How does Dementia effect a person’s ability to enjoy their hobbies and participate in activities?
What is Nutrition Therapy and who can benefit from it?
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. The mechanisms underlying weight loss and under nutrition in dementia are complex, multi factorial, and unique to each person. Common reasons include reduced appetite, increased activity, the need for a modified diet and, decreased nutrient absorption. For some forms of dementia, it may be that central regulation of appetite and metabolism is disturbed as an inherent feature of the disease. Although we can’t avoid these symptoms which lead to malnutrition and under nutrition, we can manage them with a variety of Nutrition Therapy Options. Orchard at Tucker’s Nutrition Therapy Program is designed to help combat under nutrition and bring back the joy of eating to those who have lost it.
We are in the Final Testing Stages..
After many months of work with our team and partnering dieticians, Orchard Senior Living is in the Final Testing Stage of our 4 Part Nutrition Therapy Program. Today’s enriched smoothies were a huge hit. These enriched smoothies are designed to help those in the moderate to severe stage of dementia, who have lost significant weight in the last 6 months, and for whom all other care and environmental modifications have failed. Each 4 oz pretty glass delivered 240 calories, 9 grams of Organic Protein, and so much more. Most importantly each glass looked and tasted amazing!
Challenges at mealtime are extremely common for those with dementia. These mealtime challenges will change as dementia progresses. There are distinct and separate challenges that are associated with early, middle and late stage dementia.
What are the common mealtime challenges for those in the Early Stage of Dementia?
- Loss of concentration
- Changes in food preferences
- Reporting that foods taste bland (foods previously enjoyed)
- No longer enjoying favorite restaurants
- Unable to hold attention through a meal
- Distracted by the environment at mealtime
What are the common mealtime challenges for those in the Moderate Stage of Dementia?
- Confusion and unawareness of surroundings, place and time
- Appetite increase and weight gain
- Decreased appetite and weight loss
- Failure to understand proper use of utensils
- Refusal to sit during meal times- pacing, wandering
- Increased difficulty with word finding and decision making
- Unable to recognize food temperatures
- Unable to see food as food (may think food is poisoned)
- Unable to recognize food items once liked
- Hiding of food
What are the common mealtime challenges for those in the Severe Stage of Dementia?
- Preference for liquids over solids, due to appetite change or lack of swallowing ability
- Aggressive or combative behaviors during a meal
- Clenches jaw, or closed fist when attempting to feed or be fed
- Refusal to eat due to unknown reasons (variety reasons could be at play)
- Inability to self feed, not being used to being fed
- Swallowing impairments ranging from mild to severe
- Weight loss despite regular caloric intake (can also be due to increase activity due to increased anxiety)
What are some important tips for a creating a dining environment for those with Dementia?
- Tableware contrast ( avoid white plates on white linens)
- Too many utensils
- Avoid high gloss floors
- Natural light is best
- Avoid a distracting dining environment with too many items on the table
- Make sure the table and chair is sturdy, and of the right height
- Simplified dining room is best
- All food served at once is usually best (although there are some exceptions)
- Offer finger foods (avoid finger food that are too intricate or rare)
What if the above tips do not work?
If the above tips do not help with the challenges presented at mealtime, your team needs to take further steps to make sure that nutritional needs are met and your resident with Dementia is getting adequate caloric intake and the necessary nutrition.
The first thing your team needs to do is to do a full assessment of each person’s unique situation and determine the specific deficiencies caused by the mealtime challenges. During the assessment your team must set goals and prioritize the deficiencies, identify resources needed based on the severity of a person’s challenges. Your team needs to also identify possible behavioral and nutrition interventions such as a change of dining environment. Finally your team should specify the time and frequency of the intervention.
Please check back soon for Part II of this article
What is Dementia?
Dementia is the loss of many or all cognitive abilities, such as thinking, remembering, and reasoning, as well as behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.
What happens to many caregivers of loved one’s with Dementia?
Caring for a loved one with dementia can be challenging and, at times, overwhelming. Frustration is a normal and valid emotional response to many of the difficulties of being a caregiver. While some irritation may be part of everyday life as a caregiver, many caregivers feel feelings of extreme frustration. Frustration and stress negatively impact their physical health and may cause a caregiver to be physically or verbally aggressive towards their loved one.
