorded message.
• A talking clock could remind the person about meal times
DEM 302
How could you help the person with dementia to
cook food?
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The person could be given simple written instructions
Ready meals might to easier than cooking a full meal
They may need someone to cook with them
They may need someone to place all the equipment on a table in front of
them
• Microwaves and cookers may need to be risk assessed for safety of use
DEM 302
How could you help the person with dementia to
eat and drink ?
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The person may need prompting to eat or a companion
The environment should help them to focus on eating
Provide them with appropriate cutlery and drinking cup
Do not put out condiments if it causes confusion
The person may need assistance to eat
The person may prefer to eat frequent small snacks rather than a big meal
Strong smells may help to stimulate the appetite
DEM 302
Things which the person with dementia may find
difficult
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Using utensils in the correct way if they lack coordination
Sitting for a long time if they are anxious or agitated
Explaining their likes and dislikes
Knowing what is edible
• Eating food which is hard or chewy
• Following socially accepted ‘table manners’
DEM 302
The meal time environment can help a person
with dementia to eat well
• Avoid distractions such as the television
• Remove distracting clutter
• Choose attractive and appropriate cutlery and crockery
• Contrasting colours may be helpful but avoid over busy
patterns which may confuse
• Quiet music in the background may relax the person
DEM 302
Eating Out
• A person with dementia may enjoy eating out with friends
and family provided the environment is sympathetic to their
needs
• Many areas have dementia cafes which offer a welcoming and
supportive environment to people with dementia and their
carers.
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Mealtimes and snacks
• Mealtimes are a high point of
the day for many and every
effort should be made to
make these relaxed and
enjoyable occasions
• Mealtimes should be well
spaced throughout the day
• Snacks may need to be
provided or made accessible
throughout the day and night
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Special dietary needs
Some people with dementia may have special dietary needs: They may
need help and prompting to eat and drink appropriate food.
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High fibre
-To prevent constipation or
manage diverticular disease
-To reduce risk of cardiac disease and
lower blood pressure
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Low fat
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-To lose weight
Low calorie
Reduced sugar
-To control diabetes
Reduced protein/
-Kidney failure
Low salt/restricted fluids
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Food and drink choices
We all have food and drink
preferences and it is important
that people with dementia also
have choices about their diet
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Cultural needs
People with dementia may have
cultural or religious dietary
needs and these should be
supported and respected.
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Assessing nutritional needs
• An assessment should be made of the person’s preferences
and requirements.
• Find out how much help the individual needs to eat and drink.
• Where a risk of malnutrition or dehydration is identified
appropriate action should be taken to encourage a healthy body
weight.
• The results of any screening and assessment should be entered
into the plan of care and regularly reviewed
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Hydration
Many elderly people do not drink enough. This may be due to :•
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Mobility problems
Worry about being incontinent
Lack of motivation
Not understanding the importance
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Good hydration will result in:•
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Fewer falls
Less constipation
Less GP call out
Less agitation
Healthier skin
Fewer urinary infections
Reduction of obesity,
depression and fatigue.
How can you encourage people with dementia to
drink well and safely?
• Provide drinks they enjoy
• Leave drinks within reach
• Assess whether the person is safe with very hot drinks
• Make sure that they can access the toilet when needed
• Offer jellies, ice lollies and other foods which have a high fluid
content
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Soft diets
• A number of conditions including dementia may interfere
with chewing and swallowing
• The individual may need to be provided with softer foods or
puréed food.
• Where necessary seek advice from a speech and language
therapist
• The SALT therapist may recommend exercises, techniques or
a specified texture for food.
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Dysphagia diet food texture descriptors
• B
Thin puree dysphasia diet
• C
Thick puree dysphagia diet
• D
Pre-mashed dysphagia diet
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Fork mashable dysphagia diet
DEM 302
March 2012
Where puréed foods are used they should be made
to look appetising
DEM 302
Food supplements can be prescribed by the GP if a
resident is malnourished or unable to take a normal
diet
If a person with dementia is losing weight or
malnourished it is good practice to weigh them, work
out their body mass index and MUST score
DEM 302
You may then be asked to calculate the person’s
‘MUST’ index
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Helping people with dementia to eat
• People with dementia should
have the appropriate help if
they need assistance with the
process of eating or drinking
• When giving such help it is
vitally important to preserve
an individual's dignity and
independence
• Seat the person comfortably
and do not rush. Check that
the food is being swallowed
safely
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Care Plan for nutritional needs
• Any help needed should be agreed with the resident and added
to their plan of care
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Clothing should be protected from spillage.
Independence aids should be made available.
Privacy may be required
The carer should report any difficulty with eating or loss of
appetite.
• If the person is losing weight their food intake should be
recorded.
DEM 302
Equipment to help people with dementia to eat
independently.
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Food handling
• Food poisoning is any infectious or toxic disease caused by consuming food
or drink that has become infected with bacteria, viruses or parasites
• Food poisoning and infections such as salmonella are easily spread through
contaminated food and via infected food handlers
• Staff preparing food should observe all relevant food hygiene and safety
procedures.
• People with dementia may be at higher risk of developing food poisoning
because they have become forgetful and do not understand the dangers
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Hand hygiene is very important
• Care staff should wash their
hands before and after
handling food.
• People with dementia should
have the opportunity to wash
their hands before and after
eating.
DEM 302
The person with dementia may need help
with simple food hygiene precautions
• Food should not be left lying
around the house. People
with dementia may sometimes
store food in unusual places.
• Food in the fridge should not
be kept beyond its expiry date
• Raw food should be kept
separate from cooked food at
the bottom of the fridge.
• Meat must be served ‘hot’
and only reheated once.
DEM 302
Common health problems which affect the elderly
and have an impact on eating and drinking
Think about how you can help people with these
problems to eat well
• Visual impairment
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Mobility problems
Arthritis
Dental health problems
Constipation
• Urinary infection
• Diabetes
DEM 302
Monitoring the diet of people with dementia
• Any individual who has special dietary needs, who needs help
with eating or drinking or who is at risk of under-nutrition
should be appropriately assessed and monitored
• Concerns should be reported.
• Where necessary a referral for specialist help and advice should
be made , for example to :Dietician
GP
Community psychiatric nurse
Speech language therapist
Alzheimer’s association
Admiral nurse
DEM 302
People with dementia should be encouraged to
eat and drink well
Mealtimes should be enjoyable!
DEM 302
Review of learning outcomes
You should now be able to :• Understand the nutritional needs that are unique to
individuals with dementia
• Understand the effect that mealtime environments can have
on an individual with dementia
• Support an individual with dementia to enjoy good nutrition
DEM 302