Prof Jane Murphy and Joanne Holmes Bournemouth University UK Dementia Congress 7-9 th Nov 2017

Transcription

1 Implementation and evaluation of innovative training for care staff to support people living with dementia to eat and drink well Prof Jane Murphy and Joanne Holmes Bournemouth University UK Dementia Congress 7-9 th Nov 2017

2

3 Background Nutrition-related problems in dementia Risk of weight loss, malnutrition and dehydration Loss of independence associated with frailty, increased risk of falls, increased risk of infections, pressure sores Reduce food intake with declining cognitive function less able to perform daily tasks. Memory loss and confusion affects food related tasks Difficulties chewing and swallowing Inability to recognise hunger, thirst, smell Loss of appetite Inability to eat and drink independently

4 Understanding Nutrition and Delivering Dignity in Dementia Care Measures of nutritional status Food & fluid intake intake, energy expenditure/physical activity & sleep patterns (accelerometry). Focus groups/interviews All those responsible for food, nutrition and delivery of care in care homes.

5 Model to Deliver Good Nutritional Care in Dementia Murphy et al (2017) Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes BMC Geriatrics 17:55

6 Training tools 3 sections linked with training film v=dlypttibto8 3 sections Section 1: Food and drink availability Section 2: Importance of activity: encouraging food and drink intake through activity Section3: Importance of communication and relationships

7 Aims 1. To understand how this training could be applied across a range of settings ( residential, domiciliary care, NHS hospitals) 2. To identify changes in practice towards delivering good nutritional care for people living with dementia.

8 Methods Following direct requests for training tools: 1. Online questionnaire: after 6-8 weeks. Comprised 11 questions (open and closed). 2. Semi-structured (telephone) interviews: after 3 months. Lasted up to 20 minutes, Conversations were recorded, transcribed and interpreted using thematic analysis

9 Results: online questionnaire Total number of responses = 80 28% 61% Residential/nursing care domiciliary care 15% NHS hospital

10 Results: Questionnaire The workbook was well understood by 94% of respondents How useful did you find? the case studies 8.7 Weighted average Scale 1-10, 1 = least useful, 10 = most useful the tasks 8.0 the reflection upon practice sections 8.1 the extra reading 7.7 A good way to encourage someone to improve their diet could be to incorporate food in an activity. Doing a physical activity is a good way to stimulate the appetite. (Care staff, NHS)

11 Results: Questionnaire Recommendation to colleagues? 94.8% reported that they would recommend the workbook to colleagues. Changes to practice? 1 Little alot average 7.4% 2.9% 4.4% 5.9% 25.0% 13.2% 14.7% 10.3% 10.3% 2.9% 5.9% Rewritten Policy / Procedure relating to Nutrition and Hydration. Re designed fluid balance chart. Increased the use of full fat milk, creams etc. Encourage residents to drink more. Chef's visit to new residents - excellent approach to building a relationship with that new person. Helps them to settle in and feel that people are listening to them and that their preferences are important. Greater variety of drinks available. Able to understand behaviour patterns around meal times easier. This has made us all reflect on the reasons and possible complication associated with dementia, how we can adopt and adapt changing ideas keeping them person centred.

12 Results: Telephone interviews Changes made (total number of participants = 18) Have you made any changes to your practice using the MUST Screening Tool? Have you made any changes to your practice to how food and drinks are made available? Have you made any changes to your practice around the use of activity to encourage food and drink intake? Have you made any changes to your practice around communication about food and drinks? Yes Reinforced existing practice No ( but may make changes in the future)

13 Summary Findings demonstrate positive changes and quality improvements for the delivery of nutritional care in dementia. Other benefits include the flexibility of the workbook to complete in bite size chunks (combined with the film) and/or shared by staff with their colleagues; resource to guide practice; opportunities for reflection on practice Further work needs to understand the wider application in other care environments and the longer terms impact of changed practice.

14 Does it make a difference for residents? We have a resident that doesn t eat well without being prompted. Because we now changed the colour of plate they are now able to eat well. Care staff I weigh monthly and since we ve started and update must scores monthly, obviously we ve seen an increase in weight. A good couple of kilos for the majority of residents Manager and Registered Nurse Approximately 40% of those who responded reported weight gain in some of the people they cared for since using the workbook we have now revolutionised our meal times and this has proven to be of great success, in the few short weeks of implementing this we have observed and recorded an increase in weight with the majority of our residents and a more sociable and interactive feel that surrounds our mealtimes. Registered Manager

15 Any questions? Thank you for listening! Available online as PDF