PAGE 36 | THE CARER DIGITAL | ISSUE 18
FOOD AND NUTRITION
Catering with Care
By Rebecca Bridgement, managing director at Radish
Care homes and assisted living environments across the country have been on the frontline of this pandemic and they have survived the unimaginable. Covid-19 has changed life as we know it, particularly so for the vulnerable. In the darkest days of lockdown, residents weren’t always able to leave their rooms. Visits from loved ones have been and remain restricted and, for many, social activities have either been paused or moved online. Across the sector, there has been a big change in behaviour and, five months on, in habits too. The experience of those in assisted living or care environments has changed dramatically, and leadership teams have been forced to find new ways to get through these troubled times – from entertaining residents and facilitating video calls with family members, to ensuring social distancing while promoting health and wellbeing. Nutritional health remains as important as ever but catering for care homes and assisted living environments during a pandemic isn’t without its challenges. For Radish, the catering arm of Churchill Group, a typical day is a lot busier than pre-Covid19. In fact, it’s flat out. The team have had to think on their feet and adapt quickly. It has always been important to protect food from harmful bacteria, viruses and allergens that could be spread by other activities, but this understandably has had to step up a gear since the outbreak. From taking extra care when preparing food and cleaning storage areas, to running
Are You in Need of Dysphagia Training*? Did you know that between 50-75% of nursing home residents suffer from dysphagia1? Nutricia has a training solution for you, a FREE e-learning covering the fundamentals of dysphagia management using Nutilis Clear. The training is divided into 4 sections and has been specially designed for busy health and social care staff caring for people living with dysphagia. It takes 60 minutes in total to complete, however you can complete one section at a time.
HOW CAN THIS TRAINING HELP YOU? • Easy & convenient online solution to dysphagia training • Visibility to track progress in your care home • Raise the quality standard of dysphagia care in a consistent way
training on everything from handwashing best practice to operational transformation to reduce human-tohuman contact, all while adhering to ever-changing government guidelines - it’s fair to say the new normal has taken some getting used to. As you can imagine, our business has had to transform since the outbreak first hit. The operations team at Radish are no longer allowed into the environments that are catered for; they are having to manage their teams remotely which is a completely different style of management. We have really upped our communications efforts to support our teams throughout this time. Other changes are afoot, too. For example, the onsite teams at assisted living sites have had to pair up in bubbles in order to work safely and effectively. Food is prepared in the kitchen, then packaged in disposables and delivered to the doors of residents. We are really proud to have fully recyclable and compostable disposable products so having to react quickly has not had any additional impact on our sustainability efforts. Instead of eating within a restaurant, residents are eating within their own apartments – and are therefore stripped of the social element that makes mealtimes so enjoyable. To make up for that, our teams are always thinking of the little things they can do to make people smile, to make these moments more memorable. On Victory in Europe Day, for example, we delivered a special afternoon tea. We’ve come up with other ideas to help boost morale on non-celebratory days, too, including the introduction of a cupcake competition across all developments, where the residents got to taste their delicious creations. Needless to say there are ongoing challenges and risks, but let’s take some time to appreciate what the care sector has managed to achieve. Despite everything it has had to deal with, there are many examples of how working practices within the sector have transformed to keep everyone safe and well, staff and residents alike. Coronavirus hasn’t gone away and we still need to do our bit to protect each other and the vulnerable, but I believe this pandemic is bringing out people’s caring sides. And since catering is about tapping into the little things that give people joy, we believe this is our chance to shine and to truly make a positive difference to residents in care and assisted living environments. for patients with Dysphagia to complete the modules as part of their induction programme. Existing health and social care staff members should also complete the learning to support their continuing professional development. There is a certificate that can be downloaded once the training has been successfully completed. Use the camera on your phone to scan the QR code to access the e-learning and get started! For any questions contact your local Nutricia sales representative or our Resource Centre at resourcecentre@nutricia.com. Nutilis Clear is a Food for Special Medical Purposes for the dietary management of dysphagia and must be used under medical supervision.
*This training is intended for healthcare professionals only.
