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 Carol Donovan, RD - President Caring - Committed - Creative
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? Dementia in Canada 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 2011 2031 >65 Living with Dementia
Global Outlook Dementia Worldwide 140,000,000 120,000,000 100,000,000 80,000,000 60,000,000 # of People living with Dementia 40,000,000 20,000,000 0 2015 2030 2050
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 Processing Information: Taste Key Strategies Taste preferences change frequently Re-evaluate interventions
Evidence Based Practice
Evidence Based Practice Statement Grade of Evidence Strength of Recommendation Screening every resident with dementia for Malnutrition Provision of meals in a pleasant, homelike atmosphere Use of ONS to improve nutritional status Close monitoring and documentation of body weight Educating caregivers on nutritional problems related to dementia and positive strategies to intervene Very Low Moderate High Very Low Low Strong Strong Strong Strong 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 Food Service Menu Changes HEHP De Centralized Food on the Go Staggered Meals Flexibility Older Adults with Dementia Staff Staff Education Grade B Environment Small Dining Room Aquarium Background Music High Contrast Tableware
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/aboutdementia/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!