Improved Nutrition outcomes are within reach for those living with Dementia and other chronic illnesses.
A popular saying says, “We are what we eat.” A good diet is vital to everyone’s health, well-being, and quality of life. A person needs carbohydrates, protein, fat, fiber, minerals, vitamins, electrolytes, and water to survive. Obtaining the correct balance and quantities of these nutrients is essential. Insufficient nutrition and hydration can lead to deterioration of overall health, including mental health, as well as weight loss, dehydration, dizziness, increased risk of falls, prolonged recovery after surgery, change of mood, frequent colds, reduced strength, reduced mobility, reduced communication abilities, difficulty keeping warm, infections, as well as prolonged healing. Cognitive deficits such as Dementia, have a direct effect on a person’s nutrition. Malnutrition or under nutrition may occur at any stage of dementia. It is important to detect it and try to remedy this as early as possible.
Did you know? Up to 45 per cent of people living with dementia experience clinically significant weight loss over one year, and up to half of people with moderate or severe dementia have an inadequate food and nutritional intake. Some experience very quick weight loss, dropping to a withering 70-90 lbs. in a span of several months. As dementia advances, it’s difficult to ensure that those living with dementia are eating and drinking enough. Eating difficulties are also very common in those living with Alzheimer’s Disease. These challenges increase the risk for malnutrition and can worsen other health conditions a person may already have. There are numerous reasons for poor appetite to develop, including depression, communication problems, sensory impairments, change in taste and smell, pain, tiredness, medication side effects, physical inactivity, and constipation. Some people with dementia may lose their ability to concentrate, so they become distracted while eating and stop eating as a result. Other people may have trouble using utensils or raising a glass. It may also be challenging to bring the food from the plate to their mouth. Some people may need to be reminded to open their mouths to put food in it or even to chew. Another common problem in more severe dementia cases is dysphagia, which is difficulty swallowing. Dysphagia can lead to weight loss, malnutrition, or dehydration. Over time you may find that your loved one’s appetite declines or the taste of food doesn’t appeal to them. Sensory changes in sight and smell can impact their ability to enjoy food and mealtimes. Their likes and dislikes for food and drink may be quite dramatic and different from the ones they held for many years. They may also find it difficult to tell you what they want to eat.
Dementia and Alzheimer’s Disease are not the chronic conditions that often cause malnutrition or under nutrition. Other chronic conditions often impact a person’s nutrition. Many illnesses cause what is called disease-related malnutrition. Many people living with Parkinson’s disease, suffer from muscle weakness or tremors, which can make eating very challenging. Other diseases that often cause nutrition deficiencies are cancer, liver disease, COPD, and CHF to name a few.
In many of these cases, the malnutrition and under nutrition are severe, and all conventional methods have failed. Orchard’s State of the Art Nutrition Therapy Program offers hope for this group, a group that has not responded to traditional nutrition methods. Orchard has partnered with Gordon Foods and their team of experts and dieticians, as well as with dementia specialists to bring this revolutionary nutrition therapy to the community.
Join us on February 27th 4 pm-6 pm as we unveil our Nutrition Therapy Program to area professionals who are interested in helping our community battle this difficult problem. This event will be held at; Orchard at Tucker, 2060 Idlewood Rd, Tucker GA 30084. For questions or to RSVP for the event please email firstname.lastname@example.org.
What was the Inspiration behind this post?
Last week I had a doctor’s appointment with my primary care doctor. It was a 3 pm appointment. Here it was almost 4 pm and I was just getting called. When my doctor saw me, she immediately apologized and told me the reason for the delay. She said that today many of her patients had dementia, and those appointments take longer than the other appointments, yet they are scheduled for the same amount of time. My doctor knows I work in senior living, so she felt comfortable telling me her feedback of her experience with dementia patients. My Doctor told me that she spends a large part of the appointment counseling her dementia patients and their families. She also told me, the most frustrating part of her appointments with those with dementia, is explaining to them, that there is little she can do medically to alleviate the symptoms caused by dementia. She said many family members for instance notice their loved one with dementia has suddenly lost weight, and they want a prescription to combat that. She then has to give them the disappointing news that weight loss caused by dementia is a comprehensive symptom and can’t be fixed over night with a prescription. Needless to say, she was very excited to hear about Orchard’s Brand New 4 Tier Nutrition Therapy Program coming in 2018. For more information about Nutrition Therapy for Dementia please visit: http://stage-osl.daveminotti.com/final-stages-of-nutrition-therapy-development-for-dementia-residents/, as well as http://stage-osl.daveminotti.com/nutrition-therapy-at-each-level-of-dementia-care/
What Does Dementia Sensitive Primary Care Mean?
