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

1. DEM 302: Understand and meet thenutritional 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 SafetyOutcome 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

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 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 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

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 DEM 302

8. Food types: Protein, fat and carbohydrate DEM 302

9. Vitamins and minerals DEM 302

10. A healthy balanced diet 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 DEM 302

12. How can you encourage the person with dementia to plan a healthy diet? DEM 302 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

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 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 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 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 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 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’ 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 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. 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 DEM 302

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

24. Cultural needs People with dementia may have cultural or religious dietary needs and these should be supported and respected. 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 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 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 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. 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 DEM 302

31. Where puréed foods are used they should be made to look appetising DEM 302

32. Food supplements can be prescribed by the GP if a resident is malnourished or unable to take a normal dietIf 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

33. You may then be asked to calculate the person’s ‘MUST’ index 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 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. DEM 302

36. Equipment to help people with dementia to eat independently. 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 DEM 302

38. 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. Hand hygiene is very important 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. DEM 302

40. Common health problems which affect the elderly and have an impact on eating and drinkingThink about how you can help people with these problems to eat well Visual impairment Mobility problems Arthritis Dental health problems Constipation Urinary infection Diabetes 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 DEM 302

42. People with dementia should be encouraged to eat and drink wellMealtimes should be enjoyable! DEM 302

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