Providing Nutrition Care in a Dementia Care Facility

What Role Does Eating Play in Dementia?

Eating plays an important role in all our lives. Eating is often a social event, as
well as quality time shared with family and friends. Eating can also provide structure to the day.indeeee
For seniors with dementia, eating and drinking can become more difficult. They
may be less able to feed themselves and may also have a poor appetite or
lose interest in food, making it more challenging to achieve good nutrition.
This can be a source of great distress for both the resident and their family and also lead to malnutrition.

What Role Do Fluids Play in Dementia?

Drinking is also important for everyone, including for seniors with Dementia & Alzheimer’s Disease.It is important to aim for at least 8 cups of fluids a day. Fluids can include water, tea, coffee, fruit juice, liquid soup, and milk.
Although it is difficult for some people of all ages to drinking 8 cups a day, it is particularly difficult for seniors and extremely difficult for seniors with Dementia or Alzheimer’s. Some seniors with Dementia may not recognize that they are thirsty or even
may forget to drink all together. This lack of fluids can cause dehydration which leads to constipation, urinary tract infections and can also increased confusion and irritability.

Tips you can use to make eating easier for seniors with dementia?

  • Avoid distracting noises from television by eating in a dining room
  • Meal presentation must be appetizing, neat, and organized, as well as appropriately portioned.
  • Avoid serving meals of one color or one texture
  • Eating in company will enhance eating
  • Offer a variety of foods, including a variety of textures and colors
  • Provide frequent gentle reminding
  • Offer extra food if it seems a person is really eating well that day.

Tips you can use to make drinking easier for seniors with dementia?

  • Make drinks available frequently throughout the day, offer numerous times
  • Put the cup into the seniors hand to prompt them to drink, rather than leaving it on the table and them forgetting itdehydration-lead
  • Offer a variety of fluid options, not everyone will drink water
  • If you are offering water, put it in a pretty cup
  • Offer flavored water over plain water
  • Do not fill a cup that is too large and seems overwhelming

Dementia Care Combined with Comprehensive Nutrition Care

What is Comprehensive Nutrition Care?

Comprehensive Nutrition Care is a creative and comprehensive way to provide care. It takes a complete approach to nutrition care with the purpose of supporting individuals with chronic or life-threatening disease, and healthcare providers who support them, to better manage their health through optimal nutrition.

Why is Nutrition Care Needed for Dementia Care?

Eating and enjoying a meal is part of our everyday life and important to everybody, not least to people living with dementia. A healthy diet and nutrition is fundamental to well being at any stage of life and to helping to combat other life-threatening diseases. We believe it plays as important a role in relation to dementia progression, and a resident’s quality of life. Under nutrition is common among older people generally, particularly common among people with dementia. Under nutrition tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace as the disease progresses.

In what ways are the elderly susceptible?

  1. Age related changes in the gastrointestinal tract combined with changes in diet and immune system reactivity affect the composition of gut microbiota, leading to increased numbers of bad bacteria, decreased number of beneficial bacteria such as anaerobic lactobacilli and bifidobacteria.
  2. Osteoporosis is a disease which is characterized by decreasing bone density and increasing fragility of bones due to microexps21585_THCA153054D10_15_4b-architectural deterioration which increases the risk of fracture. Osteoporosis is exacerbated by malnutrition, low weight, poor intake of vitamin D and calcium, and in women, low levels of sex hormones.
  3. Older people need higher quantities of some nutrients, for example, calcium, vitamin D and vitamin B12 due to dementia and other physiological changes making absorption of nutrients more difficult. Studies show that calcium, vitamin D, folate, iron and vitamin B12 are the most important micro nutrients in which deficiencies commonly occur in older people.
  4. Physiological changes to the digestive system affect appetite which can affect nutrient intake. Protein energy malnutrition is common among older people with estimates that 1 in 10 people over 65 living in the community are malnourished. These numbers triple for the elderly with dementia.

     

How to Prevent Malnutrition in the Elderly with Dementia?

In order to prevent malnutrition in an elderly person with dementia, functional foods need to be added to their diet. Due to the age related changes that can make it more difficult for older people to obtain the nutrients they need from their diet, functional foods can have a role to play in improving nutrient intake.

What is a Functional Food?

