Sharing our success

Occupational therapy assessment clinic in Fife

Development of the occupational therapy clinic

Increasing rates of referrals, people waiting for treatment, travel time, staff vacancies were just a few of the triggers to lead staff in the older adult mental health occupational therapy service in Fife to say:

We are not having people waiting 4-5 months for an occupational therapy assessment

We were also acutely aware that waiting months for an assessment was resulting in people with a cognitive impairment/dementia having deteriorated over this time, increase in stress and anxiety on carers and families as well as not having accessed other services and supports that they could have been receiving. This was not a positive outcome for people living with dementia, their families or the occupational therapy staff.

We considered a number of solutions to this issue, but all of them had an adverse effect on other parts of the service. So in a room covered in “post it’s” with various ideas and suggestions plastered across the walls – the Cognitive and Functional assessment clinic was born.

The solution, simple really, we invited people to the occupational therapy service to undertake functional occupation focussed assessments which were:

Claudia Allen Screening tool: This cognitive assessment tool measures global cognitive processing capacities, learning potential, and performance abilities.

Occupational Self-Assessment (OSA): The OSA is a tool that facilitates client-centred therapy and reflects the uniqueness of each person’s values and needs. The OSA self-report and planning forms assist the client in establishing priorities for change and identifying goals for occupational therapy.

Kitchen assessment:

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We had 3 members of staff for each clinic, 2 occupational therapists and 1 member of clinical support staff. The occupational therapists carried out the standardised assessments and the clinical support member of staff carried out the OSA.

We carried out a pilot of the clinic with the grateful assistance of some volunteer service users and identified that each assessment took 30 minutes to complete. Therefore, the full assessment process took 1.5 hours. We received positive feedback from the people who we worked with during the pilot stage who were comfortable attending an occupational therapy clinic within the hospital or seeing more than one therapist which had been an initial concern for us.

“An Occupational Therapy Clinic” 7 things you need to know

  1. We treated more people in a day, offering 3 appointments at one time over 4 sessions from 9:30am-11am, 11:30am-1pm, 1:30pm-3:00pm and 3:30pm-5:00pm.
  2. We reduced the length of time people were waiting to be seen by an occupational therapist to a month.
  3. We utilised the skills of our occupational therapy staff more effectively.
  4. We had the opportunity to assess people quicker allowing us the chance to signpost to services that people thought would be helpful, make referrals to other agencies more timely or engage the person in occupational therapy sooner if required.
  5. We linked people to the post diagnostic support service in Fife if they were not already receiving support from them.
  6. We worked with carers. We invited carers to attend the occupational therapy clinic if they wished and a member of staff was available to speak with them, to offer support, advice or information which all carers who attended found very useful.
  7. It is an award winning service which we highlight in the section on “what’s next”

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What’s next?

This service was a “win win” for all concerned. The Occupational Therapy assessment clinics are now running across Fife in the Mental Health Occupational Therapy service as standard clinical practice.

We are currently planning to pilot an extended AHP assessment clinic that will include physiotherapy, mobility and falls assessments, with the hope that this prevents unnecessary falls and identifies people who will benefit from targeted intervention earlier.

NHS Fife Occupational Therapy Cognitive and Functional Assessment clinic was recognised at the Advancing Healthcare Awards in London in 2015. Winning the category for maximising resources for success, sponsored by the Department of Health, Social Services and Public Safety, Northern Ireland Award and we are going to be sharing the experience of developing the clinic at the AHP national conference in November this year as we have been invited to do a presentation and workshop session for delegates.

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There was excellent evidence of service user involvement and leadership skills were very evident in bringing the team along the change process.”

As a service, we feel very strongly that it is important that as AHP’s we constantly challenge how we work and strive to make our services more efficient, relevant and accessible to the benefit of carers and service users: the challenge for us all continues and we are always developing the occupational therapy services in Fife to be innovative, more patient centred, effective and delivered to a high quality. The assessment clinic is just one example of innovation and creative thinking which has been successful for all.

On reflection

Thank you for reading my blog post and I would welcome any comments

  • I would also invite to share, if you are an allied health professional, what have you done do enable people living with dementia to directly access your service.
  • If you are living with dementia or a family member, what service from an allied health professional would you like access to?

