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
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What is Dementia?
Statistics about Dementia in Ontario and Around the World
Responsive Behaviors
Communication through 5 Senses
Key Strategies
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
>65 Living with Dementia
600,000
400,000
200,000
0
2011
2031
Global Outlook
Dementia Worldwide
140,000,000
120,000,000
100,000,000
80,000,000
# of People living with Dementia
60,000,000
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
Show Plates/Pictures
Strategies:
Contrast color table mats and plates
Simple Table Setting
Processing Information in Dementia:
Listening/Auditory
Use Visual Cues
Key
Strategies:
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
Very Low
Strong
Provision of meals in a pleasant,
homelike atmosphere
Moderate
Strong
Use of ONS to improve nutritional
status
High
Strong
Close monitoring and documentation Very Low
of body weight
Strong
Educating caregivers on nutritional
problems related to dementia and
positive strategies to intervene
Strong
Low
Source: Volkert D et.al ESPN Guidelines on Nutrition in Dementia, Clinical Nutrition
(2015)
Evidence Based Practice
As needed Dietitian
Consultations Grade B
Food Service
Menu Changes
HEHP
De Centralized
Food on the Go
Staggered Meals
Flexibility
Feeding Assistance Grade
B
Older Adults
with
Dementia
Staff
Staff Education Grade B
Environment
Modifications 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: [email protected]
Teresa Tibbo RPN
Email: [email protected]
Thank You!