Issue 142 Supporting people to eat well and live well with dementia

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SUPPORTING PEOPLE TO EAT WELL AND LIVE WELL WITH DEMENTIA

SOCIAL CARE

There are an estimated 90,000 people living with dementia in Scotland. An estimated two thirds of them live in the community and one third in care home settings.1 Dementia is increasingly becoming part of the core remit for allied health professionals (AHPs) in acute settings, as people with dementia are more likely to be admitted to hospital than those without. This may be due to co-existing conditions and/ or secondary complications of dementia, such as falls, fractures and infections.2 Scotland has developed a network of AHP dementia consultants, working as part of a national network to support the staff and carers who are themselves supporting people to live well with dementia. In the autumn of 2017, Alzheimer Scotland launched a national AHP strategy ‘Connecting people connecting support’, which is the first policy of its kind in the UK. This, in turn, underpins the delivery of the national dementia strategy for Scotland launched in June 2017.3 The active and independent living programme (AILP) was developed with six areas of priority work streams, including dementia. Its vision is that: ‘Allied health professionals will work in partnership with the people of Scotland to enable them to live healthy, active and independent lives by supporting personal outcomes for health and wellbeing’.4 People are living longer with multiple morbidities and complex care needs. The use of polypharmacy can create its own challenges because of the many interactions, side effects and complications, which people experience.

Dietitians, like other AHP groups, have a great opportunity to realise their full skill-sets and work in new ways to deliver support and enablement for people with dementia. People with dementia are more likely to become malnourished, so

dietitians are often asked to assess and advise care staff and cooks on the best way of delivering and presenting appetising, safe, high quality food and drink. The role of public health dietitians in promoting healthier choices is also important in order to encourage the Mediterranean style approach to eating and the benefits linked to longer life and wellbeing.

In care home settings, there are between 50-70% of residents living with dementia.5 Approximately 70% of these will develop a swallowing difficulty and it is estimated that 70% will be at risk of dehydration, while 50% will be at risk of malnutrition.

Dysphagia is linked to all neurological conditions and requires great care and flexibility as it becomes more pronounced with disease progression. UK dietitians and speech and language therapists are currently working closely with health and social care staff and caterers to support the widespread implementation of the IDDSI guidelines.6 Care cooks do not always have the specialist catering skills needed to prepare appetising, safe and varied texture modified meals and snacks.

In Highland we are currently investing in this staff group by developing a bespoke catering qualification in conjunction with University of Highlands and Islands (UHI), the Care Inspectorate, local care providers and Scottish care.

Dementia should no longer be viewed as a specialist topic of practice since dietitians are likely to work both directly and indirectly with service users and family members who live with the condition. Their skill is to translate the science of therapeutic dietetics into a practical level of understanding for the

Evelyn Newman Nutrition and dietetics advisor: care homes NHS Highland Award winning dietitian, Evelyn Newman, is well known throughout the profession for her writing, volunteering with the BDA and innovative work.

She currently holds a unique role in The Highlands. @evelynnewman17

REFERENCES Please visit the Subscriber zone at NHDmag.com

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SOCIAL CARE

wider population. Public health colleagues have an important role in promoting the preventative benefits of healthy eating to live well for longer.

Clinical dietitians will have greater opportunities to influence and encourage nutritional support for those who lose weight and have altered eating behaviours linked to living with dementia.

In the Highlands, health and social care staff have proactively promoted the benefits of a person-centred food-first approach to living well, encouraging carers to engage people with dementia in proactively making choices about what meals, snacks and drinks are provided to them. One method, which has been successful, is ‘Strictly come dining’, where residents are given small portions of foods to try; they then rate them using a visual thumbs up or down sign.

Here are some other suggestions: • Building tasting sessions into activities also allows people to try a broader range of food than they might feel confident about choosing themselves, eg, using a buffet selection of crackers, oatcakes with a variety of cheeses and patés. Taste-testing a variety of flavours of squashes, smoothies and juices encourages a higher fluid intake and reduces ‘menu fatigue’, whilst also influencing the choice of drinks available.

• Food tasting can also encourage people to reminisce, eg, offering residents a choice 44

www.NHDmag.com March 2019 - Issue 142

of older style biscuits, such as Penguins, Wagon Wheels, Club, Jammie Dodgers etc, or a selection of ice lollies, such as Fabs, Rockets, Mini Milks, Strawberry Splits.

• Asking people to recall their favourite, or childhood, celebrations, such as Christmas, Easter or birthdays, will often unlock a memory of the type of food and drink that was offered, who was there and a whole host of other social history that many of their families may not even be aware of.

All this information allows staff to consider the best way of testing new menus and tempting people to eat and drink better.

• ‘Show and tell’ at mealtimes allows residents to choose meals at the point of service, taking a sensory perspective (how it looks and smells) rather than expecting people to choose from a menu.

• Occupational therapy colleagues can offer helpful, practical advice too. For example, the use of coloured plates and cups against a background of a plain tablecloth has been shown to support more independent eating and drinking, and is used to support people to eat better in many of the care homes across Highland.

My role includes supporting the thousands of unpaid carers across the Highlands in raising awareness of how best to support loved ones to eat well and live well. Carers Scotland provides a range of useful, evidence-based resources, offering ideas to help carers help their loved ones.7 Food fact sheets, covering a range of dietary topics and key facts about the role of dietitians working with dementia, are helpful resources to encourage self-care and support an easy access evidence-based learning culture for staff, whether they be carers or cooks.8 I conclude by challenging colleagues to consider how they proactively adapt their practice to engage the views of people living with dementia and develop a truly personcentred model of food, fluid and nutritional care.

Suggested reading Blog: Let’s Talk about Dementia: www.alzscot. org/talking_dementia Twitter @AhpDementia