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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: [email protected]
Teresa Tibbo RPN
Email: [email protected]
Thank You!