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DEM 302: Understand and meet the nutritional requirements of individuals with dementia Sheena Helyer.

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Presentation on theme: "DEM 302: Understand and meet the nutritional requirements of individuals with dementia Sheena Helyer."— Presentation transcript:

1 DEM 302: Understand and meet the nutritional requirements of individuals with dementia
Sheena Helyer

2 Learning Outcomes 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

3 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 Explain the role the CQC plays in maintaining standards of care DEM 302

4 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 Ask the group what they think is meant by nutrition and hydration. Allow several people to give suggestions before revealing the answers. Then ask the learners to think about the reasons why elderly people with dementia may be malnourished DEM 302

5 Effects of Malnutrition on Elderly People
Increased risk of infection Low energy levels Weakness Muscle wasting Lower blood pressure Slower pulse Increased risk of falls Poor wound healing Anaemia Lethargy/Apathy/ Depression Ask the learners to discuss in pairs the possible consequences of malnutrition for an elderly person DEM 302

6 Nutritional content of a Functions of the body Well balanced diet
Carbohydrates Main source of energy (330g daily) Fibre is good for health Protein Growth and repair (100g daily) Fat Energy, storage, synthesis (75g daily) Repair of cell parts Water Solvent, lubricant, medium (2000g daily) for transfer, temp control Vitamins Enable chemical reactions (<300mg daily) in the body Minerals Aid enzyme functions, (5-10g daily) electrical balance, nerves Ask the group what they think are different types of nutrient. Allow some discussion before revealing the points one at a time. For each element, ask them what they think carbohydrates are important for, etc.

7 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 Ask the group to discuss how food can be served in a way which preserves the nutritional value of the food. Then ask them to discuss the ways that their clients cook and prepare food. DEM 302

8 Food types: Protein, fat and carbohydrate
Check that the learners can identify the different food types. Ask them to give further examples of each type DEM 302

9 Vitamins and minerals DEM 302

10 A healthy balanced diet
Ask them to consider whether the service users they visit have a healthy balanced diet and to discuss their dual role of encouraging choice while at the same time trying to promote good health. Ask them what they can do if one of their service users is making unhealthy choices DEM 302

11 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 Ask learners to think about the damage which occurs to the brain with dementia: brain shrinkage, enlarged ventricles and damage to specific areas. Ask the learners to consider how this may affect the ability of the person with dementia to eat and drink DEM 302

12 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 Ask the learners if they can share how they manage menu planning with service users who have dementia DEM 302

13 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 Ask learners to describe how they help people with dementia to go out and shop. How do they get there? How do they get around the shop? How do they get money? How do they carry the shopping back home? Etc. DEM 302

14 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 Do the learners have any experience of people with dementia getting confused and losing things in the kitchen. How have they helped them? DEM 302

15 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 Preparing food can be an enjoyable activity for a person with dementia but help may be needed. DEM 302

16 How could you help the person with dementia to cook food?
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 Learners need to be able to make careful risk assessments of whether people with dementia can safely use kitchen appliances. DEM 302

17 How could you help the person with dementia to eat and drink ?
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 The group could have experience of feeding each other a variety of foods and textures. They could then discuss what was helpful and what made the experience unpleasant. DEM 302

18 Things which the person with dementia may find difficult
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’ Ask the learners about the people they care for with dementia. Do they have difficulties sitting and enjoying a meal. What changes have had to be made to help them. DEM 302

19 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 Encourage the learners to discuss the way the food has been presented in the above photos. Also discuss how a formal or informal carer can support a person with dementia to eat well. Sometimes there can be tensions generated between a couple which make meal times fraught. How could a carer help to defuse the tension? DEM 302

20 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. Discuss with the group the kinds of problems which might occur when someone with dementia is eating out. DEM 302

21 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 Ask the students to think about what foods might be appropriate for snacks DEM 302

22 Special dietary needs -To prevent constipation or High fibre
Some people with dementia may have special dietary needs: They may need help and prompting to eat and drink appropriate food. High fibre Low fat Low calorie Reduced sugar Reduced protein/ Low salt/restricted fluids -To prevent constipation or manage diverticular disease -To reduce risk of cardiac disease and lower blood pressure -To lose weight -To control diabetes -Kidney failure Ask the learners to suggest reasons for these diets before revealing DEM 302

23 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 Providing options and enabling a service user to have autonomy and freedom of choice is a key theme running through the Essential Standards and the Health and Social Care Act In the context of Outcome 5 this includes a real choice of what, when and where to eat and drink. People with dementia may still be able to make valid choices. If they cannot ‘best interest decisions’ should be made on their behalf. a choice for each meal that takes account of their individual preferences and needs access to snacks and drinks throughout the day and night mealtimes that are reasonably spaced and at appropriate times, taking account of reasonable requests including their religious or cultural requirements information on what constitutes a balanced diet to help them make an informed decision about the type, and amount, of food they need. DEM 302

24 Cultural needs People with dementia may have cultural or religious dietary needs and these should be supported and respected. Ask about the group’s experience of providing food for people from a different cultural or religious background. Ask them to think about the practicalities of preparing food they are not familiar with. DEM 302

