ANALYSIS
Nutritional care must be improved to prevent malnutrition among patients with dementia. Katie Osborne reports from last week’s nutrition summit
Identifying the nutritional needs of dementia patients is essential An estimated 1.3 million people over the age of 65 are believed to be malnourished in the UK. A report published earlier this year by Alzheimer’s Disease International, a worldwide group of dementia charities and health organisations, warned malnutrition is a ‘major problem’ among people with dementia. Patients who have poor nutrition and hydration have longer hospital stays, a higher incidence of post-operative complications and a greater need for drugs and other interventions. In patients with dementia, malnutrition can be a particular problem because people may experience greater difficulty chewing and swallowing as the dementia progresses. Changes to the brain can also affect their relationship with food and eating. Yet too few nurses working in acute settings, many of whom deal with dementia patients on a daily basis, feel confident to deliver nutritional advice. That was the consensus at the National Nurses Nutrition Group (NNNG) conference in Warwickshire last week.
Unfit for purpose
Among the speakers at the conference was New Cross Hospital Wolverhampton clinical director for care of the elderly Daryl Leung. He says many acute hospitals are ‘not fit for purpose’ for dealing with dementia patients, and that nurses have a key role in changing the environment. Dr Leung has been leading a project to transform his hospital into a dementia-friendly environment – and adequate nutrition and hydration 14 july 16 :: vol 28 no 46 :: 2014
Ageing and malnutrition – the facts There are about 800,000 people in the UK with dementia. An ageing population means around 1.7 million people are expected to have dementia by 2051. One in three people over 65 will develop dementia, and two thirds of people with dementia are women. A 2014 study by Alzheimer’s Disease International said malnutrition affects up to 10 per cent of older people with dementia living at home, 30 per cent of those living in care homes and 70 per cent of older people in hospital. Age UK’s Hungry to Be Heard campaign calls for an end to malnutrition among older hospital patients. It focuses on seven key areas, including taking a patient’s height and weight measurements on admission, consulting patients on meal requirements and food preferences, and protected mealtimes to give people the time and support needed to eat. Source: Alzheimer’s Society and Age UK
are top priorities. But he says that one of the main barriers is a lack of understanding and education about the complexities of the illness. ‘A person with dementia needs assistance with food and sometimes needs to have the spoon or the cup of tea put to their lips,’ he says. ‘But the staff involved need to understand that this is a requirement. No one would put a three-course meal in front of a six-month-old baby and tell them to get on with it, yet that is
happening every day in elderly care wards because we do not understand that the patient with dementia has lost the ability to sequence the task of getting that food, if they even recognise it as food, into their mouths.’ New Cross Hospital has a team of volunteers who help feed those patients who are unable to feed themselves. Dr Leung also advocates ‘therapeutic visiting’, where relatives are encouraged to come into the hospital to assist with mealtimes.
Reassurance
He added that nurses should try to get to know their patients, provide reassurance and engage in conversation with them – whether they are able to reply or not. All this, he says, leads to patients feeling more settled, less anxious and therefore more willing to eat and drink. It is the simple things that often make the biggest difference. Allowing patients to have a cup of tea with a nurse while she carries out her paperwork duties at the nurses’ station can go a long way to reassure a confused patient – even if it is against hospital rules,’ says Dr Leung. Often, he says, it is as simple as asking a patient if he or she needs to go to the toilet, or reminding the patient where he or she is. ‘I would not fancy eating if I did not know where I was,’ he says. ‘I worked for a decade as a consultant and I assumed in that decade that everyone with dementia in hospital would lose weight, and I saw everyone in hospital with dementia lose weight.
