Dietitians Week 2015

Dietitians in Dementia

This week is Dietitians Week (8-12 June 2015) which is led by the British Dietetic Association (BDA) and was established as part of Trust a Dietitian, which highlights the work of the dietetic profession in the UK. The world’s first Dietitians Week took place last year: 9-13 June 2014, demonstrating and promoting the great variety of roles within the profession and the significant impact dietitians have on public health.

Dietitians Talking about Dementia at Scottish Parliament

This year the BDA Scotland Board hosted a Scottish Parliamentary Reception on Wednesday June 10^th to showcase the role of Dietitians and their work in the area of dementia. They invited all 128 MSP’s along with an external list of interested parties and all Scottish Dietitians. This area of work was chosen as dietitians play a vital part when working with people with dementia.  Dietitians can:

• Help you with diet and nutrition-related problems
• Provide you advice on appropriate food choices, the importance of hydration and eating environments
• Help to reduce the stress and distress that can be associated with eating when someone is living with dementia and
• Provide you with advice and support to family and professional carers who are involved in food provision.

Dietitians: Agents of Change in Dementia

At the event the three publications that dieticians have supported, the Alzheimer Scotland AHP leaflet and the carers resource were all shared at the reception. The links are at the end of this blog.  In addition to this, one of the many projects dietitians are developing was shared, below is the example by Sheila Riddoch

“A Good Meal: Important to everybody”

Eating and having a good meal is part of our everyday life and important to everybody, not least to people living with dementia. However dementia can greatly affect a person’s relationship with food and eating. Whilst the difficulties experienced vary from one individual to another the result is often weight loss and deteriorating health. Under nutrition is common among older people generally; and the consequences include increased frailty, skin fragility, falls, hospitalisation and increased mortality. In people with dementia, under nutrition is particularly common. It also tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace across the disease course. However, whilst weight loss is a common problem for people with dementia, under nutrition can and should be avoided.

Eating & Drinking: what does the research tell us

The cause of under nutrition in people living with dementia is often multi-factorial involving the behavioural, emotional and physical changes which take place as dementia progresses. However one of the common problems which people living with dementia encounter is a change in vision and a reduced understanding of what they are seeing. This led to research by a team at Boston University who showed that if we change what we do, and thereby allow people to see their food; they are much more likely to eat it. In context, what the team did was serve food to people with advanced Alzheimer’s disease on standard white plates and then served the same food to the same client group on red plates. What they found was that people eating from the red plates consumed 25 percent more food than people eating from white plates. The simple reason for this improvement was that the contrast in colours between the food and the crockery allowed people to see their food more easily and subsequently they were more inclined to eat it.

Implementing the Evidence: changing the crockery & tumblers

With this research in mind NHS Grampian trialled the use of colour contrast crockery and coloured reusable drinking glasses in a local assessment unit for older people. When compared to the use of the traditional crockery and disposable white tumblers, positive feedback was received.  Since the provision of a good quality eating experience is an integral part of the therapeutic care provided in hospital and the results of the trial were so positive, a decision was taken to introduce the new crockery & tumblers to all hospital wards in NHS Grampian. This is seen to be a very positive move given the fact there is a high number of people who could potentially benefit from high contrast crockery. This move also serves to ensure that there is a consistent approach across the Board and it supports equitable access whilst eliminating the ‘labelling’ of people with individual needs. 

On reflection, we have shared one example of how making a small change can have a large impact, it would be great to hear of other examples.