Useful resources

You can read more about this work on pages 27-28 in the Alzheimer Scotland publication http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4052050/02295%20AHP%20report%20on%20post-diagnostic%20support.pdf

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For more information on the Chamberlain Dunn awards 2015, follow this link http://www.chamberlaindunn.com/AHA/documents/AHAAwards2015Compendium.pdf

I am proud to also share a picture of my family supporting everyone ‘Talking About Dementia’ – Lynn

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Pic 6Lynn Dorman

Occupational Therapy Professional Manager

@dorman_lynn

I work in NHS Fife Mental Health Occupational Therapy Service where I manage the adult and older adult service across 3 clinical hubs. I have been an Occupational Therapist for 20 years and spent most of that time working older adult mental health services so am passionate about improving services for people with dementia and their families, hence the development of the assessment clinic.

Dr Norma Clark

AHP Clinical Services Manager and Lead OT

@normaAHPMH

I work in NHS Fife Mental Health Occupational Therapy service as the Lead OT. I am also an AHP Clinical Services manager within Fife Mental Health Service. I am always thinking of creative an innovative ways to improve the quality and efficiency of services for people with mental health problems in Fife and together with Lynn, came up with the idea of the cognitive and functional assessment clinic.

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Building Bridges

Collaborating to Support AHP Placements in Alzheimer Scotland

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An inside-out approach to contemporary AHP Placements

From research we know that student placements have a huge impact on where students want to work and their understanding of who they want to work with. We also know that wherever our AHP workforce work, they will work with people living with dementia. We are in a great position to develop this opportunity from within Alzheimer Scotland.

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Within Scotland’s leading dementia organisation, there is an opportunity to work in a way that fits with evolving national and local dementia services to build meaningful relationships and systems that support sustainable AHP education and practice and connect to people who are living with dementia and those that support them.

For this reason we wanted to develop AHP student placements within Alzheimer Scotland with three aims

  1. Provide AHP students with undergraduate experience of working with people living with dementia, therefore contributing to the skills of the future AHP workforce
  2. Provide AHP students with first hand experience of working with and gain an understanding of Alzheimer Scotland as the leading organisation in dementia.
  3. Provide an opportunity for people who come to Alzheimer Scotland to work with a range of allied health professionals for mutual benefit

In this week’s blog we are sharing with you the first AHP students who worked with us 2014, we hope you enjoy it.

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Building Bridges: An Expanding AHP Placement Programme

Since making this film, we have expanded our AHP placements in Alzheimer Scotland and developed ten things we think you need to know:

  1. We are working with all four HEI’s in Scotland who educate our AHP students
  2. We are working with Glasgow and Clyde College who educate our AHP support workers
  3. We are developing links with St Johns University, York and Sheffield Hallam
  4. We will have offered 43 AHP students placements by the end of 2015
  5. We have offered AHP placements in occupational therapy, speech and language therapy, music therapy, art psychotherapy and physiotherapy
  6. We are developing AHP placements with dietitians
  7. We signed a Strategic Alliance with Queen Margaret University
  8. We have mentors and supervisors ranging from Alzheimer Scotland dementia advisors and Alzheimer Scotland AHP Consultant
  9. We are have developed 6 AHP Alzheimer Scotland AHP internships, 5 in occupational therapy and 1 in music therapy
  10. We are starting our first Alzheimer Scotland occupational therapy volunteer in the autumn

We are absolutely committed and passionate to work with our higher education institutions. We know the benefits of working with our new student population to people living with dementia, the benefits of student and interns to Alzheimer Scotland and the great projects and ideas the students and interns generate and implement when working with us.

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Reflection

Thank you for watching the video and reading our blog

  • We would welcome your thoughts or ideas on our developing allied health professional student placements in Alzheimer Scotland?
  • What has been your experience of working with allied health professional students?

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Adrienne McDermid-Thomas

Alzheimer Scotland AHP Practice Education Facilitator

@adrienneahpmh

My role is to build on a programme of work of developing AHP student practice placements, an AHP internship programme and AHP volunteer opportunities in Alzheimer Scotland supporting the aspiration that all allied health professional students are skilled in dementia care on graduation.  I have had some really positive experiences of joint AHP working in the past and am very much looking forward to this further opportunity to work together with AHP colleagues and Alzheimer Scotland to develop ways of working which are sustainable and best suited to meeting the needs of people living with dementia and their carers and families.