NURSING STANDARD
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CHARLES MILLIGAN
ANALYSIS
Engaging with patients helps them to feel more at ease and therefore more willing to eat
‘But six months after we changed our approach I was astounded that many of the patients on my dementia ward had gained weight.’ According to NNNG chair and nutrition nurse specialist Liz Evans, time is nursing’s biggest enemy when caring for patients. She says: ‘How can we persuade doctors to stop writing “encourage oral diet and fluids” in a patient’s notes when we do that already. It can take 45 minutes to get a dementia patient to take ten spoonfuls of fluid.’ RCN dementia lead Rachel Thompson agrees it is vital that undernourished patients with dementia receive the appropriate care. But she said it was the responsibility of individual trusts to ensure the correct staffing levels were in place, and that staff had enough time and flexibility to devote to patients. ‘You can adapt systems, even in an NHS setting, to make things more person-centred,’ she said. ‘There are many places with excellent models already in place.’ She said that initiatives such as overlapping shifts to ensure the
NURSING STANDARD
maximum number of staff are on the ward at mealtimes should be encouraged. ‘To sit down with someone and encourage them to eat can take 40-45 minutes per patient.’ She adds that flexibility around mealtimes should be considered because some patients with dementia do not feel like eating at set times. The NNNG conference also looked at how nutrition and hydration can be
‘STAFF NEED TIME AND FLEXIBILITY TO DEVOTE TO PATIENTS’ – Rachel Thompson
improved for residents with dementia living in care homes. More than 80 per cent of patients living in UK care homes have a form of dementia or severe memory loss, according to the Alzheimer’s Society. One privately run care company, Barchester Healthcare, runs ‘memory lane communities’ where dementia patients are cared for in specifically designed environments. The aim is to
ensure individuals feel comfortable, safe and engaged. Barchester director of dementia services and registered nurse Sheena Wyllie told the NNNG conference: ‘The role of food has great significance on how we feel and think. But looking at nutrition alone is not enough – we have to look at the whole person.’ She says dementia patients like to live in the ‘here and now’ but often they regress to a previous time in their lives. To make sure they eat and drink enough, the memory lane communities try to accommodate even the most unusual needs. For example, she explains, one resident had returned to his army days in his mind and wanted spicy curry and rice. Another had returned to her time as a young mother and insisted on having her ‘baby’, in the form of a doll, in a highchair next to her at every meal so she could feed her. ‘This meant the resident was settled so she ate too,’ said Ms Wyllie. A resident’s life story is important and taking the time to understand this is crucial, she concludes NS july 16 :: vol 28 no 46 :: 2014 15
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Nutritional care must be improved to prevent malnutrition among patients with dementia. Katie Osborne reports from last week’s nutrition summit
Identifying the nutritional needs of dementia patients is essential An estimated 1.3 million people over the age of 65 are believed to be malnourished in the UK. A report published earlier this year by Alzheimer’s Disease International, a worldwide group of dementia charities and health organisations, warned malnutrition is a ‘major problem’ among people with dementia. Patients who have poor nutrition and hydration have longer hospital stays, a higher incidence of post-operative complications and a greater need for drugs and other interventions. In patients with dementia, malnutrition can be a particular problem because people may experience greater difficulty chewing and swallowing as the dementia progresses. Changes to the brain can also affect their relationship with food and eating. Yet too few nurses working in acute settings, many of whom deal with dementia patients on a daily basis, feel confident to deliver nutritional advice. That was the consensus at the National Nurses Nutrition Group (NNNG) conference in Warwickshire last week.
Unfit for purpose
Among the speakers at the conference was New Cross Hospital Wolverhampton clinical director for care of the elderly Daryl Leung. He says many acute hospitals are ‘not fit for purpose’ for dealing with dementia patients, and that nurses have a key role in changing the environment. Dr Leung has been leading a project to transform his hospital into a dementia-friendly environment – and adequate nutrition and hydration 14 july 16 :: vol 28 no 46 :: 2014
Ageing and malnutrition – the facts There are about 800,000 people in the UK with dementia. An ageing population means around 1.7 million people are expected to have dementia by 2051. One in three people over 65 will develop dementia, and two thirds of people with dementia are women. A 2014 study by Alzheimer’s Disease International said malnutrition affects up to 10 per cent of older people with dementia living at home, 30 per cent of those living in care homes and 70 per cent of older people in hospital. Age UK’s Hungry to Be Heard campaign calls for an end to malnutrition among older hospital patients. It focuses on seven key areas, including taking a patient’s height and weight measurements on admission, consulting patients on meal requirements and food preferences, and protected mealtimes to give people the time and support needed to eat. Source: Alzheimer’s Society and Age UK
are top priorities. But he says that one of the main barriers is a lack of understanding and education about the complexities of the illness. ‘A person with dementia needs assistance with food and sometimes needs to have the spoon or the cup of tea put to their lips,’ he says. ‘But the staff involved need to understand that this is a requirement. No one would put a three-course meal in front of a six-month-old baby and tell them to get on with it, yet that is
happening every day in elderly care wards because we do not understand that the patient with dementia has lost the ability to sequence the task of getting that food, if they even recognise it as food, into their mouths.’ New Cross Hospital has a team of volunteers who help feed those patients who are unable to feed themselves. Dr Leung also advocates ‘therapeutic visiting’, where relatives are encouraged to come into the hospital to assist with mealtimes.