Further information on the publications:

http://www.alzscot.org/news_and_community/news/3197_three_new_publications_for_allied_health_professionals

Allied Health Professionals Dementia Champions: Agents of Change

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4051528/AHP%20Dementia%20Champion.pdf

Allied Health Professionals Delivering Post-Diagnostic Support: Living Well with Dementia

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4052050/02295%20AHP%20report%20on%20post-diagnostic%20support.pdf

Allied Health Professionals Delivering Integrated Care: Living Well with Community Support

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4056217/Integrated%20dementia%20care%20living%20well%20with%20community%20support.pdf

Alzheimer Scotland AHP leaflet

Eating Well with Dementia – a guide for carers. A guide for carers of people with Dementia, to support eating and drinking for nourishment and well being.

http://www.ndr-uk.org/vmchk/EDS/Eating-Well-with-Dementia-a-carers-guide.html

Sheila Riddoch,

Lead Dietitian, Acute Services, NHS Grampian

Sheila has worked in the NHS as a dietitian for over 30 years and been responsible for delivering a clinical service within a range of hospital services including Adult Acute Specialties; Continuing Care; Community Hospitals & Mental Health. Specialist areas of practice have been Care of the Elderly, Post Acute Rehabilitation and she has a special interest in Nutritional Support. For the past few years she has had a Lead role in supporting the delivery of good Nutritional Care throughout all hospitals in NHS Grampian, a role she undertakes as part of a core team including  NHS Grampian Nurse Consultant in Nutritional Care & Head of Catering Services.

Nutrition & Dementia : what you need to know

Food and drinks, a social activity

Food and fluids are a basic human need. However they are much more than this.  Food and drinks are often involved when we socialise with friends and family. We use them to celebrate special occasions such as birthdays and weddings or other key events in our lives.  What we choose to eat and drink also helps us to express our beliefs and who we are as individuals.  Providing food and drink to others can also be a way of showing hospitality to others or that we care.

So how can dementia affect what you eat and drink? 

Activities that had previously been second nature can often become more challenging such as cooking and shopping and even eating itself when you have dementia.  This can be frustrating and at times upsetting.  However there are plenty of things you can do to make sure you keep getting the right nutrients your body need to keep you healthy and well.

Seven Tips to Eating Well, if you have dementia

1. The more variety you eat the better! 

Try to include some meat, fish, poultry or beans/pulses at least twice a day.  Have a starchy food such as cereals, bread, pasta, rice or potatoes at each meal.  Have vegetables and/or fruit at each meal and include fruit as snacks.  The eatwell plate* below gives you an idea of how your meals should look.

2. Make sure you drink enough

Poor hydration can make you feel tired, lack energy, make you more prone to constipation and can add to memory problems.  Make sure you get at least 8-10 cups of fluid each day.  Be particularly careful during hot weather or if you are inside during the winter with the heating on high.

 

3. Get into good shopping habits

Make a list of items you need, ask someone to shop with you or try online shopping.  That way you are less likely to forget items you may need.  If you are not comfortable using new technology, some voluntary groups are providing sessions to let you try it out with support.

 

4. Keep to regular mealtimes where possible

If you sometimes forget to have meals try setting an alarm on your mobile phone to remind you.  Eat somewhere you find relaxing which is well lit and comfortable.  If possible eat with others as this can be more enjoyable.

 

5. Eat out

Why not arrange a regular lunch or a coffee date with friends or family.  You may also discover events in your local area such as community cafes that you might like to get involved in.  Ask local voluntary organisations, the library or check in local newspapers or community websites to see what is going on in your local area.

6. Enlist the help of friends and family

If preparing food is becoming a challenge – enlist the help of friends and family.  Cook in bulk and freeze portions away for later.  Label clear containers with the contents and when it was prepared.  Use ready or part prepared foods; these can include fresh, dried, tinned or frozen foods to make things easier.  Why not develop a check list or use recipes with clear instructions on each step.  You could even tick each step off as you go to keep you on track.

 

7. Seek further advice as needed

If you notice you have been losing weight without trying or you are not eating well for more than a week, then please speak to your GP or any other health professional for further advice.

 

I am inviting you to consider three questions as part of my blog post and would welcome your views and ideas:

1. What kind of information about your nutrition would you find most useful?  How would you like to access this information?
2. Do you know how a Dietitian could help you if you are having problems with your nutrition?
3.  What do you find most challenging about trying to maintain a good diet?