Elaine HunterElaine Hunter
Allied Health Professional Consultant, Alzheimer Scotland
@elaineahpmh 

My remit in Alzheimer Scotland is to bring the skills of AHPs to the forefront of dementia practice and to share with them the principles and practice of working in a major charity that is dedicated to “making sure nobody faces dementia alone”. I am leading the delivery of commitment 4 of Scotland’s Dementia Strategy. In short, a great job working with great people.

 

 

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 4 “Ask a Physiotherapist” by @lynnflannigan1

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Hello & Welcome

Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice (CSP 2015). Physiotherapists are specialists in enablement and rehabilitation who can support people with dementia to remain as active and independent as possible.

Physiotherapy can have a significant positive impact on some of the difficulties that people with dementia can have with their walking, balance and muscle strength. See below for what the new Alzheimer Scotland Allied Health Professionals leaflet has to say about physiotherapy.

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We asked people with dementia and their carers what questions they would like to ask a physiotherapist and this is what they asked;

Question 1

Can you offer any hints and tips about keeping the person with dementia mobile? Carer

There is an old saying most of us will be familiar with – “if you don’t use it you lose it”. We know that people with dementia are less active than those without dementia. Mobility problems in people with dementia may be caused as much by a lack of activity as by the dementia itself, therefore it is important to try to keep as active as possible. It is important that the person with dementia tries to keep doing the things they enjoy, especially if they involve physical activity and exercise. The main thing is not to sit for long periods of time as this can cause the muscles to waste and the joints to get stiff.

Sometimes a person with dementia will lose their confidence to do activities they used to enjoy. Their health or social care professional should be able to offer advice about this. Alzheimer Scotland also has a guide for carers around Activities – the link can be found at the bottom of the page.

If a person with dementia is having difficulty with their mobility then a physiotherapist can offer them some advice and may provide some exercises to help.

Question 2

How can you best help someone out of their bad or chair without hurting them? Carer

Unfortunately, it is possible to hurt someone when you are assisting them out of a chair or bed. It is also possible that the carer can be injured when doing this. The main piece of advice would be never to pull someone up by the arms as this can cause serious damage to the shoulder joint. The most common mistake people make is to rush the person with dementia or not to explain what you want them to do well enough. Always explain what you want the person to do, without giving too much information at the one time. It sometimes really helps the person if you show them visually first what you want them to do. Try to encourage the person to do as much for themselves as they can – only provide physical assistance if you have to. Sometimes moving and handling equipment will be recommended if the person with dementia cannot be assisted by another person safely.

If you are unsure about how to best encourage someone to be as independent as possible or to assist them where required, a physiotherapist can offer you advice.

Question 3

How do I prevent my mum from falling? Katy, carer

Falls aren’t an inevitable part of living with dementia, however, some of the symptoms can make people with dementia more at risk of falls. People with dementia can also have the same health conditions that increase the risk of falls as people who don’t have dementia. There are lots of different factors that can put a person with dementia at risk of falls. Of course we can all have a slip or a trip, however, there are some factors which will increase the risk of having a fall. These include; problems with mobility, reduced strength or balance, medication side effects, continence problems, problems with feet/footwear, poor nutrition/hydration, a history of previous falls, vision problems, hearing problems, dizziness/fainting, how you interact with the environment and confusion/dementia.

It is important that your Mum’s own individual risk factors for falls are identified so that where possible they can be reduced/managed. This is usually done by a health or social care  professional such as a physiotherapist using a multifactorial risk assessment, which is a risk assessment which looks at the most common factors which can cause falls . A personalised action plan should then be completed. Physiotherapists are commonly involved with providing exercises which increase strength and balance and therefore reduce the risk of falls.

General advice about how to reduce falls can be found in the NHS Scotland Up and About booklets which can be found at the link in the references section. NHS Inform also have a falls prevention webpage with a section on dementia and falls which can also be found in the references section.