25 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 Ask the learners to describe the assessment which is made of their service user’s nutritional needs DEM 302

26 Hydration Many elderly people do not drink enough. This may be due to :- Mobility problems Worry about being incontinent Lack of motivation Not understanding the importance Good hydration is essential for the health and wellbeing of older people, not only in helping to make people more alert but also helping to prevent confusion, constipation, pressure sores, kidney stones, blood pressure problems and headaches. In addition, evidence suggests that hydration can also promote healing and help to prevent falls, obesity, depression, inactivity and fatigue. Ask the group why they think service users can sometimes be reluctant to drink water. This is often because some elderly people worry about possible incontinence, particularly close to bedtime. Where older people worry about incontinence care it may be possible to access suitable equipment for them and they should not be encouraged to drink close to bedtime. DEM 302

27 Good hydration will result in:-
Fewer falls Less constipation Less GP call out Less agitation Healthier skin Fewer urinary infections Reduction of obesity, depression and fatigue. DEM 302

28 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 Ask the students to suggest ways of increasing the fluid intake of a service user with dementia. DEM 302

29 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. Updated nutritional care guidelines for older people published by the Social Care Institute for Excellence (SCIE) in March 2009 state that where puréed foods are used, they should be made to look appetising. Where the texture of food needs to be modified due to swallowing difficulties the guidelines state that providers should seek advice from a speech and language therapist. The guidelines remind providers that not all food for people with swallowing difficulties needs to be puréed and that it is important for the quality of the eating experience to keep different foods separate and not mix them all together. DEM 302

30 Dysphagia diet food texture descriptors March 2012
B Thin puree dysphasia diet C Thick puree dysphagia diet D Pre-mashed dysphagia diet E Fork mashable dysphagia diet These descriptors have been developed by the National Safety Agency (NPSA) in association with Cardiff university. They are intended to be a nationally recognised standard. DEM 302

31 Where puréed foods are used they should be made to look appetising
Discuss with the learners how pureed food can be made to look and smell appetising by serving it hot, preparing it in moulds and keeping the food types separate on the plate. DEM 302

32 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 Learners could be encouraged to calculate their own BMI and MUST score DEM 302

33 You may then be asked to calculate the person’s ‘MUST’ index
Explain how MUST can be used as a useful tool to identify people ‘at risk ‘ of malnutrition DEM 302

34 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 People who require assistance with eating or drinking should have their needs fully assessed and discussed with them. A suitable plan of care should be agreed, with specialist input as required, which clearly identifies any assistance needed. Some people may need encouragement to use a spoon or pick up food. Others may start eating when they see someone eting and can copy them. The provision of adequate support and assistance to eat and drink is specified in Regulation 14 as “support, where necessary, for the purposes of enabling service users to eat and drink sufficient amounts for their needs”. This is supported by a number of Prompts (5A) including: the provision of all assistance necessary to ensure service users actually eat and drink where they want to but are unable to do so independently the need for staff to act with sensitivity and respect for service users’ dignity and ability the need for service users to be enabled to eat their food and drink as independently as possible the need to have adequate and appropriate supportive equipment available to enable service users to eat and drink independently, wherever needed the need for staff to help service users into an appropriate position that allows them to eat and drink safely, wherever needed. Staff who assist service users with eating and drinking should be appropriately trained and supervised and there should be adequate numbers of such staff on duty at mealtimes. Privacy may be especially important for a person who has to have direct help with eating. This can be accommodated in a particular part of a dining room, in a separate dining room for those in need of assistance with eating or in the resident’s own room. DEM 302

35 Care Plan for nutritional needs
Any help needed should be agreed with the resident and added to their plan of care 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. At this point introduce the scenario exercise which will help the learner’s assessment skills. DEM 302

36 Equipment to help people with dementia to eat independently.
Specialist utensils may enable a person with dementia to maintain independent eating for longer. Ask the learners to look at the range of equipment available in a medical equipment/ rehabilitation catalogue. Encourage to share their existing knowledge of specialist equipment DEM 302

37 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 Any storage or handling of food in a service user’s home raises a potential risk of food poisoning. It is therefore essential that, wherever food is prepared, handled, stored or served, the highest standards of hygiene are observed by all staff at all times, especially with regard to hand washing. The person with dementia may start to become neglectful of hand hygiene and basic food hygiene standards which could put them at risk of illness. DEM 302

38 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. Ask the learners to think of other ways in which infection might be spread in the home of someone with dementia and how this could be avoided DEM 302

39 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. Ask the learner’s to think about their own fridge and those of people they visit. Are they as safe and hygienic as they should be? DEM 302

40 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 Mobility problems Arthritis Dental health problems Constipation Urinary infection Diabetes Put the learners in pairs and ask them to think about one of these conditions and to feedback ideas to the group on how help might be given DEM 302

41 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 Ask the learners if they know what these professionals may be able to do to help, where they are based and how they can be contacted. Admiral nurses are specialist advisers in dementia care within the community but they are not available in all parts of the country. DEM 302

42 People with dementia should be encouraged to eat and drink well Mealtimes should be enjoyable!

43 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

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