What are the Warning Signs of caregiver frustration?
Shortness of breath or knot in the throat
Stomach cramps or chest pains
Headache which could be severe
Compulsive eating or excessive alcohol consumption
Increased smoking or drug use
Lack of patience or the desire to strike out
- Sleepless Nights
Why is dementia education important for families caring for loved ones with dementia?
Dementia is called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone. Education helps caregivers understand their loved one’s challenging behaviors and how to respond to them correctly. Often starting out caregivers use intuition to help decide how to respond to a challenging behavior. Unfortunately, dealing with Dementia is counter intuitive, and often the right thing to do is exactly opposite of what seems like the right thing to do. Caregiver education also helps families understand the progression of their loved ones disease. They will learn what to expect and therefore have an opportunity to prepare for these changes. Changes in their loved one’s cognitive abilities wont be a shock every time they happen, because a caregiver will be prepared for them to happen. Caregivers will also learn which skills are typically retained the longest and can tailor their interactions with their loved ones’ based on these abilities.
How can communities help educate dementia care givers?
- community workshops and educational forums
lecture series followed by discussion
skill-building groups, case studies
individual counseling and training
technology-based training that can be done at home
At Orchard Senior Living, we find all of the above methods useful. Each of these methods should be utilized by a community whose priorities are to provide comprehensive dementia care to their residents and their family caregivers. Currently we offer our 3 Step Navigating the Transition Program to individual and families. We also offer our monthly 2 hour Live and Learn Series which combines skill building, lecture, discussion, as well as an educational forum. Both of these programs are presented by a dementia specialist, specializing in family counseling and dementia training. We also offer a support group facilitated by a Clinical Social Worker. We are currently in the final stages of bringing a web based training program to our residents’ family members to help them on a daily basis. We believe comprehensive dementia care is more than the traditional model of a secure memory care, care partners helping with ADLs, and an Activity Calendar. Comprehensive Dementia Care is taking care of a resident and their families from the time prior to a move in, as well as throughout their entire journey. To find out about the Comprehensive Care Programming at the Orchard call us at 404-775-0488 for a private counseling appointment to determine how we can help. If we can’t help you in your unique situation, will will provide you with the information for those who can.
Which last longer for those with Dementia or Alzheimer’s Disease? Memories or Emotion?
Have you seen long lasting emotions in a loved one with Dementia or Alzheimer’s after the memory causing the feelings have faded? I have on many occasions. Although I have seen it live on so many occasions, there is now science behind it. It’s no surprise that people with Alzheimer’s have trouble recalling memories. It is, after all, the hallmark symptom of the disease. However, a new study has found that events can have a longer term and profound effect on how they feel even if they do not remember the particular event.
A new University of Iowa study further supports an inescapable message: caregivers have a profound influence—good or bad—on the emotional state of individuals with Alzheimer’s disease. They may not remember a recent visit by a loved one or having been neglected by a loved one, but those actions can have a lasting impact on how they feel. University of Iowa researchers also showed individuals with Alzheimer’s disease clips of sad and happy movies. The patients experienced sustained states of sadness and happiness despite not being able to remember the movies.
The Emotional Life of those with Dementia and Alzheimer’s Disease….
These studies confirm that the emotional life of those with dementia and Alzheimer’s disease last far beyond the tangible memory of an event, regardless if the event was good or bad. “This confirms that the emotional life of an Alzheimer’s patient is alive and well,” says lead author Edmarie Guzmán-Vélez, a doctoral student in clinical psychology, a Dean’s Graduate Research Fellow, and a National Science Foundation Graduate Research Fellow.
The Take Away…
Despite the considerable amount of research aimed at finding new treatments for Alzheimer’s, no drug has succeeded at either preventing or substantially influencing the disease’s progression. Against this foreboding backdrop, the results of this study highlight the need to implement new care giving techniques and care models aimed at improving the well-being and minimizing the suffering for the millions of individuals afflicted with Alzheimer’s. These studies prove that traditional thinking about the emotional life of someone with Dementia and Alzheimer’s Disease is lacking immensely. Traditional thinking still tries to convince people that if they don’t remember it does not matter. At the Orchard at Tucker, we feel it Not Only Matters, but it Matters More. Although these studies are wonderful, we see the importance of emotion based care each and everyday by watching our residents.