Question 4

My mum (Mrs T) walks with a stick and is waiting for a replacement knee operation.  She’s always been independent and likes to do her own shopping, but recently fell outside her local supermarket when carrying her shopping and is now too frightened of falling to go out.  I think my mum is getting very depressed and I was wandering what aids (other than her stick) might be there to help mum keep her balance outside.

As her daughter has seen a fear of falling is a serious consequence of falls which can lead to low mood, a loss of confidence and a resulting restriction in activities. Restricting activities can then lead to a vicious cycle of further loss of confidence and physical deterioration which can further increase risk of falls

As a physiotherapist I would firstly want to assess why Mrs T is falling to see if I can offer any advice, provide an exercise plan or signpost her to other services to reduce her risk of falls. If her stick is no longer providing Mrs T will enough support and Mrs T was unsafe then I would consider providing her with a delta rollator which is a 3 wheeled rollator. As a physiotherapist I would always rather provide rehabilitation to avoid providing walking aids wherever possible, however, the right walking aid can increase mobility and confidence for some people.

References

Alzheimer Scotland Activities: A Guide for Carers of People with Dementia http://www.alzscot.org/assets/0000/0266/activities.pdf

CSP (2015) http://www.csp.org.uk/your-health/what-physiotherapy

NHS Inform Falls Prevention Page http://www.nhsinform.co.uk/falls/about/

NHS Scotland: Up and About Taking Positive steps to avoid trips and falls http://www.healthscotland.com/uploads/documents/23464-UpAndAbout.pdf

 

Lynn Flannigan

Lynn Flannigan
Up and About in Care Homes Deputy Project Lead
@LFlannigan

I am a physiotherapist with a special interest in dementia. I am currently seconded to the Scottish Government as part of the Up and About in Care Homes Falls Prevention Project.

 

Tomorrows Blog with be by Joy and “Ask a Speech and Language Therapist ” Q & A.

5th June will be by Joy @joysltdem

5th June will be by Joy @joysltdem

 

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 3 “Ask an Occupational Therapist”

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Welcome to day three of our AHP Dementia blog posts.  I’m really pleased to answer some questions as an occupational therapist.  People often think of occupational therapists as the people who provide equipment and while this is an important aspect of the role we can also help in other ways.  It’s about what people need to do and want to do in their daily lives, the habits and routines that we have and the roles and responsibilities.  But without any further ado I will answer the questions….

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“My mum used to be very creative.  Painting, dressmaking, soft furnishings etc.  I have bought pastels and crayons to encourage her to draw/colour in, but she thinks these are childish activities.  What approaches would the OT recommend?” Catriona, carer

Thanks Catriona, that’s a great question.  Supporting people to be involved in activities is so important but it can be challenging at times to get that “just right fit”.  For an activity to be enjoyable for any of us we need to find it interesting and relevant to our lives and it needs to be something that is realistic for us to do but not so easy that we find it boring.  Here are some suggestions for approaches to try and hopefully you will find something that helps.

  • Sometimes people might comment that an activity is childish if it is too easy or if the materials appear child like. If your mum was not previously interested in colouring in she might consider this an activity for children.  However, colouring in for adults has become quite fashionable and there are a number of colouring books designed for adults that you could try.  There are a range of designs with some very intricate but some more simple and lots of themes from the animal kingdom, art deco, flowers and geometric patterns.
  • I’ve found when using art as an activity that the type of art materials used can make an activity more or less inviting for people. Some of the materials which have worked well in my experience are colouring pencils which you can then apply water to and they look like watercolour paints, having a sketch book rather than sheets of paper, a simple paint pallet with a good quality brush etc.
  • Sometimes people can find it challenging to get started with an activity and creating the right environment can be helpful. Setting up a spot at a table with good lighting and the required materials in clear view can be helpful.  Your mum might also find it helpful to have some inspiration to get started with painting.  In the past I’ve used a selection of photographs as a starting point e.g. a beautiful scene, a familiar place etc something to trace can even work.  Sometimes taking a sketch book and pencils/paints out for a drive and seeing if your mum is inspired to do some sketching of a view.
  • Sometimes having a goal or an end product that is going to be used can make an activity more inviting. Here are a few ideas I’ve used in the past:
    • Using blank greeting cards or postcards which can then be sent or given to mark an occasion.
    • Scanning the finished art work and it can then be used to make a calendar, magnet, integrated into a printed photo book etc.

