Oxfordshire Skills and Learning Service

Unit 108 (3565) (D !30" #"""$366) %no&ledge 'ork(ook Understand and )eet the n*tritional re+*ire)ents of individ*als &ith de)entia

Learner na)e, Learner signat*re, Date co)3leted, 0eco))ended /L4S, "6

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5ssessor na)e, This unit is about understanding that individuals may have specific nutritional needs because of their experience of dementia. Learners will develop their knowledge and skills in meeting these nutritional requirements and be able to provide evidence of their competence to enable individuals with dementia to eat and drink well Learning outcome 3 needs to be assessed in the workplace environment You must understand your organisations policies and procedures before attempting to answer the learning outcomes ead the guidance on the terms used in this workbook before you start. !age " of #"

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Learner 5ssess)ent 0ecord Unit 2*)(er, 108 Unit 6itle, Understand and )eet the n*tritional re+*ire)ents of individ*als &ith de)entia Date 'ork(ook s*()itted, 1st $$$$$$$$$$.. "nd $$$$$$$$$$.. %ssessment %ssessor 'eedback "st #nd &riteria (ubmission (ubmission )utcome )utcome !ass* efer !ass* efer "." ".# ".3 ".+ "., #." #.# #.3

Learning outcome 3 must be assessed in a real work environment and your %ssessor will agree additional methods to cover these- including observation of your practice

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%ssessor comments to Learner

Target date and action plan for resubmission .if applicable/

)utcome of second submission

0 confirm that this assessment has been completed to the required standard and meets the requirements for validity- currency- authenticity and sufficiency %ssessor (ignature1 2ate1

0 confirm that the assignment work to which this result relates- is all my own work Learner (ignature1 2ate1 0nternal 3erifiers (ignature1 2ate1

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5dditional g*idance %n individual is someone requiring care or support !erson4centred approach1 This is a way of working which aims to put the person at the centre of the care situation taking into account their individuality- wishes and preferences 5eal times1 5eal planning 'ood shopping 'ood preparation !re4 and post4meal activities 2ining (nacking 6ell4being1 %ppropriate weight gain*loss 0mproved sleep patterns educed confusion 0mproved physical health 0mproved emotional state educed infections educed constipation 7or )ore detailed infor)ation 3lease research, www.al7heimers.org.uk http1**www.scie.org.uk*publications*dementia*index.asp

