Feeding and nutrition in the older patient with dementia

Feeding and nutrition in the older patient

with dementiaNursing Conference

Healthcare Recruitment and Training FairLondon

17 September 2016

Roger Watsonwww.slideshare.net/RogerWatsonPhDRNFAAN

Learning objectives

• The causes and consequences of dementia

• The effect of dementia in eating and nutrition

• The evidence for effective interventions to alleviate feeding difficulty

• Assessing feeding difficulty in dementia

• Recent research into alleviating feeding difficulty in dementia

What is dementia?

• Various brain disorders that have, in common, loss of brain function which is progressive and, eventually, severe.

• How many people have dementia?– 750,000 in UK (population 50 million)

What causes dementia?

· Genetics· Co-morbidity· Lifestyle· Infection· Old age?: 40-65 1 in 1000

65+ 1 in 5070+ 1 in 2080+ 1 in 590+ 1 in 2

• At present there is no ‘cure’ for dementia

What happens to someone with dementia?

• Progressive cognitive decline:· loss of memory· subtle changes in personality

• Behavioural change:· wandering· aggression· incontinence· problems with eating

Food and dementia

• Almost inevitable disturbances to eating in dementia with decline in eating towards the terminal stages

• Weight loss is also associated with dementia but this may not just be the result of eating difficulty

• In fact, it has been demonstrated that weight loss can precede the onset of dementia

Records identified = 353

Remaining after duplicates removed and

papers screened = 13

Discarded =

340

Qualitative synthesis = 13

Meta-analysis = 0

Conclusions

• General methodological weakness:• Small samples (type II error)• Confounding variables• Impossibility of ‘blinding’ participants

• ‘Bottom drawer’ phenomenon

• How do we know what is clinically significant?

Assessment of feeding difficulty

Recent research into alleviating feeding difficulty

Montessori and spaced-retrieval methods

Maria Montessori

• Spaced retrieval, also known as expanded retrieval or uniform retrieval, is a learning technique, which requires users to rehearse information to be learned at different and increasing spaced intervals of time or a set uniform amount of time.

Montessori and spaced-retrieval methods

• Procedural memory is a part of the long-term memory that is responsible for knowing how to do things, also known as motor skills. As the name implies, procedural memory stores information on how to perform certain procedures, such as walking, talking and riding a bike.

Results• EdFED scores and assisting feeding scores for the SR and

Montessori-based activity groups after intervention were significantly lower than that of the control group, which indicates that SR and Montessori-based activity may decrease the eating difficulty of residents with dementia and decrease need for feeding assistance by caregivers. However, the frequencies of physical assistance and verbal assistance for the Montessori-based activity group after intervention were significantly higher than that of the control group, which suggests that residents who received Montessori-based activity need more physical and verbal assistance during mealtimes.

• In terms of the effects of nutritional status after intervention, MNA in the SR group was significantly higher than that of the control group, while MNA in the Montessori-based activity group was significantly lower than that of the control group.

ReferencesLin L-C, Huang Y-J, Su S-G, Watson R, Tsai BW-J, Wu S-C (2010) Using spaced retrieval andMontessori-based activities in improving eating ability for residents with dementia. International Journal of Geriatric Psychiatry 25, 953-959

Lin L-C, Huang Y-J, Watson R, Wu S-C, Lee Y-C, Chou Y-C (2011) Using a Montessori method to increase eating ability for institutionalised residents with dementia: a crossover study. Journal of Clinical Nursing 20, 3092-3101

Liu W, Cheon J, Thomas SA (2014) Interventions on mealtime difficulties in older adults with dementia: a systematic review. International Journal of Nursing Studies 51, 14-27

Watson R, Green S (2006) Feeding and dementia: a systematic literature review. Journal of Advanced Nursing 54, 86-93

Wu H-S, Lin L-C (2013) The moderating effect of nutritional status on depressive symptoms in veteran elders with dementia: a spaced retrieval combined with Montessori activities. Journal of Advanced Nursing 69, 2229-2241

Wu H-S, Lin L-C, Wu S-C, Lin K-N, Liu H-C (2014) The effectiveness of spaced retrieval combined with Montessori-based activities in improving the eating ability of residents with dementia. Journal of Advanced Nursing 70, 1891-1901

r.watson@hull.ac.uk

0000-0001-8040-7625

@rwatson1955