Functional food is a conventional food product modified in some way to give a health benefit above and beyond basic nutrition. Functional foods can also be designed to fight a certain health condition. Functional foods are generally considered to be those food products which provide a specific health benefit over and above their basic/traditional nutritional value. Examples of functional foods are breakfast cereals with folic acid, yogurt with additional probiotic, vitamin D and calcium fortified orange juice are just a few examples.

The Takeaway..

An elderly person with dementia that has lost weight and is exhibiting symptoms of malnutrition, needs abundant additional assistance to get out of the malnutrition danger zone. Because of the chemical and physical changes, nutrition therapy may be the only option to help them stay healthy and thrive. Nutrition Therapy is a daily ongoing person centered care program that can change lives.

 

Proper Hydration Care is Essential in Dementia Care

Why is Proper Hydration Important?

Drinking fluids is crucial to staying healthy and maintaining the function of every system in your body, including your heart, brain, and muscles. Water and fluids carry nutrients to your cells, flush bacteria from your bladder, and prevent constipation. Dehydration is the most common fluid and electrolyte problem and one that can have devastating long-term effects.

Who is most at risk of getting dehydrated?

Seniors often don’t get enough fluids and risk becoming dehydrated, especially during summer when it’s hotter and people perspire more. Older people don’t sense thirst as much as they did when they were younger. And that could be a problem if they’re on a medication that may cause fluid loss, such as a diuretic.

What are the Symptoms of Dehydration..

 

  • Increased thirst
  • Dry mouth
  • Tired or sleepy
  • Decreased urine output
  • Urine is low volume and more yellowish than normal
  • Headache
  • Shriveled Skin
  • Dizziness and Vomiting
  • Muscle Weakness/Muscle Cramps
  • Increased Pulse Rate

Why is Dehydration so detrimental to Proper Dementia Care?

Dehydration increasesdehydration-lead confusion, causes muscle weakness and extreme fatigue. Increasing confusion in a person with dementia may lead to a dangerous and a negative event such as falling and breaking a hip b405bf69ae40082ad930857892a8991a. Increased muscle weakness in a person who already has dementia makes them many times more likely to have a fall and end up in the hospital or rehab.

How to Defeat Dehydration?

In a Community caring for residents with Dementia or Alzheimer’s, who are normally confused or forgetful, extra diligence in providing proper hydration as well as monitoring for dehydration is essential. Those who have dementia, need to be reminded to drink fluids throughout the day. Fluids should also be brought directly to the person with dementia and they should be encouraged to drink. Flavored waters in pretty containers are helpful and yield a more positive outcome. A group hydration station is a fun activity that could be done daily. A variety of colors and flavors should be offered each week, to keep hydration fun. You should also remind those with dementia and their family members that fluids will decrease pain, keep them more alert, reduce constipation, and keep them out of the hospital. Dementia or not, no one wants to go to the hospital.

 

 

Anxiety is Another Road Block to Dementia Care at Home

Common Psychological Conditions

Apathy, depression and anxiety are common conditions experienced by people with dementia. They are known as psychological conditions because they can affect a person’s emotional and mental health.

What is Anxiety?

Anxiety is a normal feeling that everyone experiences now and again. In
some people, however, these feelings can be very strong and persistent.
This can interfere with a person’s everyday life. Anxiety is the main symptom of several conditions, such as
anxiety disorder, panic disorder, phobias and obsessive
compulsive disorder.

Who gets Anxiety or One of the Related Disorders?

About one in 10 people will experience an anxiety disorder at some point in
their lives and many people will have more than one form. Anxiety is substantially more
common in people with dementia than those without.

Why do those with Dementia get Anxiety?

In the early stages of dementia, anxiety may be linked directly to a person’s
worries about their memory and about the future. Changes to the brain, caused by the
dementia, may also lead to anxiety. Anxiety in people living alone has been linked to unmet needs,
including a lack of daytime activities and a lack of company. As dementia
progresses, people become more disorientated and confused, more forgetful and worse
at thinking things through and planning. This constant struggle to make sense of the
world around them can therefore be an underlying cause of anxiety.

How to Manage Anxiety?

People with Dementia and Anxiety benefit from being listened to and reassured. Living in an environment where someone is always available if needed to reassure a person and to make them feel safe is crucial to minimizing feelings of anxiety. Other ways of helping include creating the right environment, so that their living environment is calmer and safer, and they have an improved structure to everyday life. Social Engagement is very important in soothing anxiety. Providing the right activities and encouragement for those with dementia and anxiety has been shown to be very effective. Productive activities include exercise and activities which have meaning for the person.

anxiety

Apathy is a Main the Road Block of Dementia Care at Home

HTML5-roadblock-ad-formatPsychological Condition..