http1**www.logontocare.org.uk*e4learning8*

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5ssess)ent -riteria 111, ho& cognitive8 f*nctional and e)otional changes associated &ith de)entia can affect eating8 drinking and n*trition
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2ementia can greatly affect a person9s relationship to food and eating. The behavioural- emotional and physical changes that take place as dementia progresses can all have an impact upon a person9s eating habits and on their intake of food and drink. 0t is important to do what you can to make sure that the person you are caring for en:oys their food and eats a healthy- balanced diet. %s dementia progresses eating can become difficult for some people. ;owever- by making a few changes you can help keep mealtimes as en:oyable and stress free as possible. % person with dementia may no longer recognise the food in front of them. They may struggle to use a knife and fork as co4ordination becomes difficult. The person may not open their mouths as food approaches and may need reminding to do so. 'ood may be difficult to chew or swallow or they may not want to accept assistance with eating. 0f you are supporting a person with dementia at mealtimes it is important to remember that these reactions are not a deliberate attempt to be 9difficult9- or a personal attack. The difficulties are likely to be related to changes caused by the person9s dementia. 6hen supporting a person at mealtimes it can be a challenge to identify what the problem is- particularly if the person themselves is finding it difficult to find the words to explain. 5ssess)ent -riteria 11", ho& 3oor n*trition can contri(*te to an individ*al9s ex3erience of de)entia1 5ssess)ent -riteria 113, ho& other health and e)otional conditions )a: affect the n*tritional needs of an individ*al &ith de)entia 5ssess)ent -riteria 11#, the i)3ortance of recognising and )eeting an individ*al9s 3ersonal and c*lt*ral 3references for food and drink 5ssess)ent -riteria 115, &h: it is i)3ortant to incl*de a variet: of food and drink in the diet of an individ*al &ith de)entia !eople with dementia need to make sure they eat a healthy balanced diet. % balanced diet provides all the nutrients the body needs in the right amounts to stay healthy. %s dementia progresses- changes in a person9s eating habits and ability to eat often take place. 2ifficulties swallowing- changes in taste and smell or a poor appetite can
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make it increasingly difficult to ensure that an adequate amount of nutritious food is eaten. % healthy diet is only as healthy as the food that is eaten. 0t is therefore important to take into account the person9s likes and dislikes and their ability to manage certain foods. &onsider ways of preparing food to stimulate interest- particularly if the person9s appetite is poor. emember- eating healthily does not mean that certain foods have to be avoided. =verything in moderation and a little bit of what you fancy is the key to en:oying food and staying fit and well. 5any foods provide a range of nutrients and similar foods are often grouped together into 9food groups9. Listed below are the different food groups and the nutrients they provide. &hoosing a variety of foods from different food groups is the best way to ensure a balanced intake of all the different nutrients needed for good health. !ilk and dair: food This group includes milk- cheese and yoghurt and foods made with milk- such as custard- milky drinks or milk puddings. These foods are a good source of protein- which is needed to build and repair body tissues. They also provide a rich source of calcium- needed for strong bones and teeth. To help the body absorb calcium from food- we need vitamin 2. 3itamin 2 is mainly formed by the action of sunlight on the skin- but can also be found in foods such as oily fish- margarine and eggs. ;owever- for older people who are housebound- or spend little time outdoors- a vitamin 2 supplement may be required. &heck with the >! or dietician. !eat8 fish and alternatives This group includes meat- poultry- fish- offal- eggs- nuts- beans- lentils and soya products such as tofu. These foods are a good source of protein and also provide some of the ? group vitamins .see ?read- cereals and potatoes/. 'oods of animal origin- such as meat- fish- offal and eggs- are good sources of vitamin ?"#. 3itamin ?"# is needed for a healthy nervous system and the formation of red blood cells. !age @ of #"

'olate and iron are also needed to keep the blood healthy. Liver is a good source of folate .see 'ruit and vegetables/ and iron can be found in red meat- oily fish- liverkidney- beans and lentils. =ating fruit and vegetables that are rich in vitamin & can help with the absorption of iron from food .see 'ruit and vegetables/. )ily fish- such as salmon- mackerel- herring and sardines- is a rich source of essential fats called omega43 oils. These oils play an important part in maintaining the health of the heart and the nervous system. =ating oily fish at least once a week is recommended. 'or those who choose not to eat meat or fish- foods such as pulses .beans- peas and lentils/ nuts- eggs- cheese and soya can be eaten instead. % variety of these foods should be eaten to ensure a good range of nutrients. (ome people who avoid all animal foods 4 meat- fish- eggs and dairy foods 4 will probably need a vitamin ?"# supplement. &heck with the >! or dietician. ;read8 cereals and 3otatoes This group of foods provides energy and is a good source of ? group vitamins. %s well as keeping the blood and nervous system healthy- ? vitamins break food down to release energy. 'oods in this group include1 ?read .wholemeal or white/- including chapatti- nan and pitta breadA crackersA crumpetsA muffins- and teacakes !asta- such as spaghetti or macaroniA noodles- and rice !otatoes- plantain and yam ?reakfast cereals and flour. ?reakfast cereals are fortified with added vitamins and minerals- such as folate- vitamin ?"# and iron. (erved with milk- they provide a nourishing snack that can be eaten at any time of the day- not :ust in the morningB 6holemeal bread- wholemeal pasta and wholegrain breakfast cereals are all good sources of fibre. =xamples of wholegrain breakfast cereals include porridge oatsbran flakes and whole wheat biscuits. 7r*it and vegeta(les This group includes all fruit and vegetables- dried fruit and fruit :uices. 'ruit and vegetables are packed full of fibre and vitamins 4 in particular- the antioxidant vitamins &- = and beta4carotene. These vitamins help to protect the healthy cells of the body from damage and support the immune system to fight infections. ?eta4carotene is found in yellow and orange fruit and vegetables and in dark green leafy vegetables. )nce in the body- it is converted into vitamin % as !age C of #"