 

 

Gillian 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.

 

 

 

 

Useful links to support this blog post :

 

Useful resource if you are a carer 2Eating well with dementia A carers guide”

http://www.scotland.gov.uk/Resource/0044/00449379.pdf

 

BDA food facts providing advice on a range of nutrition topics https://www.bda.uk.com/foodfacts/home

Carers uk information on nutritional health http://www.carersuk.org/help-and-advice/health/nutrition as well as

Alzheimer Scotland pages on keeping well which includes a section on diet http://www.alzscot.org/assets/0000/0168/healthylivingwithdementia.pdf

 

*Eatwell plate is subject to Crown copyright  ‘Public Health England in association with the Welsh government, the Scottish government and the Food Standards Agency in Northern Ireland.’

 

A snapshot of what an allied health professional can do for you

 “People with dementia will have the opportunity to be included in community life and meaningful activities as they wish.  All services will give people with dementia the support they need, wherever they are living, to continue to be involved in their ordinary activities such as exercise, involvement in music, dance, social events and religious activity and to become involved in new activities and experiences”

This is a direct quote from the Standards of Care for Dementia in Scotland (2011) and reminds us all that people with dementia can be involved in everyday activities, both old and new.

The standard also states “services will give people with dementia the support they need”. In Scotland we invited my allied health professionals colleagues to share with us what they can do to support someone with dementia.  In this blog I am sharing a “snapshot” of how 5 of the allied health professions describe their role when working with people with dementia and their carers, partners and families.

Who are we?

Allied health professionals are registered therapists who can help when people are worried about their memory, if a person has a diagnosis of dementia or if someone in the family has dementia. They offer information, advice and treatment tailored to individual needs. They are experts in rehabilitation, focusing on strengths and assisting people to stay connected to their community and remain in their home for as long as possible. In no more than 50 words this is what they say they can do for you if you have a diagnosis of dementia or are caring for someone with dementia:

• Dietitian – will help you to eat well
• Occupational therapist – will help you take part in social activities, hobbies and interests that are important to you.
• Physiotherapist – will help with physical activity
• Podiatrists – will help you look after your feet
• Speech and language therapists – will help you maintain everyday conversations

 

How can a dietitian help?

A dietitian can assess, diagnose and treat diet and nutrition problems at an individual level.  Uniquely, they use the most up to date public health and scientific research on food, health and disease, which they translate into practical advice to help people make appropriate lifestyle and food choices.

 

How can an occupational therapists help?

The occupational therapist can help people to continue to do as much as they can in their daily lives, offering strategies to allow people to participate in social activities, hobbies and interests that are important to them. They understand the link between occupation and good health. They can advise people on small changes to the home environment to make life easier, recommending the right type of equipment to meet a person’s needs from memory equipment to kitchen equipment.

 

How can a physiotherapist help?

A physiotherapist can help if the person has difficulties with walking; experiencing falls or feel they are unable to access the activities they enjoy.   They can provide the person with advice on, or offer an exercise programme to improve strength and balance, equipment to help walking and help with accessing community services.

 

How can a podiatrist help?

Healthy, pain free feet are important in maintaining mobility and enabling people to engage in a range of activities and be an active member of the community. NHS Podiatry services are available for people who have a foot problem or have a medical condition requiring podiatric intervention. (Personal foot care such as toenail cutting is not provided by NHS Podiatry services).

 

How can a speech and language therapist help?

Speech and language therapists are experts in communication and interaction and help people who have difficulty with everyday conversations. They are also experts in eating, drinking and swallowing difficulties. The speech and language therapist’s aim is always to enable a person to participate to their full potential in their chosen activities.

We are collating this information, with a description of how to access these professions into a leaflet that will be available in the Alzheimer Scotland resources centres, on our mini bus, available from our link workers and will be in our offices throughout Scotland.  However we are really interested to know, when living with dementia or caring for someone with dementia “what matters to you and how can we help?”

Elaine 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.