Apathy, and anxiety are common conditions experienced by people with dementia. They are known as psychological conditions because they can affect a person’s emotional and mental health.

What is Apathy?

Apathy is a persistent loss of motivation to do things, or a lack of interest in things. It is different from depression. Many people feel short of ‘drive’ or ‘lose their ‘spark’ occasionally, but apathy is a consistent and persistent state of mind. Apathy is much more common among people with dementia than in older people without dementia. About 2–5% of older people without dementia have apathy at any one time, but
about 50–70% of people with dementia have apathy. These numbers are so significant that the relationship between dementia and apathy is unavoidable. Apathy can start at any stage of dementia but often develops early on. Many studies suggest that apathy becomes more common as dementia progresses. Once present, apathy tends to persist rather than come and go.

What are the symptoms of apathy?

A person with dementia and apathy will have less motivation, as well as
some or all of the following changes:

  • lack of effort or energy to do everyday tasks
  • lack of structuring their daily activities, and/or reliance on others to structure daily activities
  • loss of interest new things, such as meeting people and current events
  • lack of concern about their own problems or lack of planning to address these problems
  • unemotional responses to news or personal events (news or events that would have received an emotional response prior to the dementia)
  • lack of interest in friends and extended family
  • lack of interest in hobbies and activities previously enjoyed

What can be done to help?

Although numerous studies have found that brain changes as a result of dementia are the main culprits of apathy, it does not mean that a person with dementia who has apathy is not able to have fun or enjoy themselves. It means it will take more effort and creativity to accomplish this.  Creating as many opportunities as possible to socialize and reduce isolation is extremely important. Encouraging a person daily to perform activities that they used to enjoy is necessary and important. Having these activities close by and readily available is key. Creating an environment where activities are plentiful and different in scope is important. Addressing the apathy and isolation as soon as possible is key. The longer a person stays isolated the more likely that isolating lifestyle will become a habit that is harder to break.

The Importance of a Cognitive Care Community for Dementia Care

We All Age But…

There is no way to avoid the aging process. Our bodies age, we get new wrinkles in relative the same pace. The one difference is, our Brains age differently. The majority of us will encounter some level of age related decline, but some of us will experience a more pronounced level of cognitive decline and/or dementia. Although our chances of getting dementia increase with age, dementia is not a part of the natural aging process. Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease or a series of strokes.

Many Studies have been done Comparing the Aging Population with those with a Cognitive Impairment or Dementia…

There have been numerous studies done involving those with Mild Cognitive Impairment (MCI) or Mild Dementia that looked at how that impairment changed a person’s views about themselves. These studies showed that Cognitive Impairment showed  could profoundly affect a person’s understanding of their place in the world.

Two Groups of Seniors…..

Studies looked at two groups of seniors. One group of seniors without a cognitive impairment or dementia and one group with one or both of those impairments. Both groups described experiencing common memory mistakes such as forgetting names of friends and neighbors, misplacing common items, and repeating themselves in conversation. These incidents resulted in a variety of negative emotional experiences and self-evaluations that were expressed differently by the two groups. Participants with age-normal memory changes described feeling as if they are getting forgetful but attributing that forgetfulness to normal aging that happens to everyone and laughing it off as a goof. On the other hand the group with the  MCI or dementia felt “bothered,” “upset,” and “embarrassed” by their memory mistakes. They expressed some degree of self-doubt about their abilities and a tendency to put themselves down.  Some even said that their memory mistakes made them “feel stupid.”

More Differences Between the Two Groups of Seniors…

Memory changes showed to have important consequences for everyday social interactions and relationships with others. The changes described were generally positive for older adults with age-normal memory changes and generally negative for those with a MCI or Dementia. The group with normal memory change described a sense of camaraderie with their same-age peers who experience similar types of memory changes.  In contrast to the normal memory group, individuals with Cognitive Impairment spoke about how their memory problems have led to social withdrawal and isolation . They also stated that they “don’t get out as frequently,” that they are “withdrawing more from social occasions,” and even that they have become more “introverted.” There are a variety of reasons as to why memory problems have led to social withdrawal in the group with the Cognitive Impairment. Remembering friends’ names and shared experiences is an important part of social relationships, and failure to do this can be embarrassing or frustrating. For some individuals, withdrawing from social interactions is a way to avoid embarrassment. Seniors with a Cognitive Impairment, said they have more difficulty engaging in activities because their more significant memory problems leave them feeling lost, confused, or embarrassed. They describe feeling left out or disregarded in social interactions, thus causing them to withdraw from these activities to an even greater degree. In many cases the result is a loss of confidence which leads to withdrawal from social and leisure activities, and the consequent decline in participation in these activities results in increasing difficulty in these areas, followed by further loss of confidence and feelings of inadequacy.