required. 3itamin % can also be found in animal foods such as liver- eggs- cheese and butter. 3itamin = is present in green leafy vegetables- vegetable oils- butter and nuts. 3itamin & is needed to keep gums- teeth and skin healthy. 0t also helps the body absorb iron from food .see 5eat- fish and alternatives/. &itrus fruit- such as orangesstrawberries and kiwi fruit- and tomatoes and potatoes are good sources of vitamin &. 'or those who find it difficult to eat or prepare fruit and vegetables- drinking a glass of orange :uice every day is a good way to ensure an adequate intake of vitamin &. >reen leafy vegetables- ?russels sprouts- oranges and other citrus fruit are all good sources of folate. % general guide is to try to have five servings of fruit and vegetables a day to ensure a good range of nutrients for health. ;owever- individual dietary needs can varyparticularly for people with dementia- and may be influenced by the stage of dementia- ability to eat certain foods- the person9s medical condition and other circumstances. This guide may not be appropriate or achievable for all people with dementia. ;owever- every little helps- so encourage and accept what each person can manage. 7ats8 oils and other foods This group includes margarine- butter- ghee and vegetable oils such as sunflower oil and olive oil. These foods are concentrated sources of energy- so are not needed in large amounts. They do provide some vitamins. 5argarine contains vitamins 2 and = and vegetable oils are a good source of vitamin =. 9)ther foods9 include cakes- pastries- biscuits- confectionery- crisps- and soft and alcoholic drinks. These foods are not nutrient rich. They mainly provide calories or energy from fat and*or sugar. They can be included as part of a healthy balanced diet- but if eaten too frequently they may dampen the appetite for more nutritious foods. 0t is a question of moderation. 5 &ord a(o*t fi(re 'ibre is important to help prevent constipation. The risk of constipation is greater for people who are inactive- do not drink enough or eat a low fibre diet. &ertain medications can also aggravate the problem. !age D of #"

% good way of preventing constipation is to include foods that are a good source of fibre in the diet 4 fruit and vegetables- salads- beans- lentils- wholemeal bread or wholegrain breakfast cereals- for example. ;owever- it is best to introduce high fibre foods gradually if the person is not used to eating them. Too much fibre in the diet can be bulky and uncomfortableA small changes are usually sufficient. 0t is not advisable to add raw bran to foods as this can cause bloating and discomfort. 0t can also make it difficult for the body to absorb nutrients such as calcium and iron. To help prevent constipation also try- if possible- to encourage daily activity for those who are able. % short gentle walk is a good start. Drink to think 2rinking enough fluid every day is vital for good health. % low intake of fluid is likely to result in dehydration. This can increase the risk of constipation and affect moodresulting in increased irritability and confusion. (ome people with dementia may not recognise that they are thirsty or may simply forget to drink. 'luids include water- tea and coffee- fruit :uice- milk and other soft drinks. >entle reminders and prompts to drink may help. )ffering the person the cup rather than leaving it on the table may prompt a person to drink. (ome supermarkets offer a delivery service- where orders can be placed by phone or through the internet. This is a good way of ensuring a regular stock of fresh food and can help if time is limited or it is difficult to get to the shops. There may be a charge for this service- so it is best to ask first. <oor a33etite There are several reasons why a person with dementia may have a poor appetite or seem uninterested in eating. 0n the early stages of dementia some people lose interest in food because they are depressed. 2epression is very common but there are effective drug treatments available. 0f you suspect this is a problem- consult your >!. 6hen the depression lifts- the person9s appetite should return. % sore mouth- badly fitting dentures or sore gums can make eating uncomfortable. egular dental care is important- so seek the advice of a dentist. 0f the person is inactive during the day- they may not feel hungry. =ncourage activity such as walking- if appropriate.