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  • Sometimes we assume that people will want to continue with an interest or hobby from the past. This is often the case but people can find it less enjoyable as they might compare what they are able to do now with their previous abilities.  If you have a few examples of projects that your mum has completed in the past you could use these to prompt a discussion and get a sense of how she feels about these activities now.
  • If your mum is still interested in her creative hobbies but doesn’t want to paint or colour in you could try:
    • Joint projects can be a good way to involve the person
    • Having a box of fabrics, threads, yarn etc that your mum can enjoy looking through and sorting.
    • Looking at patterns, photographs, books related to the interests.
    • Going to an exhibition or group related to the interests. You might find a session for people with dementia e.g. the National Gallery of Scotland runs a Social Gallery event where people with dementia can visit the gallery to see the art, join in a practical art session and have tea and cake (https://www.nationalgalleries.org/education/gallery-social-programme/ )

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The last question in this blog has some other ideas about finding activities that you might find useful too.

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If you do not have a CPN, can you still get help in the community if you need aids and adaptations in your house?  Alison, living well with dementia

Thanks for your question Alison, you do not need a CPN to get access to aids and adaptations.  If you think you would benefit from a piece of equipment you should be able to refer yourself via your local social work department or you could ask your GP to make a referral on your behalf.  Many councils have a selection of simple equipment that you can access directly e.g. a grab rail or cutlery that’s easy to grip.  This information will probably be available on the council website.

If you aren’t sure what you need or if you think you need a bigger piece of equipment or adaptation to your home then you can ask for an occupational therapy assessment through your local social work department.  You can usually do this via a telephone call or some council web pages have a form you can complete on line.

The web site “ask sara”  is another place where you can find out more information about equipment.  You can select an aspect of your health, home or daily life that you are finding challenging e.g. your memory, the stairs or communicating and the website will ask you some simple questions which will guide its recommendations.  It may suggest some strategies, sources of help and advice as well as equipment that you might be able to borrow or purchase.

If economics & person centred care are behind the drive towards greater care in the community, who is looking at the provision of equipment in the home to enable carers to care at home for longer? (e.g. wet rooms, hoists, bed raisers, rise & recline chairs, hospital beds.  It seems to be getting harder not easier to obtain support as local funds are being tightened.  How can we rethink ways in which expensive equipment might be safely repurposed and recycled?  Kathryn, carer.

Thanks for your question Kathryn.  This is a challenge indeed and it is being looked at by the Scottish Government (information available here).  The west of Scotland has a service which decontaminates and recycles equipment and this has been shown to save a considerable amount of money.  We can all play a small part in helping to recycle equipment too.  If you or someone you know has been provided with a piece of equipment which is no longer required then you can contact your council and ask for it to be collected, I’ve often come across equipment when I’ve been out to visit someone as an OT that people hadn’t thought they could return.

My father can no longer follow TV programmes or read books and my family are concerned about him.  He’s never been very outgoing and refuses to go to day care or any clubs.  They want to know what they can do to keep him occupied during the day?

Thanks for your question, sometimes people can find activities that use lots of language harder to concentrate on so reading and watching television can become tiring and less enjoyable.  Everyone is different but here are a few ideas to find things for your dad to be involved with:

  • What other hobbies and interests has your dad had? Did he enjoy gardening, watching or playing sport, listening to music, walking, painting, going to the theatre or cinema, photography etc.       This can be a really great place to start.
  • Starting with a few ideas of things that have interested your dad in the past you can have a trip down memory lane and chat about these things and your dad’s memories. That might give you a sense of how he feels about trying these things again.       Sometimes it helps to have a few props to hand to help the conversation e.g. a few photographs.
  • If your dad identifies something he enjoyed and would like to do then its finding a way to help him to do the activity (you might find some ideas in the answers to the first question on this blog too).
  • Your dad might need a bit of help to get started with an activity – it might be as simple as getting the things he needs out and putting them all in the one place, making sure there is good lighting and inviting him to be involved.
  • Your dad might find it easier to do an activity jointly e.g. doing some gardening with another family member.
  • There are an increasing number of dementia friendly initiatives in the community as a recognition that not everyone with dementia wants to go to day care they might want to keep going to the theatre or football just as they did before. There are an increasing number of events which are being advertised as being dementia friendly e.g. relaxed theatre performances with less people in the audience, shorter performances that are more visual and less reliant on language. Have a look online to see what’s available in your local area.
  • Some people find listening to music a really good activity that can be relaxing, spark memories and even inspire people to get on their feet to have a dance.  The charity Playlist for Life  has lots of useful information about using music that’s personal to the individual.

