Preference Centered Therapeutic Diets in Dementia & Alzheimer’s Care

puree5What is a Therapeutic Diet?

A therapeutic diet is a diet that controls the intake of certain foods, liquids or nutrients. It is part of the treatment of a medical condition and are usually prescribed by a physician and planned by a dietician or a nutrition specialist. A therapeutic diet is usually a modification of a regular diet with items added or subtracted from a diet. Therapeutic Diet is modified or tailored to fit the nutrition needs of a particular person.
Types of Therapeutic Diets? There are many more than listed below..
  • 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?

Example 1.

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.

Example 2.

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.

The Subtle Signs of Swallowing Problems for Those with Dementia and Other Diseases

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,Nutella-Stuffed-French-Toast-with-Strawberries and before it causes a resident irreversible harm.

Transition Care Giving is Essential in Dementia Care

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.

Nutrition Assessment is a Part of Dementia & Alzheimer’s Care

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 Diagnosisexps21585_THCA153054D10_15_4b
  • 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

The Takeaway…

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.

 

 

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…