Why is our brain so important?
The brain is the most important organ in the human body. It controls and coordinates actions and reactions, allows us to think and feel, and enables us to have memories and feelings. Furthermore the brain runs everything. It is the guiding, maintenance, and managing system for hundreds of a human beings needed abilities.
When does dementia occur? The quick answer…
Dementia occurs when the brain is damaged by disease. Sometimes it is one part of the brain, sometimes it is multiple parts.
To understand dementia, we must first understand the brain…
The brain can be divided into different parts: the brain stem and cerebellum, the limbic system, and the cerebral hemispheres. Each part has different functions.
Brain stem and cerebellum…
The brain stem is at the base of the brain. It controls basic bodily functions such as heartbeat and breathing. The cerebellum
controls balance and posture. Breathing and staying upright are things that we normally do automatically.
The limbic system…
The limbic system is deep inside the brain. It links the brain stem and the cerebral hemispheres. The limbic system includes structures with key roles in memory (the hippocampus) and emotions (the amygdala). The limbic system is the first part of the brain to develop and is sometimes referred to as our “primal brain” and manages many of our survival reflexes. It includes the amygdala which is in charge of the “flight, fright, fight response.
The tissue that makes up three-quarters of the brain is called the cerebrum. It is responsible for consciousness, memory, reasoning, language and social skills. A deep groove that runs from the front to the back of the cerebrum divides it into left and right halves: the two cerebral hemispheres.
The left and right cerebral hemispheres have different functions. For example, language is usually dealt with mainly by the left hemisphere. In contrast, awareness of where things are around us is usually dealt with mainly by the right hemisphere.
The four lobes are: occipital, temporal, parietal and frontal lobes. Each lobe does different things, though they also work closely together.The lobes are responsible for our senses. There are 5 ways human beings take in information (data) about the world through their nervous system.. What you see, hear, touch/feel, smell, and taste.
The lobes are some of the first areas effected by Dementia..
Dementia diseases often impact abilities in the occipital lobe of the brain which affect a person’s visual field. Dementia commonly affect the temporal lobes asymmetrically; typically attacking left temporal lobes before the right. This means more loss in language stored on the left, and more preserved skills for much longer. In dementia, different forms of damage to the lobes in the brain can cause someone to become either over-emotional or lacking in feelings. This is one of the reasons that a person with dementia exhibits changes in behavior along with memory loss. Sometimes the changes in behavior may be more pronounced than the memory loss. In these cases, many times dementia gets misdiagnosed since common thinking is, that dementia causes just memory loss.
What is the biggest misconception about the dementia brain and those with dementia?
Emotional memory is stored in the hippocampal area and is commonly a preserved skill. Persons living with dementia may not remember the details of what happened, but will almost always remember how an experience made them feel. Traditional thinking is if someone does not remember what they did specifically shortly after they did it, their day has less relevance, their life should be less purposeful. This is the biggest misconception in traditional dementia care. Those with dementia may get to a point that they don’t remember going to a great concert the next day, or helping to bake and delivering cookies to a police department, but they remember till almost the very end how much they enjoyed the concert, and how good they felt delivering those cookies over to those officers.
The Take Away…..
Orchard Senior Living is determined to bring a new type of dementia care to those inflicted with dementia. It is an engagement focused cognitive care model, where we focus on activities that will be stored in our residents’ emotional memories which they will have with them till they take their last breath.
- Nutrient Modification Diets such as renal diet, low salt diet, diabetic diet
- Texture Modification Diets such as puree diet, mechanical soft diet, liquid diet
- Food Allergy or Food Avoidance Diet such as gluten free or lactose free diet
- Supplemental Diet where additional supplements or fortification is added
What is a Preference Centered Therapeutic Diet?
A diet that takes into account the resident’s clinical condition or limitations, in conjunction with personal preferences, when there is a nutritional indication. It is designed based upon resident’s preferences and desires for their quality of life. Residents goals are also at the center of a preference centered diet. Residents must be provided with all of their nutritional options, detailed description of the need for therapeutic diets, and the consequences and risks associated with not following the recommended diet. A resident needs to be provided with every alternative available, as well as the recommended time frame for the diet.
Examples of a Preference Centered Therapeutic Diet?