The quality standards aim is for all new health and social care staff members caring
Tackling Malnutrition in Dementia Patients
By Gillian Farren, Registered Dietitian
NUTRITIONAL CHALLENGES Patients with dementia face numerous challenges, all of which can have a significant impact on their ability to eat and drink. In the UK alone, it is estimated that 3 million older people are malnourished or at risk of malnutrition.1 Alongside weight loss, key micronutrient deficiencies are recognised, with an estimated 35% of older people showing deficiencies in vitamins A, B12, iron and zinc.2 Although weight loss is part of the natural ageing process, dementia is recognised as a key contributor.3 Moreover, the link between dementia and weight loss strengthens as dementia becomes more severe.4,5 It is important to support dementia patients in eating and drinking well, as inadequate nutritional intake can make a person with dementia more confused.6 Recent guidance from NICE recommends that carers “encourage and support people living with dementia to eat and drink, taking into account their nutritional needs” and “consider involving a speech and language therapist if there are concerns about a person’s safety when eating and drinking”.7 However, dementia carers face specific challenges in supporting patients to eat and drink enough.8
DYSPHAGIA: A BARRIER FOR DEMENTIA SUFFERERS Dysphagia is a term used to describe difficulty or discomfort in swallowing food, fluids and saliva. Dementia is a well-recognised cause.9 Signs of dysphagia in people with dementia include coughing or choking; difficulties chewing; spitting out food; wet gurgling voice after eating; and food/drink spilling from or residue in the patient’s mouth after eating.10 If dysphagia is not managed appropriately, patients can suffer severe health consequences such as chest infections, aspiration pneumonia and choking-related death 9.
PROMOTING A SAFE SWALLOW The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard that describes correct and appropriate thickening of liquids and food texture modification, to ensure that they are safe to offer to patients with differing degrees of dysphagia.11 IDDSI gives clear descriptors for all levels of consistency, from level 0 (thin/unthickened) up to 4 (extremely thick) for fluids, and from level 7 (regular) down to level 3 (liquidised) for foods.11 It is vital that patients with dementia are only offered foods and drinks that are a safe and appropriate texture for their current level of dysphagia. This should be assessed and regularly monitored by a registered speech and language therapist. Many dementia patients dislike the taste and texture of thickening agents. Thus, products which do not require added thickener may be more acceptable, and can make it easier when patients with dementia are preparing their own drinks. Interestingly, research suggests that use
products which do not require added thickener can lead to increased food and fluid intake.12
PERCEPTION, DEXTERITY AND DISTRACTIONS Dementia often changes how patients recognise once-familiar foods, drinks and utensils.6 Additionally, preference for sweeter tastes and contrasting colours are commonly observed 3. Involving patients in preparing their own foods and drinks, alongside the use of adapted utensils and cutlery, and a reduction in distracting sounds, sights and objects at mealtimes, can encourage independence and focus, while preventing wandering off during mealtimes.13
USING THE “FOOD FIRST APPROACH” For patients with small appetites, foods and drinks can be enriched by adding foods rich in fats and sugars – such as butter, jam, cheese and cream – to increase energy and protein intake without increasing the amount of food eaten. This is referred to as a “food first” approach.14 While this is the preferred first-line strategy to tackle malnutrition, dementia patients can still struggle to meet their needs from food alone, and oral nutritional supplements or nutrition shakes such as NuVu Life are often recommended to fill the gap.15
HOW NUVU LIFE CAN HELP Made up with 200ml whole milk, one 50g sachet of NuVu Life delivers an impressive 362 kcal and 27.5g protein. When mixed with water or milk, it is IDDSI level 2 consistency. For patients requiring level 2 thickened fluids, NuVu Life removes the need for added thickening agents, thus saving time and reducing risk of error for carers and patients alike. Moreover, NuVu Life is enriched with vitamins and minerals, including those identified earlier in the article (i.e. vitamins A, B12, iron and zinc), which are a specific concern for older people. Just one 50g sachet on NuVu Life provides 100% of the recommended daily intake for these key micronutrients. NuVu Life is available to purchase online (www.nuvulife.com), RRP depends on the quantity purchased. Use voucher code TC30 to claim 30% off your order. For sales enquiries, or to request a sample of NuVu Life, please email sales@nuvulife.com or call: 07740 844 405.