What Happens when the Two Groups Consistently Interact….

In most cases Cognitive Impairment or Dementia will not get better. It is a progressive disease that only gets worse. Currently there is no cure. It is almost impossible to teach all those Without a cognitive impairment how to interact with those With a cognitive impairment correctly. In many cases they wont even understand or know what they are doing wrong. When seniors with no cognitive impairment consistently interact with seniors with cognitive impairment, the deficits of the impaired group become more and more obvious each day. These results lead to decreased confidence and ultimately isolation for the group that is cognitively impaired.

screensavers-widescreen-field-tulips-screensaverWhat is the Answer?

Although there is no perfect answer or a solution, the best answer is a Cognitive Care Community.  A community where all the residents have a degree of cognitive impairment and are grouped by the level of their impairment. In a Cognitive Care Community, residents interact with those that are on their level cognitively. They may be enjoying a lunch where all the table mates take turns telling the same story they already told. Because all of them are doing it, no one is made to feel worse than the other. There is no one at that table that will cut off a table mate mid story and say “you already told us that story”, “stop being repetitive”. All four leave the lunch feeling good about themselves without their deficit being in the forefront.  The goal is to make those good feelings last for as long as possible…

 

Mom Needs Memory Support not Memory Care

Does mom need Memory Support or Memory Care? Good Question

I would first like to start with saying that appropriate Memory Support prolongs the need for Memory Care. In a traditional community setting, those with moderate dementia are either not thriving in Assisted Living or have to move to Memory Care too soon. In my opinion providing the right amount of memory support is the toughest area of senior care because it is not strictly defined.

Can Memory Support ever be Strictly Defined?

The answer is No. imagesqqProviding Memory Support to someone with Alzheimer’s & Dementia is like providing a step stool for someone who needs a boost to see over a ledge. The difference is there are different ledges so different step stools are needed. Providing the right amount of support will enable a person to function as independently as possible. Providing too much support will further disable a person and result in a cognitive decline, and providing too little will hinder a person’s abilities to function and thrive. Cognitive Care is another way to describe Memory Support. Memory Care is a specialized care unit/section/or building where maximum cognitive assistance is provided and independence is limited. Memory Care is also usually a small, secure section, where activities and daily interactions are done in a group setting.

Types of Memory Support

  • have duplicates for commonly lost items, and also knowing the hiding places (for this group of folks, the less space they have the better)
  • know their schedule and guide the person through the day, personally guide to appointments and events
  • anticipate needs and provide assistance without being asked
  • explain tasks by breaking them into parts, with easy to understand sentences
  • know and understand the daily routine and provide assistance in a way that does not make a person feel that they need assistance
  • do not assume a person ate if you did not see them eat.
  • while providing additional assistance, make it seem like you are providing a regular service.
  • keep an eye on someone from 10-20 feet away so they don’t feel like you are hovering over them, but you are watching for safety.

Specific Examples

Jan is 78 and has Alzheimer’s Disease. She missed her last doctor’s appointment, hair appointment, and her favorite church concert. While living at home alone, Jan did not eat for 2-4 days, passed out and found herself in the hospital suffering from malnutrition and hydration. What could have been done to avoid these scenarios?

  • Keep track of Jan’s appointments, by helping her make them at a time when transportation is available, if transportation is necessary. Remind Jan earlier that day, make sure she is ready, and personally take her to the appointment.
  • Bring Jan to breakfast, make sure she gets it in front of her.  After breakfast, tell Jan the next meal is lunch and you will get her for that meal. This will put her at ease.
  • Everyday at 2 pm come to Jan with a pretty glass of water, encourage her, and then watch her drink it. Make sure Jan has a beverage in front of her for her meals and that she is drinking. Replace the beverage with an alternative option if needed.