Dan has been exhibiting chocking during his meals following his stoke. He has undergone a full evaluation by his doctor and speech therapist who both deemed Dan has dysphagia. Following this diagnosis Dan was prescribed a puree diet. His care partners then started turning his usual meals into puree form. Dan was presented with pureed steak, carrots, pork, and other foods he used to enjoy before the diet restriction. Dan has not enjoyed those pureed meals and has lost 20 pounds in one month. One of the care partners noticed that Dan will eat puree items that naturally come in puree form such as mashed potatoes, smoothies, yogurts and puddings. After these observations, a nutrition specialist created a menu for Dan that includes only puree items in their natural form. Additional flavors of mashed potatoes and yogurt along with other naturally puree foods were ordered in order to fill up Dan’s week with a healthy diet with a variety of choices.
Angie has heart disease. After an examination, Angie’s doctor placed her on a salt restricted diet. Following these orders, Angie has refused to eat most foods and lost 15 pounds. She complained that her food tasted bland and she did not want it. Angie’s care partners contacted her doctor and explained the dilemma and requested that the doctor look into liberalizing Angie’s diet. Angie was also explained in detail the risks and consequences of putting salt back into her diet with her current heart disease. Knowing all the risks, Angie deemed that at 90 years old her Goal was not prolonging longevity, but having the best quality of life. It was her preference to add salt back to her diet, understanding the risks. Her doctor felt that Angie and her family understood the risks and liberalized her salt intake. Angie gained 10 pounds the following month. She was able to enjoy her food again.
The Take Away..
Although therapeutic diets are sometimes necessary and beneficial to a resident’s health, a preference centered therapeutic diet just enhances the benefits buy focusing on the residents’ goals, desires, preferences, along with their nutritional needs and doctor’s orders. All five components work together to create a therapeutic diet that is beneficial to residents’ health yet minimally negatively impacts their desires and quality of life.
How does swallowing actually occur?
The oral phase of swallowing requires a complex interplay of chewing, food bolus formation, and push of the bolus to the back of the throat for the process of swallowing and movement to the esophagus and stomach. Multiple facial and oral muscles, such as the tongue, are responsible for this phase. Once the food bolus is to the back of the throat a series of muscular contractions occur to move the bolus into the esophagus and away from the airway. The airway is temporarily closed as the food bolus is pushed past the tracheal opening and into the esophagus. The food bolus then makes its way to the stomach through another series of coordinated muscular contractions within the esophagus.
Sounds Complicated Right? It is and lots can go wrong..
Due to the complexity of the swallow mechanism, a multitude of problems that can arise. The most common cause of oral dysphagia (swallowing trouble) is stroke, with up to 45 percent of stroke patients develop swallowing problems following the stroke. Other neurological diseases such as Parkinson’s disease, Multiple Sclerosis, Dementia, and Alzheimer’s disease are known to cause swallowing difficulties. Lesions, re flux conditions, and cancer have also caused swallowing troubles but to a lesser extent.
There are obvious and less obvious signs of swallowing difficulties…
Everyone knows that if a person coughs up food or gags while eating, they likely have swallowing troubles. However there are other more subtle signs that can go easily unnoticed such as long breaks between bites, being horse, drooling, frequent heartburn, and acid re-flux.
What can happen if these subtle signs are ignored?
If subtle signs are ignored they can result in choking, where food partially or fully obstructs a person’s airway, aspiration or inhalation of food or liquids, oral secretions or gastric secretions into the airway and lungs. Also gastric secretions may be inhaled without bacteria causing aspiration pneumonia. A person may aspirate not only food or fluids that are introduced into the mouth but also their own saliva or any gastric secretions, which may be re-fluxed into the airway.
What can be done?
In a community setting, all care partners must be trained to carefully observe each resident for not blatant signs such as chocking, but for the subtle signs such as drooling, and long pauses and usually get confused for something other than swallowing challenges. When a person lives alone, the signs of swallowing trouble usually go ignored until they end up in the hospital. In many setting, little attention is paid to dining room observation. Orchard at Tucker understands the importance of monitoring these subtle symptoms and finding the problem while it is minor, and before it causes a resident irreversible harm.
