Responsive Behaviours in the Dining Room Apri ril 5, , 2016 TWC - PowerPoint PPT Presentation

How BSO and Dietary Can Work Together Responsive Behaviours in the Dining Room Apri ril 5, , 2016 TWC C Cu Culin linary and Nutrition Summit Ter eresa Tib ibbo RPN, Twin inkle le Patel el RD

Seasons Care Dietitian Network Carol Donovan, RD - President Caring - Committed - Creative

Objectives o What is Dementia? o Statistics about Dementia in Ontario and Around the World o Responsive Behaviors o Communication through 5 Senses o Key Strategies o 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 Behavioral Anxiety Agitation Calling out Wandering Cursing Apathy Verbal aggression Crying Delusions Physical aggression Restlessness Depressed mood Repetitive questioning Pacing Hallucinations Shadowing (stalking) Screaming Misidentifications Sleeplessness 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 Key Use Visual Cues Strategies: Keep Noise/Volume to minimal Avoid Distractions Be Flexible with providing meals in different areas

Processing Information in Dementia: Touch / Sensation Let them use their Hands Key Strategies: 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 Clear Uneaten Foods for Resident Safety Strategies Processing Information: Taste Key Taste preferences change frequently Strategies Re-evaluate interventions

Evidence Based Practice

Evidence Based Practice Statement Grade of Evidence Strength of Recommendation Screening every resident with Very Low Strong dementia for Malnutrition Provision of meals in a pleasant, Moderate Strong homelike atmosphere Use of ONS to improve nutritional High Strong status Close monitoring and documentation Very Low Strong of body weight Educating caregivers on nutritional Low Strong problems related to dementia and positive strategies to intervene Source: Volkert D et.al ESPN Guidelines on Nutrition in Dementia, Clinical Nutrition (2015)

Evidence Based Practice As needed Dietitian Environment Feeding Assistance Grade Consultations Grade B Modifications Grade B B Older Adults Food Service Environment with Dementia Menu Changes Small Dining Room Aquarium HEHP Background Music De Centralized Staff High Contrast Food on the Go Tableware Staggered Meals Flexibility Staff Education Grade B

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/About- dementia/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: twinkle@seasonscare.com Teresa Tibbo RPN Email: Ttibbo@extendicare.com

Thank You!