REFERENCES: 1. Stratton R, Smith T, Gabe S. Managing malnutrition to improve lives and save money. BAPEN Report 2018. (available at http://www.bapen.org.uk/pdfs/reports/mag/managingmalnutrition.pdf ) [accessed 07 June 2020] 2. Maggini S, Pierre A, Calder P. Immune function and micronutrient requirements change over the life course. Nutrients. 2018; 10(10):1531. (Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212925/ ) [accessed 07 June 2020] 3. Prince M, Albanese E, Guerchet M, Prina M. Nutrition and dementia: a review of available research. Alzheimer’s Disease International 2014. (available at https://www.alz.co.uk/sites/default/files/pdfs/nutrition-and-dementia.pdf) [accessed 07 June 2020] 4. White H, Pieper C, Schmader K. The association of weight change in Alzheimer's disease with severity of disease and mortality: a longitudinal analysis. J Amer Geriatrics Soc 1998; 46(10):1223-7. (available at https://onlinelibrary.wiley.com/doi/10.1111/j.15325415.1998.tb04537.x) [accessed 07 June 2020] 5. Albanese E, Taylor C, Siervo M, Stewart R, Prince MJ, Acosta D. Dementia severity and weight loss: A comparison across eight cohorts. The 10/66 study. Alzheimer’s & dementia: the journal of the Alzheimer’s Association. 2013; 9:649-656. (Avaiable at https://alzjournals.onlinelibrary.wiley.com/doi/full/10.1016/j.jalz.2012.11.014) [accessed 07 June 2020] 6. Alzheimer’s Society. Caring for a person with dementia: a practical guide. 2019. (Available at: https://www.alzheimers.org.uk/sites/default/files/202003/caring_for_a_person_with_dementia_600.pdf ) [accessed 07 June 2020] 7. National Institute for Clinical Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97). 2018. (Available at: https://www.nice.org.uk/guidance/ng97 ) [accessed 07 June 2020] 8. NHS Education for Scotland. Supporting People with Dementia in Acute Care: Learning Resource. 2016. (available at: https://www.knowledge.scot.nhs.uk/media/11866144/supporting%20people%20with%20dementia%20in%20acute%20care%20final%202016%20web.pdf) [accessed 07 June 2020] 9. Holdoway A, Smith A. Meeting nutritional need and managing patients with dysphagia. Journal of Community Nursing. 2020; 34(2):52-59. (Available at: https://www.jcn.co.uk/files/downloads/articles/12-nutritionalneed.pdf) [accessed 07 June 2020] 10. Hansjee D. 5 Fundamental Ms: cutting aspiration risk in dementia and dysphagia patients. Nursing Times. 2019; 115(4):38-41. (Available at: https://cdn.ps.emap.com/wp-content/uploads/sites/3/2019/03/190327-5-Fundamental-Ms-cutting-aspiration-risk-in-dementia-and-dysphagia-patients.pdf) [accessed 07 June 2020] 11. International Dysphagia Diet Standardisation Initiative. Complete IDDSI Framework detailed definitions 2.0. 2019. (Available at: https://ftp.iddsi.org/Documents/Complete_IDDSI_Framework_Final_31July2019.pdf ) [accessed 07 June 2020] 12. McCormick S, Stafford K, Saqib G, Ni Chronin D, Power D. The efficacy of pre-thickened fluids on total fluid and nutrient consumption among extended care residents requiring thickened fluids due to risk of aspiration. Age and Ageing. 2008; 37(6):714–715. (Available at: https://academic.oup.com/ageing/article/37/6/714/40923 ) [accessed 07 June 2020] 13. Crawley H, Hocking E. Eating well: supporting older people and older people with dementia. Caroline Walker Trust. 2011. (Available at: http://www.cwt.org.uk/wp-content/uploads/2014/07/EW-Old-Dementia-PracticalResource.pdf ) [accessed 07 June 2020] 14. Forbes C. The ‘food first’ approach to malnutrition. Nursing and Residential Care. 2014; 16(8): 442-445. (Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/nrec.2014.16.8.442 ) [accessed 07 June 2020] 15. Robinson K. Nutrition and Dementia. Dietetics Today. Sept 2018; 42-43 (Available at: https://www.bda.uk.com/resource/nutrition-and-dementia.html ) [accessed 07 June 2020]