Dementia Sensitive Primary Care, are primary care services that are provided solely to individuals living with dementia. These services are provided by professionals that specialize in dementia, and in many cases only treat those with dementia. This type of care can be provided in a clinic or by a mobile service, by a medical professional ranging from a Nurse Practitioner to a Doctor. This clinic and or professional is designed to replace a person’s primary care provider that they had prior to the dementia.
What is an Example of Dementia Sensitive Primary Care Center?
The Integrated Memory Care Clinic, located in Atlanta, is a nationally-recognized patient-centered clinic that provides primary care for someone living with dementia. The clinic provides a variety of services to meet the challenging needs of those living with dementia. Whether the patient living with dementia has a cold, needs a vaccine, or has a change in behavior, the clinic can help. Dementia and other chronic conditions are managed exclusively by nurse practitioners who collaborate with geriatricians and neurologists on the team. The nurse practitioners have advanced training and specializations in dementia, geriatrics, and palliative care. A clinical social worker is also a vital member of the team. I personally know people that are patients at The Integrated Memory Care Clinic, and I know some of the professionals that manage it. I can say this clinic does an absolutely amazing job, and I would recommend it to anyone who is looking for Dementia Sensitive Primary Care.
Can Dementia Sensitive Primary Care be done outside of a clinic?
The answer is yes. I personally work with several medical groups that provide concierge dementia sensitive care in a person’s home. They can go to someone’s home or to their community. The group I work with closest has a team of professionals that provide the care. Their team is made up of a Geriatric Psychiatrist, a Nurse Practitioner and a Doctor trained in dementia care, as well as an Occupational and Speech Therapist. These professionals work as a team to define the patient’s cognitive, functional and behavioral profile, and create a care plan to manage their care. The extent to which each specific professional sees the patient depends on the patient’s needs and their profile. These services are offered in a person’s home, and at the Orchard, or another community.
Why do we need Dementia Sensitive Primary Care for those with Dementia?
Currently, 50-90% of all dementia gets misdiagnosed or gets missed all together until a crisis happens. Even if Primary Care Professionals start to more accurately recognize dementia, the quality of management of the disease after the diagnosis is usually sub optimal. Even if a PCP can diagnose dementia, in many cases they do not have a plan for follow up management. After dementia is diagnosed, there needs to be a plan of care set up to address potentially starting dementia-specific drug treatment to slow the decline, assessment and management of Behavioral and Psychological Symptoms of Dementia (BPSD), safety issues in and out of the home, side effects of psychotropic drugs, as well as the stress of family care givers. Most Primary Care Professionals today are not equipped to provide follow up dementia care. These PCPs are missing the coordination of primary healthcare partners, as well as the implementation of support for both people with dementia and their caregivers. Hopefully in the next few years, more Integrated Memory Care Clinics will spring up, and more people with dementia will receive the Dementia Sensitive Primary Care they need.
Are Patients with Dementia Smarter than their Primary Care Practitioners?
The answer is not necessarily, however patients with dementia work much harder to mask and hide their dementia from the PCP, than their PCP works to diagnose their patients’ dementia.
How Has the Role of a Primary Care Practitioner Evolved?
Due to the increasing numbers of people living with Dementia and Alzheimer’s Disease, primary care practitioners, are seeing their patient loads be filled with more and more dementia patients. Primary Care Practitioners are usually the first health professionals that either patients or their families contact if concerned about memory decline. However only 60% of the people who meet the diagnostic criteria receive a formal diagnosis of dementia. Failure/Misdiagnosis rates have been estimated between 50% and 80% for moderate-to-severe dementia and up to 90% for mild cases. PCPs are usually the ones who have a long relationship with patients as well as their families, so patients and their families usually turn to the PCPs for sensitive matters such as memory loss or other signs of dementia.