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  • Another activity which I’ve found works for lots of people is making a life story. It can be a good family activity gathering some photographs and stories together in a photo album, scrap book or box and then this can be used as a conversation starter or just an enjoyable book/box to look through. There is some really helpful guidance on life story work in the Communication and Mealtimes Toolkit  if you would like some ideas to get started.
  • Other ideas might just be in finding ways to keep your dad involved in the daily routines at home e.g. getting out for a walk to buy milk, helping out with washing the dishes, meal preparation, washing the car etc.

Thanks to everyone who submitted a question and have a look tomorrow for answers from our Physiotherapist colleague, Lynne.

We welcome ideas and comments from our readers about this blog.

Tomorrow’s blog will be by Lynn – “Ask a Physiotherapist” Q & A.

Jenny ReidJenny Reid
AHP Dementia Consultant (NHS Lothian)
@JennyAHPDem

My role involves raising awareness of the contribution AHPs make to helping people with dementia, their families and carers live well and supporting AHP service development, education and evaluation.  The national remit of my role includes producing the Dementia AHPproaches newsletter, leading a national pilot of the Tailored Activity Programme and supporting AHPs in the development of early interventions and supported self management for people living with dementia, their families and carers.

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 2 “Ask a Dietitian”

Hello and welcome to today’s blog.  The following questions were asked by people who care for someone with Dementia on the topic of nutrition.  Hopefully you will find the practical advice given useful.

Question 1

Tips on how to keep your loved one interested in food. ‘My mum’s diet is becoming more and more limited. By using dessert forks (they are light and pretty) she is continuing to feed herself.’ Catriona, carer

  • Try buffet style foods such as cut vegetable sticks, pork pies, quiche, pizza, cocktail sausages, fish cakes, fish or chicken goujons, bite sized pieces of meat or rolled up cold meat and cut pieces of fruit which your Mum will find easy to eat herself if she finds cutlery can be a problem.

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  • If your Mum is only using one piece of cutlery try place this in her dominant hand as a prompt.
  • Use food as a conversation starter or memory jog – if your Mum used to like to go to a particular place or enjoy a particular food trying having that food and taking about times when it was enjoyed before such as on a holiday or a family event. Use a cup that your Mum is familiar with to encourage drinks.

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  • Eat together where possible and talk about the taste and smell of the food as you are eating. Verbal prompts can help to encourage someone to eat better in a relaxed way.
  • Try foods which have a strong flavour such as sweet, sour or spicy foods or even foods your Mum previously didn’t include. You may find that what she enjoys has changed. As we get older we have fewer taste buds in our mouth.       In addition the signals to tell us what food look, taste and smell like are not always recognised when you have Dementia. Foods to try could include curries, lasagne, chilli con carne, sweet desserts, citrus flavour or simply adding some herbs or spices to regular dishes.

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Question 2:

Taking the stress out of mealtimes. ‘My mum will only eat food if plates are piping hot. As her vision is not great, I’ve been looking at tableware designed for people with dementia but it is really ugly, chunky and cannot be microwaved. Some of it is melamine so would not be suitable as it would never be hot enough. There don’t appear to be plain blue or red china plates around.’ Catriona, carer

  • Try ceramic plates which tend to hold more heat or use a plate warmer under regular crockery.
  • Encourage a relaxing environment – put on a piece of favourite music. Some people are able to concentrate better if there are no distractions, everyone is different.
  • Use a high contrast table mat under the plate.
  • Serve smaller portions at a time to keep food hot.       An additional portion can be given after if desired.
  • Ensure good lighting where your Mum is eating.

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  • Include bright coloured foods and foods which are high contrast to the background colour of plate e.g. dark on light or light on dark. Doing this will help to make foods clearer to see.