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0n the later stages of dementia- people may no longer understand that the food in front of them is there to be eaten- even if they are hungry. This is because the nerve pathways in the brain are damaged and the messages do not get through. >entle prompts and reminders to eat may be helpful. =ating in company can act as a useful cue- reminding the person what to do and how to eat. 5edication can sometimes affect the appetite. (ide4effects such as constipation- changes in taste or a dry mouth can reduce the desire to eat. &onstipation can be helped by increasing fibre and fluid intake. Eeeping food moist by adding sauces or gravy can help the person to eat more easily if their mouth is dry. (mall sips of water taken while eating may also help. &hewing and swallowing sometimes becomes a problem as dementia progresses. !eople may find chewing solid food difficultA they may hold food in their mouths rather than swallow it- or you may notice that they cough after swallowing. 0f you have any concerns about chewing and swallowing food- a speech and language therapist can advise. (ome people with dementia find eating with a knife and fork difficult because they have problems with co4ordination. This can be frustrating and they may feel embarrassed if they drop food or if the task becomes messy. This can be sufficient to put a person off eating at mealtimes. Try offering finger foods to boost confidence and maintain independent eating. !eople with dementia often experience changes in food preferences. This is thought to be a result of damage to specific areas in the brain or it may be due to the person simply forgetting which foods or drinks they used to like. &hanges in taste and smell can all impact on the amount and variety of foods eaten. 0f food preferences become very limited- the person will probably not be getting all the nutrients they need to stay healthy and they may lose weight. % dietician can offer practical advice on how to enrich food and drink to help with a poor appetite and weight loss. (ome people with dementia may need food supplements- such as energy4 and protein4enriched drinks. These are usually prescribed and should be taken under the guidance of a dietician and >!. (ome supplement drinks can be purchased from chemists and supermarkets. These often come in a powdered form and can be made into a drink- usually by adding milk.

Losing weight is not an inevitable part of having dementia. 6ith time- effort and knowledge of the person- food intake can be increased. 0t is helpful to be aware of some of the changes that can occur as dementia progresses- such as difficulties using cutlery and changes in visual perception1 these changes can result in a person eating and drinking less than they need to stay healthy and well nourished.

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5easuring a persons weight each week can help to indicate any changes that need attention. This is part of what is called Fnutritional screening- a process of identifying people who are malnourished or at risk of becoming so. 4o& and &hen to eat This depends on the individual and how they prefer to eat. % person with a good appetite may have no problem eating sufficient food at regular mealtimes. ;owever- a person with a small appetite may not respond well to generous servings of food three times a day. Too much food on the plate can be off4putting to someone whose appetite is poor. 0n this case- try serving smaller portions at mealtimes and offer nourishing snacks in between mealtimes to supplement food intake. )ffer dessert as a separate course an hour or so after the main meal- rather than presenting both courses at the same time- as this may also help. %lternatively- you may find the person prefers to eat 9little and often9 4 five smaller meals spread over the day instead of the usual three- for example. 0t is a matter of finding out what works best for the individual. Drinks =ncourage milky drinks- hot or cold. 5ake malted milk drinks or hot chocolate with milk. Snacks (andwiches with fillings such as egg- tinned fish- meat- cheese or peanut butter &heese and biscuits Toast with cheese- pGtH- peanut butter or yeast extract ?uttered scones- toasted teacakes- buttered crumpets or muffins 'ruit loaf or malt loaf 5ilk pudding- breakfast cereals and milk- yoghurt 'ruit cake or gingerbread1

