1. OCTOBER 2014 WESTMINSTER CANTERBURY BLUE RIDGE DINING WITH DEMENTIA

2. WHAT IS DEMENTIA? “Dementia is the slow deterioration of mental capacity impacting memory and judgment as a result from the progression of a disease which can cause emotional disturbances and personality changes.” Dementia is caused by damage to the vascular and neurologic structures of the brain and result in degenerative and/or irreversible conditions

3. SYMPTOMS Difficulty performing ADL’s Impaired motor symptoms Severe memory loss Complete disorientation Tongue usage problems Swallowing and chewing difficulties Decreased language and problem-solving skills Impaired recognition Bold indicates symptoms that can impact nutrition

4. NUTRITION AND DEMENTIA Dining Services staff can play a crucial role in the prevention of nutrition-related complications Dementia-related nutrition complications: Malnutrition- foods not being consumed Dehydration- lack of fluid intake Inadequate nutrient intake- limited variety of intake

5. CARING FOR PATIENTS WITH DEMENTIA Patient-centered care is crucial to this population Extra assistance may be needed during meal times Recognition of signs and symptoms can help YOU and the resident during meal times 3 stages of Dementia: Early Stage Middle Stage Late Stage

6. EARLY STAGE Forgetfulness Difficulty communicating thoughts Unable to hold attention through meal Changes in food preferences May be distracted by environment at mealtime SIGNSSolutions Review meal preference sheet Supervise eating Encourage consumption of food Serve one course at a time Offer alternatives Serve promptly after resident sits

7. MIDDLE STAGE Confusion Unaware of surroundings Difficulty remembering names Unable to perceive food as food Failure to properly use utensils SIGNSSolutions Redirect attention to meal Introduce yourself and members at table Explain what foods are on plate Serve meals with a fork or spoon only

8. LATE STAGE Reduced ability to make decisions Communication difficulties Unable to self-feed Swallowing impairments Preference of liquids over solids Refusal to eat SIGNSSolutions Utilize all solutions from previous stages Introduce yourself prior to serving meal Offer assistance with cutting food Provide scents of foods to stimulate memories Provide options for liquefied-versions of meals

9. GENERAL GUIDELINES Speak “low and slow” Introduce yourself to resident before serving meals Verbalize what food items are on the plate Make eye contact Be aware of food temperatures Remind/tell residents if the food is hot or cold Offer simple choices for meals Offer drinks regularly to avoid dehydration Consider putting food in a bowl rather than plate Provide alternative choices

10. MODIFIED DIETS Liquefied Puree Menu items that have been thinned with added liquid Beneficial to residents who prefer liquefied foods Residents in the late stage may benefit from this diet Finger Foods Menu items that can be picked up with fingers May be beneficial to residents in early and middle stages

11. MODIFIED DIETS MENU Regular DietLiquefied DietFinger Foods Minestrone SoupPureed minestrone soup thinned with extra broth Minestrone soup served in a mug Roasted turkey with gravy Pureed turkey, gravy thinned w/ broth Roasted turkey wrap with green beans, stuffing, cranberry sauce Fresh green beansPureed green beans thinned w/ whole milk Pumpkin PiePureed pumpkin pie thinned w/ milk Pumpkin cannoli

12. SUMMARY Remember, you can play a major role in providing adequate and essential nutrients to residents! Knowing your residents and which foods are available will help to create an enjoyable dining experience

13. THANK YOU Questions?

14. RESOURCES Morrison Senior Living. Dignified Dining. A guide to enhance dining experience for resident living with dementia.