Basket | Login | Register

 
 
 
 

P18. Genetics, prevention and treatment: Nutrition

Detailed programme and abstracts

P18.1. The role of food and mealtimes in the recognition of people living with dementia on acute hospital wards

NORTHCOTT Andy1, FEATHERSTONE Katie2

1De Montfort University, Leicester, United Kingdom, 2Cardiff University, London, United Kingdom

Within the hospital ward many of the everyday items that define an individual and their personhood are stripped away. Clothing is replaced with gowns and pyjamas, names are replaced with bed numbers, people and personalities are overshadowed by conditions and diagnosis. Mealtimes, however, have the potential to offer respite from this anonymity. Patient choice and preference is re-prioritised three times a day. In hospitals in England and Wales staff offer food from lengthy lists of meal options, serving choices and alternative menus. For people living with dementia, however, mealtimes, their presentation, and their delivery, can be a time of anxiety and conflict as they struggle to meet the institutional expectations of choice and consumption.

This paper draws on an ongoing program of ethnographic study (NIHR HS&DR researcher led funding) of care for people living with dementia in hospitals across England and Wales. The research aims to explore and highlight the everyday care of people living with Alzheimer’s and/or other forms of dementia during an acute hospital admission. In this paper we highlight the pivotal role the everyday routines of mealtimes play in the in the ways in which people living with dementia are seen. Looking beyond the standard anecdotal derision of hospital food as unpleasant and unappetising, we will demonstrate the inadvertent role that the routines and rituals of that the provision of hospital food plays in the classification of acute patients living with dementia. It will explore how the expectations placed on those categorised as needing help, or ‘feeding’ at mealtimes, differ from those perceived as being able to eat independently. We explore how this impacts not only what people are served and how they are served it, but also its impact on people living with dementia and their place within the social organisation of the hospital ward.

P18.2. “Nutritional status of the elderly after discharge from the acute geriatric unit” a pilot study

BLONDAL Berglind

University of Iceland, Reykjavik, Iceland

Nutritional status of hospitalized old adults is often inadequate after discharge. The aim of the study was to assess dietary intake, food security and nutritional status of old adults after discharge.

In this pilot study community-dwelling old adults (N=13; 87.7±5.6yrs; MMSE≥20; no catabolic diseases) discharged from the Acute Geriatric Unit of the National University Hospital of Iceland were included. Anthropometrics, dietary intake, food security and quality of life (QoL) were assessed at discharge, one week (home) and two weeks later (home).

Baseline BMI was 24.7±5.1 kg/m2 and there was significant weight loss during the 2 weeks’ period in participants (-2.6 kg, P=0.0001) resulting in an endpoint BMI of 23.8 ±4.7 kg/m2. Actual daily energy-(759.0±183.4 kcal) and protein intake (35.1±7.5 g) were significantly lower (both P<0.001) than the corresponding estimated requirements (2061.6kcal; 82.4g). Kitchen assessment revealed that 33% of all foods were expired and 24% of all foods had visible mold. Of the participants, 75% experienced loneliness and QoL (31.5±8.6) was significantly lower than the age and gender dependent reference values of 50. According to the mini-mental-state-examination (MMSE) 6 of the 13 participants had a decline in mental health.

Loneliness, malnutrition, inadequate dietary intake and food insecurity are serious problems in discharged old adults in Iceland. Individuals with signs of dementia and Alzheimer have an even greater risk of being malnourished and therefore even more important to find ways to secure sufficient dietary intake. There is a great need for individualized nutritional therapy, during and after hospital stays to ensure proper dietary intake with the aim to reduce malnutrition and re-admissions as well as to increase the quality of life of old adults.

P18.3. Impact of innovative training to improve nutrition and hydration in people living with dementia

MURPHY Jane, HOLMES Joanne

Bournemouth University, Bournemouth, United Kingdom

Nutrition-related interventions for people living with dementia can interrupt the risk of weight loss, undernutrition and dehydration, consequent decline in cognitive function as well as alleviating the associated care burden. Therefore, it is important that care staff receive evidence-based training to ensure they have the knowledge, skills and tools to ensure those living with dementia receive appropriate food and drink to meet their nutrition and hydration needs. We have developed research informed training tools (workbook and film) on nutrition and hydration for staff caring for people living with dementia in care homes. (http://www.bournemouth.ac.uk/nutrition-dementia). We aimed to understand how this training could be applied across a range of care settings (elderly residential, domiciliary care, NHS hospitals) and to identify changes in practice. An online questionnaire was sent after about 6-8 weeks following engagement with the materials. Of the 84 respondents, most (57.9%) were care home staff, 29.8 % were from NHS hospital settings and 15.8% from domiciliary care. Some participants worked across more than one setting. The workbook was well understood by over 95% of respondents and signposting to resources, tasks, reflection upon practice and case studies were reported as useful/very useful. The majority (94%) would recommend the training tools to colleagues. Different approaches to practice included encouraging residents to eat together, introduction of fluid charts and coloured crockery, develop educational toolboxes for staff, introducing finger food/fortifying food, involving families at mealtimes. These findings show how this training can make positive changes and quality improvements in nutritional care for people living with dementia. Other benefits include the flexibly of the workbook that could be self-completed and/or shared by staff with their colleagues to reflect on practice. Further research is needed to understand the wider application of the training tools including the nutritional care of people with dementia living at home. 