Reassurance
He added that nurses should try to get to know their patients, provide reassurance and engage in conversation with them – whether they are able to reply or not. All this, he says, leads to patients feeling more settled, less anxious and therefore more willing to eat and drink. It is the simple things that often make the biggest difference. Allowing patients to have a cup of tea with a nurse while she carries out her paperwork duties at the nurses’ station can go a long way to reassure a confused patient – even if it is against hospital rules,’ says Dr Leung. Often, he says, it is as simple as asking a patient if he or she needs to go to the toilet, or reminding the patient where he or she is. ‘I would not fancy eating if I did not know where I was,’ he says. ‘I worked for a decade as a consultant and I assumed in that decade that everyone with dementia in hospital would lose weight, and I saw everyone in hospital with dementia lose weight.
NURSING STANDARD
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CHARLES MILLIGAN
ANALYSIS
Engaging with patients helps them to feel more at ease and therefore more willing to eat
‘But six months after we changed our approach I was astounded that many of the patients on my dementia ward had gained weight.’ According to NNNG chair and nutrition nurse specialist Liz Evans, time is nursing’s biggest enemy when caring for patients. She says: ‘How can we persuade doctors to stop writing “encourage oral diet and fluids” in a patient’s notes when we do that already. It can take 45 minutes to get a dementia patient to take ten spoonfuls of fluid.’ RCN dementia lead Rachel Thompson agrees it is vital that undernourished patients with dementia receive the appropriate care. But she said it was the responsibility of individual trusts to ensure the correct staffing levels were in place, and that staff had enough time and flexibility to devote to patients. ‘You can adapt systems, even in an NHS setting, to make things more person-centred,’ she said. ‘There are many places with excellent models already in place.’ She said that initiatives such as overlapping shifts to ensure the
NURSING STANDARD
maximum number of staff are on the ward at mealtimes should be encouraged. ‘To sit down with someone and encourage them to eat can take 40-45 minutes per patient.’ She adds that flexibility around mealtimes should be considered because some patients with dementia do not feel like eating at set times. The NNNG conference also looked at how nutrition and hydration can be
‘STAFF NEED TIME AND FLEXIBILITY TO DEVOTE TO PATIENTS’ – Rachel Thompson
improved for residents with dementia living in care homes. More than 80 per cent of patients living in UK care homes have a form of dementia or severe memory loss, according to the Alzheimer’s Society. One privately run care company, Barchester Healthcare, runs ‘memory lane communities’ where dementia patients are cared for in specifically designed environments. The aim is to
ensure individuals feel comfortable, safe and engaged. Barchester director of dementia services and registered nurse Sheena Wyllie told the NNNG conference: ‘The role of food has great significance on how we feel and think. But looking at nutrition alone is not enough – we have to look at the whole person.’ She says dementia patients like to live in the ‘here and now’ but often they regress to a previous time in their lives. To make sure they eat and drink enough, the memory lane communities try to accommodate even the most unusual needs. For example, she explains, one resident had returned to his army days in his mind and wanted spicy curry and rice. Another had returned to her time as a young mother and insisted on having her ‘baby’, in the form of a doll, in a highchair next to her at every meal so she could feed her. ‘This meant the resident was settled so she ate too,’ said Ms Wyllie. A resident’s life story is important and taking the time to understand this is crucial, she concludes NS july 16 :: vol 28 no 46 :: 2014 15
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