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Nutritional Issues in Dementian Care
One of the many challenges in dementia care is nutritional management. The Gentlecare Approach descibed below will help those living with dementia and their direct carers to help overcome that challenge.
Continuing repetition of the nutritional management cycle is a guarantee
of quality in overall management of care.
The Gentlecare Approach
COMPLETE THE INDIVIDUAL'S PERSONAL PROFILE:
Diagnosis/medical history
Stages of the disease
Family/social/cultural information
Energy expenditure
Preferred meal patterns – times and foods
CARRY OUT THIS NUTRITIONAL ASSESSMENT:
Eating and swallowing function
Physical disabilities
Gentlecare hydration programme
Incontinence
Medications can affect eating
CONSIDER THESE ENVIRONMENTAL STRESSORS THAT AFFECT EATING:
Behavioural mapping
Sundown syndrome
The eating environment
System changes
Environmental influences
Current meal pattern
Stress profile
Influence of staff and family members
THE DEVELOPMENT OF A NUTRITION CARE PLAN:
The Gentlecare formula
Considered factors
Energy requirements
Personal meal planning
Therapeutic diets
Assistance with eating
Prosthetic dishes and utencils
Physical positioning
Triggering strategies
Encouraging eating
Food textures
Gentlecare 24 hour nutritional clock
Review and documentation of the plan
STAFF COMPLIANCE CHECK:
All staff cooperation
Partnership with family members
Encouragement of volunteers
EVALUATION & UPDATE OF THE NUTRITIONAL CARE PLAN:
This is the final step in the nutritional management cycle
This phase ensures foods provided match the individual’s special and changing needs
Revision is determined by the person’s nutritional health status or risk
Considered at least biannually by the MDT
© Dr D J Nightingale 2007
Depression
Depression does not just describe a mood; it also has an effect on and changes thinking, behaviour and biology.
Symptoms are: Sadness, irritable mood, feeling guilty, no interest or pleasure in usual activities, withdrawal from or avoidance of people, difficulty in doing usual tasks, seeing self as worthless, trouble concentrating, difficulty in decision making, suicidal thoughts, recurrent thoughts of death, ideation of suicide plan, low self-esteem, future appears hopeless, self critical thoughts, constant tiredness, no energy, significant weight loss and or decrease in appetite (not due to diet), significant change in sleep pattern, decreased sexual desire.
Learning to change how you think is a main focus of CBT for depression.
Medication can also be helpful, especially for people who experience intense or long lasting depression.
Rating moods during activities, analysing patterns can suggest behavioural changes to ease depression.
Pleasurable activities or activities that allow people to achieve something can help people to feel better when they are depressed.
Anxiety
Anxiety is the most common behavioural symptom found in people living with dementia. If this challenge can be addressed and effectively managed through psychotherapy, many of the behavioural presentations can be greatly reduced.
Anxiety disorders include phobias, panic attacks, post-traumatic stress disorder, obsessions, compulsions and generalised anxiety.
Anxiety symptoms include muscle tension, rapid heartbeat, light-headedness, avoidance and nervousness.
Cognitive components of anxiety include the perception of danger, vulnerability or threat.
Thoughts that accompany anxiety often begin with ‘What if……’ and contain the implication that something terrible is going to happen.
Panic is extreme anxiety accompanied by catastrophic misinterpretation of body and mental sensations as impending insanity or death, etc..
Anxiety can be diminished or eliminated by cognitive restructuring, relaxation training and overcoming avoidance.
Down's syndrome and Alzheimer's Type Dementia
Down's syndrome is due to an abnormality of chromosome 21 (trisomy 21).
The gene for beta amyloid protein, involved in amyloid deposition in the brains of Alzheimer's sufferers, has also been found to be on chromosome 21. Could an abnormal gene on chromosome 21 be implicated in DAT?
In fact, although an abnormal gene has been found in some families with early onset DAT, this has turned out to be a rare occurrence. Since then various other abnormalities have been found in the uncommon familial varieties of DAT, including abnormalities of chromosomes 1, 14 and 19.
Most people with Down's syndrome who reach the age of 35 have developed pathological changes similar to those in DAT sufferers. Some of these people will develop DAT, however, in spite of the presence of pathology, many DO NOT develop the condition itself, perhaps because of ApoE status (Apolopoprotein)
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