Responsive Behaviours in the Dining Room...Shadowing (stalking) Screaming Culturally inappropriate...

How BSO and Dietary Can Work Together

Responsive Behaviours in the Dining Room

April 5, 2016

TWC Culinary and Nutrition Summit Teresa Tibbo RPN, Twinkle Patel RD

Seasons Care Dietitian Network

Caring - Committed - Creative

Carol Donovan, RD - President

Objectives

o What is Dementia? o Statistics about Dementia in Ontario and Around the World o Responsive Behaviors o Communication through 5 Senses o Key Strategies o Evidence of Success

Dementia and Common Forms

“Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in

memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities..”

Source: http://www.alz.org/what-is-dementia.asp

“It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not

affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in

emotional control, social behaviour, or motivation.” source: http://www.who.int/mediacentre/factsheets/fs362/en/

3 Most Common Forms of Dementia

Alzheimer's disease

Vascular dementia

Lewy Body Dementia

This Is Why We Are Here Today

Source: http://braintour.alzheimer.ca/09.htm

What is Alzheimer's?

What do the Statistics Say?

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

2011 2031

Dementia in Canada

>65 Living with Dementia

Global Outlook

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

2015 2030 2050

Dementia Worldwide

# of People living with Dementia

BPSD Breakdown

Psychological

Anxiety

Apathy

Delusions

Depressed mood

Hallucinations

Misidentifications

Sleeplessness

Behavioral

Agitation Calling out

Wandering Cursing

Verbal aggression Crying

Physical aggression Restlessness

Repetitive questioning Pacing

Shadowing (stalking) Screaming

Culturally inappropriate behavior and disinhibition

Processing Information

Sensation - external stimuli that the brain processes both consciously and unconsciously

Perception – Internal interpretation of the external world

Emotion – Each memory links to an emotion

Evaluation – Feelings are evaluated and a response is determined

Demonstrated Behavior – Feelings and thoughts become behavior

What Are We Doing About It?

Behaviour Supports Ontario (BSO)

A province wide approach to care for older adults living with dementia who present with responsive behaviours.

Staff in the homes are providing care according to this evidence based model of care that is focused on the meaning behind the behaviour.

Focus is prevention and non-medicinal interventions used before medication.

Mobile team an asset for LTC and transition to LTC.

Responsive Behaviours

• Preferred term – represents how their actions, words and gestures are a response

• Often intentional that expresses something important about their personal, social or physical environment

• Result of change in Brain affecting Memory, Judgement, Orientation, Mood and Behavior

Triggers to Responsive Behaviours

The factors contributing to these behaviors may be broken into several categories:

•Medical

•Emotional/Psychological

•Medications

•Environmental

Get to Know your Resident

Their Favorite Foods…That reminds of Good Days

…..Not so Good Days…..

Where they Grew up

How Dementia Impacts Nutrition

5 Senses

Processing Information in Dementia: Visual Data

Key Strategies:

Show Plates/Pictures

Contrast color table mats and plates

Simple Table Setting

Processing Information in Dementia: Listening/Auditory

Key Strategies:

Use Visual Cues

Keep Noise/Volume to minimal

Avoid Distractions

Be Flexible with providing meals in different areas

Processing Information in Dementia: Touch / Sensation

Key Strategies:

Let them use their Hands

Finger Foods

Allow Experimentation

Face is the most sensitive part of the body

Ensure safe food temperatures

Hand Under Hand Technique

Teepa Snow Hand Under Hand Video

“Hand Under Hand”

Processing Information: Sense of Smell

Key Strategies

Clear Uneaten Foods for Resident Safety

Key Strategies

Taste preferences change frequently

Re-evaluate interventions

Processing Information: Taste

Evidence Based Practice

Evidence Based Practice

Statement Grade of Evidence Strength of Recommendation

Screening every resident with dementia for Malnutrition

Very Low Strong

Provision of meals in a pleasant, homelike atmosphere

Moderate Strong

Use of ONS to improve nutritional status

High Strong

Close monitoring and documentation of body weight

Very Low Strong

Educating caregivers on nutritional problems related to dementia and positive strategies to intervene

Low Strong

Source: Volkert D et.al ESPN Guidelines on Nutrition in Dementia, Clinical Nutrition (2015)

Evidence Based Practice

As needed Dietitian Consultations Grade B

Feeding Assistance Grade

B

Environment Modifications Grade B

Older Adults with

Dementia

Staff

Staff Education Grade B

Environment

Small Dining Room

Aquarium Background Music

High Contrast Tableware

Food Service

Menu Changes

HEHP De Centralized Food on the Go

Staggered Meals Flexibility

Other Successful Interventions

o Priority Seating o Snack on the Go program o Food First Philosophy – HEHP interventions o Hydration Program o Finger Foods Menu o Always available Items o Small Home like Dining Rooms o Medpass Supplementation o I pod o Stimulation activity before a meal

“Snack on the Go”

Non-Pharmacological Nursing Approaches to Care…

• Single most effective way to prevent responsive behaviours:

• Understand triggers to responsive behaviour for this individual

• SLOW down…outpacing causes frustration, frustration causes responsive behaviours

• Using the STOP approach…Stop Think Observe Plan

• Give back CONTROL

• Check your body language…know your agenda but don’t show your agenda

• Know your limits and ask for help

• Do not let your own beliefs or cultural norms impact the care you provide.

• Educate staff and hold them accountable for actions

Communicate

Other innovative concepts

• Dementia Village, Hogeway, Netherlands

Canadas Version of Hogeway: Georgian Bay , Penentanguishine

• A barber shop

• A vintage kitchen

• A garage with a 1947 Dodge

• A nursery with life-like babies

• Gardens

• An artificial beach

References • Alzheimer's Disease & Dementia | Alzheimer's Association. (n.d.). Retrieved from

http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp

• Behavior Support Alberta. Retrieved from http://www.bsa.ualberta.ca/sites/default/files/Nurses Guide PBSD IPA.pdf

• Brain Tour. (n.d.). Retrieved from http://braintour.alzheimer.ca/09.htm

• C. (2013). CNN's World's Untold Stories: Dementia Village. Retrieved April 03, 2016, from https://www.youtube.com/watch?v=jwt4uGYGGUA

• Dementia numbers in Canada. (n.d.). Retrieved from http://www.alzheimer.ca/en/About-dementia/What-is-dementia/Dementia-numbers

• Food, Eating and Alzheimer's | Caregiver Center | Alzheimer's Association. (n.d.). Retrieved April 03, 2016, from https://www.alz.org/care/alzheimers-food-eating.asp

• JBI Interventions to reduce undernutrition and promote eating in older adults with dementia Best Practice 15(14) 2011 Retrieved from Http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=7125. (n.d.).

• Shifting focus: A guide to understanding dementia behaviour. (n.d.). Retrieved April 03, 2016, from http://www.ShiftingFocus.ca/

• Teepa Snow. (n.d.). Retrieved from http://teepasnow.com/

• Volkert D et.al ESPN Guidelines on Nutrition in Dementia, Clinical Nutrition (2015) . Retrieved from Http://dx.doi.org/10.1016/j.clnu.2015.09.004. (n.d.).

• Http://www.sciencedirect.com/science/article/pii/S1525861014001212. (n.d.).

Questions, Comments, Ideas?

Twinkle Patel RD RAC-CT

Email: twinkle@seasonscare.com

Teresa Tibbo RPN

Email: Ttibbo@extendicare.com

Thank You!