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Question 3:

‘My husband has always eaten well, but now refuses to eat anything which isn’t on bread.  Recently his iron levels were found to be very low and he’s had trouble with constipation.  The doctor says he must eat more fruit and vegetables, but he just leaves them on his plate.  What can I do?’ Anon

  • Adopt a flexible approach – your husband’s diet can still be healthy with a few modifications.
  • Add a topping such as egg (poached, scrambled), cold meat – red meats such as corned beef, roast beef, ham, lean bacon, dark poultry meat, pate, mackerel/sardines, baked beans- these are all good sources of iron. Try adding salad vegetables such as cucumber, tomatoes or peppers.

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  • Encourage a glass of orange or apple juice with the meal – vitamin C helps absorption of iron.
  • Some of the foods above will help to increase his fibre intake such as vegetables, baked beans but using a wholemeal bread, seeded bread or 50:50 bread would also help. You could also try crackerbreads, pitas, bagels or crispbreads for variety.
  • Ensure adequate fluids as being dehydrated can result in constipation.

Question 4:

My dad will only eat sweet foods and doesn’t like foods he previously enjoyed.   How can I ensure my dad gets a balanced diet?’  Jean, daughter

  • You can still achieve a balanced diet with sweet foods but this can be stressful when it doesn’t look like what we typically think of as a healthy meal.
  • Add fruit – dried, tinned stewed or fresh to desserts or cereals to add extra sweetness but also additional vitamins, minerals and fibre.
  • Include dairy based desserts such as custard, rice pudding, mouse, trifle, ice-cream, yogurts, fromage frais, semolina, whipped desserts, crème caramel or crème brulee.   Dairy foods are a good source of energy, protein and calcium.
  • Use naturally sweet foods such as baby plum tomatoes, carrots, parsnips, sweetcorn to enhance the sweet flavour of dishes and again add extra fibre, vitamins and minerals.
  • Try sweet sauces such as sweet chilli or sweet and sour in savoury dishes.       Alternatively try adding sweet condiments to savour dishes such as apple sauce with pork dishes, cranberry with game or poultry dishes, sweet chilli dipping sauce, mango or other types of fruit chutney.
  • Adding a little honey, syrup or sugar to naturally savoury dishes can also help to encourage them to be enjoyed.

Question 5:

How strong is the anecdotal evidence that organic Coconoil can ameliorate some of the symptoms of dementia, even if only in the short term? e.g. memory loss, aggression, concentration  What, if any, research is being done? And what is the incidence of dementia in countries where coconoil or coconut derivatives form a staple part of the diet?’ Kathryn, carer

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Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.  There are currently a range of foods being studied to exam whether there is any benefit in prevention or treatment of dementia.  There have been some reports recently in the press of improvement in symptoms for people with dementia who are using coconoil or coconut oil.  However to date there is no conclusive scientific evidence to support including coconut oil or coconut derivatives as a prevention or treatment for dementia.  As coconut oil is high in fat and in particular harmful saturated fat, large amounts of this in a person’s diet would not be recommended as this can increase risk of heart disease and vascular diseases such as stroke or transient ischaemic attacks (TIA’s).  However as with any food, if desired coconut oil or coconut products can be included as part of a balanced, healthy diet.

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 The British Dietetic Association website has food factsheets on a range of nutrition topics which you can download for free at:   www.bda.uk.com/foodfacts/home

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 As part of Dietitians week there will be an event at Scottish Parliament to highlight the role Dietitians can play in improving nutrition for people with Dementia.  If you would like to know more you can follow ahpscot.wordpress.com and letstalkaboutdementia.wordpress.com throughout Dietitian’s Week (June 8-12).

https://ahpscot.wordpress.com

We welcome ideas and comments from our readers about this blog.

Tomorrow’s blog will be by Jenny – “Ask an Occupational Therapist” Q & A.

 

image GMcMGillian McMillan
Specialist Dietitian – Mental Health

Gillian graduated as a Dietitian from Queen Margaret University in Edinburgh in 2000. Since then she has worked for NHS Lanarkshire initially in acute hospital services and laterally in mental health services. Over the past 10 years she has gained experience in this field and specifically the nutritional care of people with Dementia. She is currently a member of the allied health professional expert group working with Alzheimer Scotland to develop the role of allied health professionals in dementia care.