5voiding over eating (ome people with dementia may eat too much food. They may forget they have :ust eaten or they may have a persistent desire for certain foods- such as sweet biscuits or confectionery- and snack on these throughout the day. )vereating can become a problem if the person gains too much weight. &arrying extra weight will make it more difficult to get around and the person will start to feel uncomfortable. !age "# of #"

(nacking frequently on foods such as confectionery or biscuits can reduce a person9s appetite for more nutritious food at mealtimes- which means they may not be getting all the nutrients they need to keep them healthy. Try to limit the availability of these snack foods if they are being eaten too often and the person is gaining excess weight. !rovide healthier alternatives- such as pieces of fresh fruit and vegetable. (ome people may eat out of boredom or loneliness- or they may not be active during the day /etting hel3 0f you have concerns about a person9s eating or drinking- help is available. Eey healthcare professionals who can offer advice and guidance include1 2ieticians- who can provide advice on issues such as poor appetite- weight loss or weight gain- food enrichment and vitamin and food supplements. (peech and language therapists- who can give advice and guidance on swallowing difficulties. 0t is important that changes to the texture of food are only made as necessary and with their professional advice. )ccupational therapists- who can advise on adapted eating aids- such as cutlery- cups and plate mats- which help to maintain independent eating.

These professionals can be contacted through their >! or consultant- who will be able to arrange for a referral. (ome professionals may be able to offer a domiciliary visit to people who are housebound. )thers may be based at a local health centre>! practice or hospital. (ervices vary from area to area. 5ssess)ent -riteria "11, ho& )ealti)e c*lt*res and environ)ents can (e a (arrier to )eeting the n*tritional needs of an individ*al &ith de)entia 5ssess)ent -riteria "1", ho& )ealti)e environ)ents and food 3resentation can (e designed to hel3 an individ*al to eat and drink 5ssess)ent -riteria "13, ho& a 3erson centred a33roach can s*33ort an individ*al8 &ith de)entia at different levels of a(ilit:8 to eat and drink
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The environment in which a person with dementia eats will have an effect on how they eat. !eople with dementia will not want to stay and eat in an environment in which they feel uncomfortable. Inderstanding the impact of the mealtime environment can help us to improve the eating experience for people with dementia. 0magine you are in a restaurant with a group of friends and there is loud music playing or a live band playing close to your table. The restaurant is busy and the conversations around your table are loud. You are trying to make a choice from a
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long list of options on the menu as well as keep up with the conversation among the friends you are with. The waiter is hovering and you are feeling pressure to choose your meal. 0t may be a challenge for you to concentrate on the conversation around you while choosing from the menu- but you will manage to make this choice and continue to converse with your friends despite everything else going on around you. 'or a person with dementia a noisy environment can be confusing1 it can make it difficult to concentrate and focus. (o if you had dementia and you were in that noisy restaurant you may have :ust got up from the table and walked out as the musicconversation and waiter were all competing for your attention. 6e need to be aware that people with dementia may struggle to concentrate at mealtimes if there are other distractions. The eating environment needs to be calm and relaxed. (witch off the television or turn down loud music to avoid distractions. % person with dementia may not be comfortable eating with other people or in an unfamiliar environment. They may have difficulty eating food and this can only make feelings of embarrassment worse if they are sitting with others. %s a result- they may leave food uneaten. %llow a person to sit and eat in a place where they feel comfortable- either at a table or perhaps sitting with a tray on their lap on a comfortable chair. 0t is important to be aware that some people with dementia may experience visual impairments that make it difficult to see the food in front of them. 2escribe the food you are offering and ensure that the food is presented colourfully and attractively. 0t should look good enough for anyone to eat. =nsure the area in which a person with dementia eats is bright and well lit so they can see the food easily 'ood and images of food can also be used for reminiscing or part of reminiscence activities. This can help stimulate discussion and interest in food and mealtimes by helping the person to reconnect with familiar food from their past. 0t is not uncommon to notice a persons likes and dislikes for food and drinks change as dementia progresses. These may be quite dramatic and very different to the preferences a person may have held for many years. 0t is wise to expect change and not make assumptions that everything will stay the same.