P18.4. ‘It’s not just what’s on the plate.’: The role of allied health professionals in the management of mealtime and swallowing difficulties in dementia

EGAN Aisling, LOWIT Anja, ANDREWS Carolyn

University of Strathclyde, Glasgow, United Kingdom

People with dementia may present with mealtime and swallowing difficulties at different points in the disease and these changes are often complex and multifactorial. Their difficulties may relate to changes to cognitive processes impacting on mealtimes such as increased confusion, behaviour changes and recognition difficulties. Swallowing difficulties, known as dysphagia, may also be related to neuromuscular changes due to the disease process. Dysphagia may lead to weight loss, malnutrition, dehydration and loss of vitality. Food and mealtimes are often associated with quality of life; the sharing of meals is a valued part of many cultures. Mealtime difficulties can lead to isolation, decline in health-related quality of life and caregiver stress. The effective management of dysphagia and mealtime difficulties is a priority issue for caregivers and allied health professionals, though role and scope may not be clearly defined.

Using semi-structured interviews, twenty dementia-specialist allied health professionals (Speech and Language Therapists, Occupational Therapists, Dietitians and Physiotherapists) were interviewed about their experiences and practices managing dysphagia and mealtime difficulties. Interviews were transcribed and analysed thematically.

Preliminary findings indicated that services offered to people with dementia were dependent on the area they lived and the type of service accessed. Findings also indicated that the scope and role of allied health professionals supporting mealtime and swallowing difficulties was variable.  Participants reported that overlap between professional roles was common, however, they indicated that increased opportunities for collaborative working would be preferred. Lack of resource - including time and access to allied health colleagues - and high support staff turnover were identified as barriers to facilitating quality mealtime support.

Findings from this study are noteworthy as they demonstrate that improved inter-disciplinary working is needed to optimally support people with dementia with dysphagia and mealtime difficulties. They also demonstrate that clearer guidance around role and scope is needed.

P18.5. Development of a multidisciplinary intervention to prevent and treat undernutrition in community-dwelling persons with dementia

VASSE Emmelyne1, GRAFF Maud2

1Dutch Malnutrition Steering Group, Amsterdam, Netherlands, 2Radboud University Nijmegen Medical Center, Nijmegen, Netherlands

Difficulties in eating and drinking and related tasks such as doing groceries and preparing a meal (nutrition related difficulties; NRD) are common in community-dwelling persons with dementia (CD-PwD) and can lead to insufficient food intake and undernutrition. The causes are multifactorial and relate to practical (e.g. inability to cook), nutritional (e.g. appetite loss) and psychosocial aspects (e.g. eating alone or together). Recent systematic reviews show that there is a lack of studies investigating interventions aimed at NRD in CD-PwD or studies describing a multidisciplinary approach although combining dietary treatment with occupational therapy to treat both nutritional and practical NRD is recommended by Alzheimer’s Disease International. An evidence-based occupational therapy intervention that supports CD-PwD in the self-management of practical difficulties in everyday life (COTiD) is already available.

The aim of this project is to develop an intervention that combines the best evidence and practice from dietetics with the COTiD intervention, and incorporates the 6 aspects of positive health (physical functioning, giving meaning, quality of life, social and societal participation, daily functioning, mental functions and perception). The medical research council framework for developing complex interventions is used as method of development. The project’s duration is 48 months (2018-2022), within this time frame we go through the developmental and feasibility/piloting stages of the framework. The project team includes dietitians, occupational therapists, care professionals, CD-PwD and informal carers.

The objectives are: 1. To develop a theoretical framework including best evidence and  key elements from occupational therapy, dietetics and the concept of positive health; 2. To develop a draft protocol that offers a diagnostic tool, guidance and directions about tailoring support and interventions and monitoring outcomes for NRD; 3. To identify the characteristics of CD-PwD  that influence successful application of intervention elements; 4. To identify barriers and facilitators for implementation into dementia care practice.

P18.6. “Some days are better than others”: The experiences of people living with dementia and dysphagia in care homes

COLLINS Lindsey1, OYEBODE Jan1, HART Andrew1, LESLIE Paula2

1University of Bradford, Bradford, United Kingdom, 2University of Pittsburgh, Pittsburgh, United States

Background: Food and drink are essential for human life, allow for social interaction through sharing mealtimes, and play an important role in cultural and societal rituals, ceremonies and celebrations. In care homes, mealtimes provide significant daily structure; have the potential to provide opportunities to build caring relationships; and generate a significant amount of social interaction compared to other times of the day. However, for people living in care homes, eating and drinking may become increasingly task focused, fail to include the values and preferences of individuals, and have the potential to negatively impact well-being. An estimated 50% of people with dementia will develop difficulties with eating, drinking and swallowing, known as dysphagia, with this number increasing to up to 93% of people living with dementia in care homes. Dysphagia has the potential to impact physical, psychological and social needs.

Methods: The initial consultation phase involved interviewing care home residents. The primary study involves structured observations and interviews with people living with dementia and dysphagia; interviews with family and paid carers; and focus groups with speech and language therapists (SLTs), the core profession who support people with dysphagia.

What this paper reports on: In this session I will present the findings from my consultation phase, sharing what is important to care home residents about eating and drinking from their perspective. I will also present the preliminary findings from my primary study, which seeks to explore and understand the experiences of living with dysphagia from the multiple perspectives of people living with dementia and dysphagia, their family members, care staff and SLTs and identify the factors that help to make these experiences more meaningful. The findings of this study will inform care practices nationally and internationally to support the physical and psychosocial needs of individuals living with dementia and dysphagia.

 

 
 

Last Updated: Friday 17 August 2018

 

 
  • Acknowledgements

    The 28th AE Conference in Barcelona received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe, CEAFA and Fundación Alzheimer España gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

Options