The Take Away……

Many people are not getting the right amount of Memory Support in their current environment. I have found that there is a large percentage of those impaired with Dementia and Alzheimer’s that need more than Assisted Living, but less than Memory Care. These folks need another option. What they need is Memory Support/Cognitive Care in Assisted Living.

Specialized Memory Care for those with Alzheimer’s & Dementia

What is Memory Care?

When you ask this question you get a range of answers. You hear Memory Care is a specialized unit for Alzheimer’s & Dementia. You also hear it is a lock down unit that is separate from the rest of the community. You hear it is a unit for wanderers. You hear Memory Care is somewhere where specialized care is provided.

What is the Answer?

Depends who is answering. Technically a Memory Care Community or a Memory Care Section is where care is provided to those who exhibit symptoms and/or behaviors related to Alzheimer’s or one of the many Dementia Types. The thing is these symptoms and behaviors are vast and vary to different degrees, effect people in different combinations.

The One Size Does Not Fit All phrase I hear everywhere?000 one size

Every community claims that their memory care offers care based on each person’s ability. How is it possible to offer this type of individualized care in a unit where you have residents that are very active physically, residents who are wheelchair bound and have lost their ability to speak, residents that are prone to outbursts or inappropriate behavior?

The Answer?

You can’t. Unless you have a private caretaker or an activity coordinator for each group of individuals you are not able to provide individualized care and engagement because the abilities of the residents with Alzheimer’s or Dementia vary to such a large degree.

The Real Answer?

A Community has to be able to offer 3-4 levels (sections) of secure care for memory support. One of the sections should include the high functioning resident that is prone to wondering, and has an extroverted type of personality. One section should include high functioning residents that need memory support that are not prone to wondering and also have introverted personalities. Another section should be for those residents in the severe stage of Dementia, who have lost most of their language abilities, as well as independent movement. These residents will also likely need specialized diets, and nutrition therapy. The abilities of these residents are the most diminished of the 3 groups and their care and activities are set up accordingly.

The Take Away….

Although there may be a desire to provide individual care and engagement, that desire is not enough if the environment is not conducive to make that happen. Because the symptoms and behaviors of Alzheimer’s Disease and Dementia vary so greatly, it is imperative to separate residents within the community into smaller groups based on their cognitive and physical abilities. Once this is accomplished, a community is able to create the environment, the care structure, and an engagement plan to meet the need of the residents in each section or group.

Nutrition Therapy in Assisted Living & Memory Care

The energy and nutrients from the food we eat are necessary to maintain health, quality of life, to prevent injury and disease, and to manage chronic illness. With the aging of the population an increasing number of older adults are living longer but many are affected by chronic conditions. Many of these conditions, such as Dementia, Alzheimer’s Disease, hypertension, congestive heart failure, and diabetes, are responsible for changes in
diet and nutrient intake. It is very stressful when someone with dementia begins to lose their appetite, or is unable to continue eating a regular diet. As a person’s dementia progresses, their relationship with food also changes. It can become hard to maintain a healthy, balanced diet. The person may struggle with chewing and swallowing, and co-ordination problems could affect their ability to eat. They might have difficulty sitting still, or no longer be able to recognize hunger. One common issue is a loss of interest in food, which can be attributed to changes in taste, as well the need for modified diets.  Modification of food and liquid is an important management strategy for dysphagia in people with dementia. A puree diet is one of the most common diets for dysphagia. Now stop and imagine yourself having to start a puree diet tomorrow? Frightening? Depressing? Both? This is how those with dementia feel about that change. Although a puree diet may be absolutely necessary, it very often results in decreased food consumption with leads to loss of energy,  large amount of weight, as well as malnutrition. Imagine if this was put in front of you?pureed

Sample 1

I don’t know about you but I don’t know what that is in that bowl and I do not care. What I do know is, I can’t blame someone for not wanting that bowl in Sample 1, dementia or no dementia. In order to manage a puree diet and other modified diets, a Nutrition Therapy Program is necessary. What if I asked you would you rather have Sample 1 or Sample 2?

puree5                                                                                                                                     Sample 2

I pick Sample 2. A pretty plate nutrition therapy program makes a modified diet as appetizing as possible and in turn increasing consumption for those that truly need every single drop for a good quality of life.

As someone who had to follow a modified diet for weeks on end several times in my life including as recently as a few years ago, I can relate to this topic personally. Stay tuned for future blog posts featuring some of my favorite delicious recipes.