Why is there such as high rate of Failure and Misdiagnosis? The Too Simple of an Answer…
Most primary care practitioners do not specialize in dementia and therefore symptoms get missed. Most PCPs rush through the appointments and do not take the time to notice dementia symptoms. Another too simple of an answer, PCPs treat dementia like they do other chronic illnesses by prescribing medications and sending the patient home. Although there is some truth in all these answers, the real answer is much more complicated.
The Real-Life Reason there such as high rate of Failure and Misdiagnosis?
Although there is some truth in the simple answers, they don’t paint the entire picture. Understanding and diagnosing dementia takes more than just being familiar with the typical dementia symptoms and being able to recognize them. There are many symptoms of Alzheimer’s and Dementia that a person exhibits before significant memory loss. Many people and their families discount these symptoms as just general senility or some other problem. These symptoms include personality changes. A warm, friendly person may turn into a bit of a grouch, at first occasionally, and then increasingly. They may start neglecting some of their grooming habits slowly. A person developing dementia may start telling inappropriate jokes in wrong settings. Another symptom is developing a problem with executive functions, such as difficulty with familiar, tasks such as cooking. A person will start having difficulty doing something that involves multiple steps, or following instructions. Word retrieval and getting out the right words can become a problem, and it may be a while before friends and family notice the more common communication problem of repeating stories or questions. Problems with depth perception or visual-spatial coordination can also precede memory problems. Usually these difficulties get blamed on vision problems and not dementia. Apathy and social withdrawal are also common with dementia. All these symptoms often precede memory loss, yet can easily be justified as being caused by something else other than dementia. Until a certain point, these symptoms do not significantly impact a person’s life, and therefore get ignored, and ultimately dementia is not diagnosed. One of the largest culprits of a missed diagnosis is masking by the person that has dementia. People with dementia usually notice something is wrong and they do everything they can to hide it. So even if a PCP asks their patient about one of the above symptoms, the patient easily comes up with a pliable excuse, such as they are tired and don’t want to do a hobby, the weather is bad, they are stressed, they need new glasses, they are not sleeping well and therefore their mind is foggy, and on and on. If a person with dementia misses their appointment, they are likely to blame it on the doctor’s office, or someone else, and even avoid making future appointments all together, due to the fear of missing the next appointment. It is very difficult, if not impossible for a PCP that treats a spectrum of patients including those with dementia and without to be able to pick up on these subtle symptoms. They are not focusing on these subtle symptoms, and because many of their patients do not have dementia, dementia and its symptoms are not in the fore front.
Why We Rarely See a Person with Mild Dementia Move to Assisted Living?
Since upwards to 90% of people with mild dementia get misdiagnosed or missed, most people do not realize something is wrong until there are blatant symptoms that usually harm a person in some way. Most people do not notice or get alarmed with a few missed medication doses, until a person either takes to many pills, or takes too few, gets dizzy, and falls. Even in those cases, they go to the hospital and the fall is at the forefront, and not the dementia that caused a person to forget their medications and fall. Rarely do families notice that their loved one is not eating, until there is a significant and visual weight loss. Families usually do not notice that their loved one is neglecting their grooming until they look obviously disheveled. They don’t notice personality changes, until something out of character and usually embarrassing occurs in public, very often in church. Most people with dementia improve their masking abilities over time, and their dementia is not addressed until they are not able to mask anymore, which is usually in the Early Moderate Stage of Dementia. By that time in many cases, substantial damage has been done, such as substantial weight loss, a broken bone due to an avoidable fall, and so much more.
The Take Away….
The solution to the huge percentages of failure/misdiagnosis of dementia, and the damage caused by these misses, is multi-faceted. There is a need for Comprehensive Dementia Education, Dementia Sensitive Primary Care Clinics and Doctors, and Cognitive Care Communities specializing in all levels of dementia from Mild to Severe. To find out more about the importance of a cognitive care community visit; http://orchardseniorliving.com/the-importance-of-a-cognitive-care-community-for-dementia-care/.
The next several posts will detail ideas and solutions to combating dementia caused crisis, and decrease the failure/misdiagnosis rates. Visit http://stage-osl.daveminotti.com/category/blog/
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.
- 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.
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.