Swallowing & Communication in Advancing Vascular Dementia Topics of Interest. Dr Jackie Kindell

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1 Swallowing & Communication in Advancing Vascular Dementia Topics of Interest Dr Jackie Kindell

2 Eating and Swallowing Difficulty Can occur at any stage of vascular dementia More common in the later stages Management should be part of overall plan of care Not isolated issue Over-chewing, holding, control of bolus Delayed swallow or difficulty initiating Food going into airway Coughing Silently Chest infection & choking risk Quality of life

3 Vascular Dementia Some individuals can still feed themselves when they have significant swallowing problems Problems with cognition and judgement limit their understanding of their swallowing Implementing advice Don t slow down Easily distractible Talk/call out when eating Carry on eating when coughing Additional management issues

4 He s on a soft diet So we put all his food in the blender So we make sure the chips aren t over-cooked

5 Lack of consistency in how we describe food textures Open to interpretation Soft..

6 Food and drink all on one scale Standardised Descriptions Ways to test clearer ONLY these labels!!

7 FOODS: From UK National Descriptors to IDDSI Subjective Some criteria weren t specifically defined. Objective, measured The IDDSI Levels are defined by measurement. Textures B to E map to IDDSI Levels 3 to 6 after adding detail and measurement Fork Mashable Define how soft. Limit size of lumps to reduce choking risk g Pre- Mashed Define moistness and particle size Thick Purée Define moistness and cohesiveness Thin Purée Define flow properties (IDDSI flow test)

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9 Watch out for: Soft and bite size 1.5cm Minced and moist 4mm & Don t guess what it means make sure you have the full description! BREAD etc

10 Tube Feeding e.g. PEG In UK Guidance NICE Guideline, Royal College of Physicians Not generally advised in advanced dementia If swallowing problem is due to dementia and not reversible Careful hand feeding May not be possible to eliminate risk Manage risk Feed at Risk

11 Communication and life story work Life story books Boards Boxes Pen portraits DVD s Collages This is me..etc.

12 An Intervention.or an approach An approach to working with a person and/or their family to find out about their life, recording that information in some way and then using the information with the person in their care McKeown et al 2015 Not one activity Range of activities

13 Various Points of Connection Conversation/interaction Emotional/relationships Practical care Build new relationships points of transition Future goals care or legacy

14 Important Steps What is the goal of the life story work? Where will it be recorded and how? Who is going to use it? A book communication aid? Can the person use this format? Good if they can but time consuming if they can t Would a board be better? Or other format? How do we USE the information in care.not just record it.

15 Understanding Behaviour in Dementia that Challenges Personality Cognitive Abilities Social Environment Background Status Mental Health Medication Life Story Physical Health Trigger Behaviour Vocalisation Need Appearance Functional Assessment Features At time of incident Newcastle Challenging Behaviour Model

16 Use & Interpretation Moving beyond facts impact on care. Don was born in London Don has a great sense of humour and likes a joke Using information interpreting. Don has never had a day off sick from his work as a gas fitter What does this tell us about Don? How can this help us interpret behaviour?

17 Communication - Conversation Transaction information Interaction social connections As dementia progresses less able to provide information.due to language difficulties Need to value interactional abilities Nonverbal ways to connect

18 Interaction Turn taking Eye contact Facial expression Pointing Body positioning Music

19 Thank you Some questions