Transition and change in general is hard on everyone…
Have you ever moved into a new house? Started a new job? If you answered yes than you can recall your first week. Do you recall how stressed out you were with the change? Change of location, change of routine is hard on everyone, however having Dementia and Alzheimer’s makes change about 10 times harder.
Transitioning While Having Dementia? About as Hard as Sky Diving While Being Afraid of Heights..
Dealing with an aging loved one that has dementia or Alzheimer’s can be very stressful, especially when it is time to move that senior into an Assisted Living or Memory Care Community. Many families see how important a familiar environment is to their loved one. Being in a familiar place with a familiar daily routine is something that many with Dementia come to rely on. Families worry about the stress that can happen with their loved one during the transition. Stress is escalated in seniors whose cognitive capacity is limited by their Dementia or Alzheimer’s disease. This is a very real fear. Depending on the progression of disease, changes can be very upsetting and disruptive to the patient. Seniors suffering with progressive degenerative brain disease cannot frame their fears and anxiety with logic, as the rest of us can. A change in environment can often cause tremendous stress for the senior.
What is Transitional Care?
A private duty caregiver meets the senior prior to the move into a community and accompanies them to the community. The caregiver than spends between 4-12 hours each day for 3-14 days with the senior. They accompany them to activities and trips. The caregiver helps a senior learn their new environment. The caregiver stays with the resident for the scheduled hours. The caregiver is there at arm’s length if a senior gets anxious, confused, or stressed out. The amount of hours and days of transitional care depends on the seniors’ cognitive level, as well as their stress and anxiety threshold.
Why is Transitional Care Important?
Many seniors whose cognitive abilities are hampered by Dementia and Alzheimer’s, have heightened levels of anxiety. They also experience higher levels of stress in many situations. They also retain less new information, which makes change this much harder. The transitional care giver is there to help lessen the stress of transition by being there with the senior to guide them one on one. Once the senior is settled in their new home, the caregiver remains a part of their care plan until they have become accustomed to their new surroundings. A transitional care taker may start out by spending 12 hours with the senior for the first 3 days. After the 3 days, they spend 8 hours for the next 4 days. After the first 7 days, the hours go to 4 hours for the next 3 days. After that the hours go to 4 hours a week. Each senior is different, however it is recommended that transitional care giver hours get cut slowly based on the seniors’ needs. It usually takes about 30 days to get adjusted to a new community and getting a transitional caregiver involved softens that blow.
Do Communities Offer Transitional Care?
Some corporate giants like Brookdale do have their own agencies. Most smaller companies partner with an agency so that transitional care is provided by a caregiver that is not employed by the company. Orchard Senior Living now has a sister company Peach Home Care which provides transitional caregivers and private duty caregivers to residents.
Determining if your loved one needs additional nutrition care or nutrition therapy starts with a nutrition assessment.
What is Nutrition Assessment?
Nutrition assessment is a process that nutritionist or dietitian uses to evaluate your nutrition level and determining your current nutrition needs. Your nutrition level ranges from great to extremely deficient. The first step is to determine your individual nutrition needs for optimal health. This step includes knowing a thorough history of your diet, lifestyle, medical, chronic conditions. The second step is the evaluation of your nutrition status, calorie, protein and nutrient needs, adequacy of your diet, possible deficiencies or food intolerance(s), need for further testing, recommendations for diet and lifestyle changes and supplements.
Your Nutrition Assessment looks at all these areas:
- Diet history
- History of Weight Loss
- Recent illnesses or Diagnosis
- Lifestyle history
- Medical history (such as Dementia or Alzheimer’s)
- Evaluation of blood and diagnostic tests
- Recommendations for testing (testing for allergies, for vitamin deficiencies)
- Evaluation of nutrition status (how serious is the deficiency)
- Calorie needs (based on height, weight, activity level, sex)
- Protein needs
- Nutrient needs
- Adequacy of your diet
- Possible diet deficiencies
- Food intolerance
Identifying malnutrition is an important first step in identifying a problem. 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. 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. Although we can’t avoid these symptoms which lead to malnutrition and under nutrition, we can manage them with a variety of Nutrition Therapy Options. Orchard at Tucker’s 2018 Nutrition Therapy Program is designed to help combat under nutrition and bring back the joy of eating to those who have lost it. However it all starts with an nutrition assessment.