1.1 Describe how cognitive, functional and emotional changes associated with dementia can affect eating, drinking and nutrition
Cognitive behaviour is dysfunctional emotions and behaviours caused by damage in brain affecting part of the brain responsible for memory and all that we learn from birth- how to talk, eat etc. This means that person with dementia can forget how important it is to eat and drink. They also may lose sense of hunger and thirst. It can become problem putting client’s health at risk. In our daycentre we have a client who can have a drink but as soon as they have finished they want another as they think they haven’t had one. It’s the same with food as well we have a client who would eat all day because they have forgotten that they have just eaten, I have known a client to say that they have just eaten so they don’t need anything at lunch but they haven’t eaten since breakfast. Functional change is losing ability to remember how to eat using cutlery. Instead, some people find easier to pick up food by hand, so finger food should be provided.
This might be a good way to avoid confusion and distress for a client. If person finds it easier food should be laid out for a client promoting their dignity. We do have some clients who can’t cut their own food and sometimes they could avoid eating it, as they don’t want to ask us to cut it up, so we now know if a client can’t cut their food up we do it in the kitchen but make it look as if it hasn’t so the client will eat it if they want. We also provide foods to each client’s needs. Emotional change can be negative emotions about the confused state when individual may not understand that there is something wrong, but behaviour of others may lead them to feeling something is wrong, which often causes stress to individual with dementia.
1.2 Explain how poor nutrition can contribute to an individual’s experience of dementia.
Poor nutrition can make the symptoms of dementia worse, increase risk of more frequent infections requiring use of antibiotics. It can also cause restlessness, agitation, agression and challenging behaviours. It can also increase the risk of a dementia patient needing hospitalized due to lack of fluid intake as it can lead to a urine infection, low immune system, constipation can also to a dementia patient decreased appetite and reluctance to eat. Malnutrition also affects immune system making it difficult to fight an infection. Effects of poor nutrition: * Higher risk of infection
* Reduced wound healing
* Dermatological problems
* Disturbed sleeping pattern
* Weight loss/gain
1.3 Outline how other health and emotional conditions may affect the nutritional needs of an individual with dementia
Dementia can be effected by other conditions that may prevent the individual from eating or drinking: Health – it is quite often for individuals with dementia to end up with Urinary Tract Infection or UTI for short, and while having a UTI the individuals may get more confused or angry causing them to not wanting to eat. Emotional – quite a few dementia suffers end up with depression because of the drastic changes in their life, such as being taken away from their home and their family which could lead to Social isolation and it can be a big factor for loss of appetite. Forgetfulness Illness and medications can result in reduced appetite and difficulties with shopping, preparing and eating food. Problems with incontinence may stop individuals eating and drinking normally. Some medication can contribute to constipation and again this may stop people eating and drinking not realising this can make it worse.
Malabsorption conditions (i.e. gastritis & pernicious anaemia) reduce ability to absorb B12 from food.
1.4 Explain why it is important to include a variety of food and drink in the diet of an individual with dementia A healthy and varied diet is likely to improve a person’s quality of life. Not eating enough can lead to weight loss and other problems including vulnerability to infection, reduced muscle strength and fatigue. People with dementia may become dehydrated if they are unable to communicate or recognise that they are thirsty, or if they forget to drink. This can lead to headaches, increased confusion, urinary tract infection and constipation. These can worsen the symptoms of dementia.While a healthy, balanced diet is important, in late-stage dementia the priority should be making sure the person with dementia takes on nutrition, and a higher-calorie diet may be appropriate. A dietitian can advise on what is best in a particular situation.
2.1 Describe how mealtime cultures and enviroments can be a barrier to meeting the nutritional needs of an individual with dementia Mealtime cultures such as having strict meal times and meal sizes, certain number of courses and in certain orders such as starter, main, dessert may not adhere to the needs of a person with dementia. Their tastes may have changed and they may not wish to eat the meals that are set out for them in a particular ‘traditional order’. They may not wish to eat at the same time as everybody else or they may wish to eat small amounts little and often. By trying to stick to normal meal time cultures, this can be a barrier to the nutritional needs of the individual. The care they receive should be person centred and to fit in with what the individual needs, this should also be true with the meals that the person receives.
Environmental factors such as being around lots of other people, loud noises, music or a busy restaurants are not ideal for a dementia people as they can become easily distracted and overwhelmed by too much information being processed at once. This can be a barrier to them being able to focus on their food. 2.2 Describe how mealtime enviroments and food presentation can be designed to help an individual to eat and drink The environment in which a person with dementia eats can have a huge impact on the mealtime experiences – it can affect a person’s enjoyment of food and how much food they eat. For many of us, the way food is presented and served, the surroundings and the company in which it is eaten all add to the satisfaction and enjoyment of eating a meal. This is equally important for a person with dementia: a good mealtime experience can have a positive impact on their health and sense of wellbeing. If you are in a restaurant with a group of friends and there is loud music playing or a live band playing close to your table, and the restaurant is busy and the conversations around your table are loud.
You are trying to make a choice from a long list of options on the menu as well as keep up with the conversation among the friends you are with. The waiter is hovering and you are feeling pressure to choose your meal. It may be a challenge for you to concentrate on the conversation around you while choosing from the menu, but you will manage to make this choice and continue to converse with your friends despite everything else going on around you. But or a person with dementia a noisy environment can be confusing: it can make it difficult to concentrate and focus. So if you had dementia and you were in that noisy restaurant you may have just got up from the table and walked out as the music, conversation and waiter were all competing for your attention. We need to be aware that people with dementia may struggle to concentrate at mealtimes if there are other distractions. The eating environment needs to be calm and relaxed. Switch off the television or turn down loud music to avoid distractions.
A person with dementia may not be comfortable eating with other people or in an unfamiliar environment. They may have difficulty eating food and this can only make feelings of embarrassment worse if they are sitting with others. As a result, they may leave food uneaten. Allow a person to sit and eat in a place where they feel comfortable, either at a table or perhaps sitting with a tray on their lap on a comfortable chair. It is important to be aware that some people with dementia may experience visual impairments that make it difficult to see the food in front of them. Sight difficulties may mean their perception of food – that is, the way they see the food – changes. For example, the shape or colour of the food may be confusing to them. Food should be presented colourfully and attractively. Always describe the food you are offering. Avoid using patterned crockery as it can be confusing and it can distract focus from the food. Keep crockery plain and simple. Ensure there is significant contrast between the colour of the crockery and the food.
For example, rice pudding in a white bowl may be difficult to see as there is poor contrast between the bowl and the rice. However, putting the rice pudding in a plain coloured bowl will help to ensure the food stands out and contrasts well with the bowl. Adding a topping such as strawberry jam further improves visual contrast. Ensure the area in which a person with dementia eats is bright and well lit so they can see the food easily. 2.3 Describe how a person centred approach can support an individual with dementia at different levels of ability to eat and drink Treating everyone as an individual and give them informed choices are the best person centred approaches. If we treat everyone as an individual then their wishes, preferences can be aware of individually.
And it will be much convenient to being aware of their wishes or preferences to meet clients satisfaction in order to provide our best quality service. Many people with dementia can make their own choices such as what they like to wear, what they like to eat or drink. If there is anyone who is unable to do so, we can inform them their available choices. They may not be able to communicate or tell us anything sometimes so we need to show them the available options. We may also be aware of their choices such as what do they like to eat or drink most from their care plans or asking the client’s main carer or family. Another important thing is observation. By observing what we see we can make a note of what they like to eat and drink most or what went well. We always should offer them with options and choices as much as we can.