“Rabbit stew anyone?”

The role of a dietetic student in a care home

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The North Highland health and social care partnership supports a strong and integrated model of care for adults, including care homes. I was appointed as the nutrition and dietetic advisor for care homes in 2014 and took the lead in championing this work, along with Emma Pasieka (the Board’s dietetic placement co-ordinator), Urray House care home (part of the Parklands care group) and Dr Myra MacKenzie from Robert Gordon’s University. AHP practice education lead, Kerrie MacLean, advised and supported the group’s work using her experience of other AHP’s placements and in linking closely with NHS Education Scotland.

We developed a pioneering, first UK experience, of placing a student dietitian in a care home setting in The Highlands. In the course of the placement, the dietetic student and activities co-ordinator engaged with a group of residents with dementia and 2 of their relatives in remembering favourite meals from childhood, mainly from the wartime. Their memories and discussion then helped care home staff and the cook design a World War II themed lunch menu. It included scotch broth, rabbit stew and clootie dumpling.

Photo kindly provided by Urray House care home (part of The Parklands care group)

Photo kindly provided by Urray House care home (part of The Parklands care group)

The themed lunch was open to all residents and their relatives and we also had interest from the local press. Some of the comments from the day are recorded below from residents, relatives and staff, which sum up the event:

“Clootie dumpling was the best part”

“We always got clootie dumpling at birthdays and if you were lucky, you got a silver threepence”

“I was brought up on rabbits; they were tastier before the war”

“The food here is excellent and the chef has a real interest in food and nutrition: it’s great that she was able to prepare this meal for residents” 

“I think the whole idea was great. My mother was telling me about when she was little when her mother used to go to the butcher and get a rabbit for a shilling. She’d then sell the rabbit skin to a man that came round the houses; there’s no way she’d have remembered that without this themed lunch bringing back those memories”

“Having a focused discussion around food memories is a great way of engaging

with residents who have dementia and their families, giving them a voice in choosing their favourite menus and following up with a themed meal, where staff dress up to serve the food. Everyone can participate have fun and enjoy the memory.”

The work of the student dietetic placement demonstrated a successful innovative, multi-agency approach to placing a student dietitian in a care home setting, facilitating active conversations with people living with dementia. It worked particularly well with the people who can at times appear quiet or withdrawn. We were also delighted that our work was recognised at last year’s Scottish Dementia Awards as a runner up in “the most innovative partnership” category.

Dietitian Students in Care at Home Settings

We have built on the success of our work in the care home setting with our dietetic students and have been continuing to develop a model of practice placements in “care at home” settings. In NHS Highland alone 19,000 people receive care at home and the provision of adequate nutrition and hydration can be a challenge within this setting. Student dietitians rarely have the opportunity to experience the reasons for this, or the opportunity to present solutions.

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As a result, in 2015 NHS Education Scotland, the Care Inspectorate, NHS Highland, Robert Gordon University and Highland Home Carers agreed to go one step further than care home placements, and test another new model of training student dietitians; this time in the context of ‘care at home’ settings. You can find out more about this work in my blog post here https://ahpscot.wordpress.com/2016/01/11/care-at-home-pre-registration-training/. I believe that we are offering a great learning opportunity for our dietetic students while also supporting the needs of individuals and their families, in a very proactive, person-centred placement model.

Our experiences of implementing and evaluating a dietetic social care placement model has just been selected to be presented in a poster session at the International Congress of Dietetic Associations in Granada, Spain in 2016.

Reflections

Thank you for taking the time to read my blog post.

Food forms such a strong part of our social and personal memories and reminiscing about events can offer a fascinating insight to family & friendships, social history and opens conversations up with groups of people from all walks of life. So can I leave with this…..

“Think back to your memories of your 10th birthday party, what food & drinks were offered to all your friends & guests?”

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Evelyn Newman RD, NHS Highland, Nutrition and Dietetic Advisor: care homes, evelyn.newman@nhs.net

@evelynnewman17

Evelyn’s role as nutrition and dietetics advisor: care homes, is unique in the UK. She works within NHS Highland’s integrated adult social care team, working at a strategic advisory level, supporting the 73 care homes in the North of Highland. The role is very varied offering: many forms of training; tailored nutrition/hydration advice for care home managers; up to date food, fluid and nutrition policy and resource development and information.

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Allied Health Professionals

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Who are they and how can they help you?

Allied health professionals are a group of various health professionals who can support you if you have dementia. They are often referred to as AHPs and are registered with the Health and Care Professionals Council (HCPC). http://www.hcpc-uk.org
Allied health professionals are experts in prevention and rehabilitation and will help you focus on your abilities and strengths so you can stay connected to your community and live in your own home for as long as possible. There are several different kinds of allied health professionals and we designed a leaflet about those AHP’s you are most likely to see in a community setting including:
Dieticians to help you to eat and drink well
Occupational therapists to help you to continue with the occupations (activities) that are important to you from getting dressed to hobbies or going to work
Physiotherapists who you to stay active
Podiatrist who you to look after your feet
Speech and language therapists who help you with your everyday conversations and any difficulties you have with swallowing food and fluids.
For other AHP’s (arts therapists, orthoptists, paramedics, prosthetist, orthotists and radiography) visit http://www.ahpf.org.uk
It is best to make early contact with an AHP if you are worried about your memory or if you or someone in your family has recently been diagnosed with dementia. That way you can get the information, advice and treatment that is right for you and your family as quickly as possible. Our leaflet describes how AHP’s can help and how to get in touch with them.

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5 things you should know about the AHP leaflet
1. We designed the leaflet in partnership with the allied health professional bodies, who endorsed and supported the content of the section about their profession
2. We worked with the Scottish Dementia Working Group (S_D_W_G) and the National Dementia Carers Action Network on the content and language use

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3. We will be updating the leaflet at the end of this year and welcome comments on how useful the leaflet. Tell us your idea and comment on this blog or email us at TalkingDementia@Alzscot.org. We will also ask you during Scotland’s Dementia Awareness week (30 May-5 June)
4. We have already shared over 3,000 of the leaflets so far since its launch last summer
5. You can receive a copy of the leaflet 6 ways
• online http://www.alzscot.org/assets/0001/7456/AHP_Leaflet_for_launch.pdf,
• from an Alzheimer Scotland link worker
• from your local Alzheimer Scotland dementia advisor
• at your local Alzheimer Scotland resource centre
• from your local NHS AHP
• email us at TalkingDementia@Alzscot.org and we will send you a copy.

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Thank you for reading this blog. We look forward to hearing your views and ideas on our allied health professional leaflet and this blog?

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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.

Dietitians Week 2015

Dietitians in Dementia

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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 10th 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.

Knife, color plate and fork, isolated on white

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.

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

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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.

“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.