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% flexible approach to providing food and supporting the person at mealtimes is vital. %s with any one of us- the appetite of a person with dementia may vary from day to day. 6e all have likes and dislikes and eating habits that are particular to us as individuals. !eople with dementia are no different. 6e need to know what type of food a person likes to eat- where they like to eat it and when they like to eat. 'or example- a person with dementia may be used to eating their main meal in the early evening by themselves- sitting in a comfortable chair listening to the radio. 0f this person is suddenly offered their main meal at lunch time and expected to sit at a dining table with others it would be no surprise if they refuse to eat the meal or leave it uneaten. This new situation may be confusing and unfamiliar to the person or they may :ust not be hungry at that time of the day. %sking people with dementia about their mealtime preferences- when and where they like to eat and what foods they en:oy is vital to ensure we provide food and options at mealtimes that are familiar to them. 'amilies and carers can be a valuable source of information if the person with dementia is struggling to communicate their eating habits and preferences for food and drinks. !eople with dementia may struggle to ask for food if they have difficulty finding the words to express themselves. 'ood and drinks need to be visible and available throughout the day so that people can eat and drink whenever they feel hungry or thirsty. =nsure that snacks and drinks are easy to access and see so that people with dementia can take a drink or eat without having to wait for it to be offered. Look at this website and view the video clip about nutritional care for older people http1**www.scie.org.uk*socialcaretv*video4player.aspJguidK3e,,CC,f4#"D84+d<e4 Cc",48D8cf,c@e<Ce

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%ssessment &riteria "."1 =xplain how cognitive- functional and emotional changes associated with dementia can affect eating- drinking and nutrition Think about an individual you support who has dementia and complete the chart below ;ow it affects their eating &ognitive changes ;ow it affects their drinking ;ow it affects their overall nutrition

'unctiona l changes

=motional changes

%ssessment &riteria ".#1 =xplain how 3oor n*trition can contribute to an individuals experience of dementia. .5inimum ,8 words/
3

6hat they can do

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%ssessment &riteria ".31 2escribe how other health and emotional conditions may affect the nutritional needs of an individual with dementia .5inimum ,8 words/

%ssessment &riteria ".+1 2escribe the importance of recognising and meeting an individuals personal and cultural preferences for food and drink .5inimum ,8 words/ !age "@ of #"

%ssessment &riteria ".,1 =xplain why it is important to include a variety of food and drink in the diet of an individual with dementia .5inimum ,8 words/

%ssessment &riteria #."1 =xplain how mealtime cultures and environments can be a barrier to meeting the nutritional needs of an individual with dementia L describe at least three for each that are common to the type of work you do

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6hat environmental barriers there may be to good nutrition

;ow 0 can reduce these barriers

6hat cultural barriers there may be to good nutrition- including organisational cultures as well as the individuals

;ow 0 can reduce these barriers

%ssessment &riteria #.#1 how mealtime environments and food presentation can be designed to help an individual to eat and drink %ssessment &riteria #.31 how a person centred approach can support an individualwith dementia at different levels of ability- to eat and drink Look at this website and view the video clip about nutritional care for older people !age "D of #"

http1**www.scie.org.uk*socialcaretv*video4player.aspJguidK3e,,CC,f4#"D84+d<e4 Cc",48D8cf,c@e<Ce Think about an individual you support who has dementia. 2escribe how you support that person to eat and drink that de)onstrates a person centred approach and ensuring all factors of this approach are taken into account. .5inimum #88 words/

)nce complete please make sure that your details are on the front of the workbook and then return it to your assessor1 )xfordshire (kills and Learning (ervice Inipart ;ouse !age #8 of #"

>arsington Lane &owley )M+ #>N

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