Dementia Nutrition Pilot Project

1
Dementia Nutrition Pilot Project

• to develop and trial a model of providing food
  services tailored to suit the needs of people
  with dementia

2
Dementia prevalence

• In 2006 - 210,000 Australians living with
  dementia
• By 2050 - 730,000 nationally
• 227,200 living in New South Wales more than the
  current number nationally

3
Living Alone

• Number of elderly people living alone increasing
• Number of primary carers expected to fall
  significantly
• By 2031 - 600 000 frail elderly with no-one to
  care for them

4
Malnutrition can lead to

• Increased risk
• Falls
• Fractured hips
• Depression
• Adverse drug reactions
• Infections
• Dehydration
• Urinary tract infections
• Constipation
• Delirium

5
Good Nutrition

• Preventative factor in the onset of dementia
• Can slow down the progression of dementia
  symptoms
• Improves cognition
• Alleviates depression

6
Malnutrition in dementia

• Forget to eat or drink
• Greatly reduced appetite
• No longer able to prepare, cook or reheat
• Difficulties shopping for food
• Failure to recognise food or unable to open
  packages

7
Existing MOW clients

• Untouched piles of food trays around the house
• Freezers loaded with frozen meals
• Cant eat the full meal - reduced appetite
• Feed meals to their pet
• Exposed to cooking hazards
• Food poisoning after eating food that is
  reheated or stored inappropriately

8
Research and scope

• Consultations with other food service providers
  around Australia and internationally
• Beyond the front door' approach
• Creative, flexible and wholistic range of
  strategies

9
Screening and assessment

• Cognitive impairment high risk factor
• Likely to be malnourished
• Protein energy malnutrition

10
Volunteers

• People interested and willing to go beyond the
  front door
• Provided with appropriate support and training
• Used 70-80 of time
• Care workers and family

11
Professional dietetic input

• Professional dietitian involved
• Ensure high fat/high protein diet
• Supplements
• Staying alive a priority

12
Bag of tricks approach

• Hot or cold meals requiring plating and
  prompting
• Frozen meals for heating later
• Finger food pack menu
• Supplements, snack packs and muesli bars
• Phone prompting
• Centre based meals

13
Project Philosophy

• Person centred care - meeting the individual
  needs of the person
• Involve the person in decision making
• Focus on remaining abilities not deficits
• Encourage community and family connectedness and
  involvement

14
Participants

• 8 clients - Hornsby area - December through to
  May
• 7 clients - Ku-ring-gai area. Some started on the
  centre-based meals in July 2006. Others commenced
  in-home support from March 2007 onwards
• Assessed by the dietitian and reviewed monthly
• Several potential clients considered often too
  late.

15
Evaluations

• No suitable tools
• Qualitative approach and indicators
• Weight measurement - most important indicator
• Other medical indicators
• Social, psychological and functionally related
  changes
• Maintenance of existing weight success!

16
Key Strategies

• Meal time assistance - volunteers
• Guidance of dietitian
• Whatever goes in is maximised
• Nutrient dense foods of maximum calorie intake
• High fat / high protein
• Supplements and puddings
• Emphasis on hydration

17
Issues and questions

• CALD and ATSI clients
• 21 meals required
• Can we really do this?
• Support from all quarters
• Integrated approach
• Urgent nutritional priority

18
Ku-ring-gai Meals on Wheels Food Service

• Kathy Sharp, Co-ordinator
• Case Study -

19
Hornsby Meals on Wheels

• Look at individual needs
• Nutritional gaps
• Integrated approach
• Some other strategies- Afternoon tea- CALD
  speaking volunteers- Flexible and gradual
  introduction

20
Volunteers

• Difficult to retain
• Half of Hornsbys original volunteers gone
• Two out of five left at Ku-ring-gai
• Use care workers when consistency required
• More volunteers coming on
• Training and support

21
What are we doing differently?

• Nutritional assessment at client referral
• Over 50 of new clients have lost weight without
  trying
• Eating Well For Good Health client booklet
• Menu assessment find gaps
• Increased fluid availability
• Small high energy meals
• Finger food packs

22
Greater understanding

• Unique issues of dementia
• Communication crucial
• Best possible outcome for clients
• Ongoing nutritional training for volunteers,
  support staff and carers