Are your care home staff drinking enough fluid?

Introduction

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A small study into the drinking habits of staff in a Highland care home has indicated that Care Home Staff are not consuming enough fluids each day. [Have a look at our poll at the bottom of this blog to see if you are drinking enough fluid]

Urray House in Muir of Ord supported Karen Gentleman, a student dietitian from Robert Gordon Univeristy, to carry out a short study with staff to clarify whether dehydration might be an area of staff health which needed more focus. Staff volunteered to record their total daily intake of fluids over a 3 day period. These were compared with their calculated daily fluid requirements (weight x 35mls) and the results showed that care staff members were only consuming an average of 56% of what was recommended. This is shown on the slide below.

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Participants noted that they experienced the following symptoms of dehydration; thirst, passing light brown/yellow urine, lack of urine, tiredness, inability to concentrate, headache and light headedness.

Reasons given for such poor intake included:

“We know we need to drink, but it’s difficult to find the time”,

“When walking about it’s difficult to carry a drink with you”,

“Sometimes you make a hot drink, but are distracted by visitors, the phone, then the drink gets cold so you don’t drink it”

Denise Scott (Urray House Manager) said: “the staff members taking part in the survey were surprised at how poor their fluid intake was and this has really highlighted to them that they need to prioritise time to take drinks throughout the day. We will be sharing this work with other staff here and more widely to support our other colleagues in The Parklands Care Group, it is also an area that could be implemented as part of staff health promotion in the induction process”

Evelyn Newman (Nutrition and dietetics advisor for care homes in NHS Highland) said “this has been an excellent way of showing staff how dehydrated they are and how they can benefit from drinking more fluid at work. We can all benefit from this approach, as it is too easy to forget to drink, while doing other work and focussing on residents rather than ourselves. I hope that we can continue to build on this work and by sharing it with a wider audience”

Conclusion

Care home staff members are generally not meeting their daily fluid requirements. This is not because there is poor access to a range of fluid in the home; rather it is because it is not part of a staff routine to take drinks at every opportunity.

The member of staff with the highest intake took more regular opportunities to drink in smaller quantities. Even so, this was still not meeting their requirements.

Dehydration can have a negative effect on staff health and well-being and may promote symptoms such as tiredness, fatigue, low mood and contribute to increased staff absence. Working in a caring environment for vulnerable adults is a demanding role, making adequate hydration essential to perform duties effectively. Dehydration can also cause feelings of irritability and a lack of concentration which could cause trips and mistakes with medication etc.; this could be detrimental to residents. It is therefore in everyone’s interest to ensure that care home staff members remain adequately hydrated.

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Recommendations

Care home managers and staff are encouraged to assess their own fluid intake and to take steps within their own care environment to ensure that drinks are encouraged at every opportunity; for example taking tea with residents; having water at staff meetings/handovers; drinking fluids during teaching sessions.

Good fluid intake is also essential for residents and service users too, so support them to have a variety of drinks and flavours; offer ice lollies or chilled jellies; soups and milky puddings and use prescribed thickening agents for anyone with dysphagia and in need of texture modification.

Evelyn Newman RD and Denise Scott, Manager, Urray House Care home.

June 2015

Resources

Click on each image for a dehydration poster

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Poll. Do you drink enough fluid at work?

Notes and thanks

With thanks to RGU student Karen Gentleman, from Robert Gordon Univeristy who is currently finishing her B placement.

The attached flyers and posters have been rolled out to all care homes and care at home providers with full support of the Director of Adult Social Care, Joanna MacDonald.

Nutrition and Hydration in Highland Home Care Settings

Evelyn NewmanBy

Evelyn Newman

NHS Highland’s Nutrition and Dietetics Advisor: Care Homes

NHS Highland has had lead agency responsibility for all adult health and social care provision since service integration in December 2012. I was appointed to my strategic role as nutrition and dietetic advisor for care homes in April 2014. This is a very unique post in the UK and offers lots of opportunity to highlight the role and impact of nutrition and hydration in supporting the health and quality of life for elderly residents and service users.

The north Highland adult health and social care partnership supports 74 care homes; 16 of which are directly managed by NHS Highland. Many of them are based in and around Inverness but I support care homes in some very remote and rural areas, from Caithness, across to Skye, down to Lochaber and over to Strathspey.

I have found care home staff, managers and owners very keen to engage with me and have been able to identify a number of common areas which I can help them with.

Supporting an increasing number of residents with swallowing difficulties, linked to stroke, dementia and other conditions led to the development of a texture modification master class, supported by colleagues from speech and language therapy and occupational therapy. So far more than 400 home care staff have attended these sessions and each time we run them we have new care homes wanting to send staff. The effect of this training has directly led to improvements in care of these residents such as: more varied menus for each texture; use of fruit smoothies; more appropriate SLT referrals; purchase of new equipment to support safer eating; and less distractions at mealtimes.Nutrition News

A quarterly, electronic newsletter (“Nutrition News”) has been developed to engage with a wider audience of care home, care at home and community clinical staff. This has helped to share good practice stories, up to date, evidence based information, details of nutrition/hydration training and resources to help them.

We have been able to pilot the first care home model of a dietetic placement in the UK with support from Robert Gordon’s University and we are now actively working with NES and the Care inspectorate to develop a care at home model, with a local independent service provider.

Evelyn receiving the Dame Barbara Clayton Award 2015
Evelyn receiving the Dame Barbara Clayton Award 2015

This work has been recognised by the Advancing healthcare awards, where we came runners up in the 2015 AHPF award for integration and more recently when we collected the prestigious Dame Barbara Clayton award at The British Dietetic Association’s annual awards dinner on the 4th of June.

Life is never dull in my role and I really enjoy being able to make a difference to the lives of service users in homely settings, sometimes with just the simplest of ideas or links I can make on their behalf.

Integrated health and social care if implemented with the service user at the centre can really transform their quality of life and help them to live life as they would want in their own home settings.

Evelyn Newman RD, NHS Highland’s Nutrition and Dietetics Advisor: care homes, can be contacted on 07870868475 on twitter @evelynnewman17 or by email on evelyn.newman@nhs.net

Q&A with Tracy MacInnes; Dietitian and Associate Chief Health Professions Officer

Tracy MacInnes with Marjory MacLeod
Tracy with Marjory MacLeod, BDA Scotland Board Chairperson

Can you start by telling the readers a little bit about yourself and your professional career to date?

Yes, I qualified as a Dietitian from what was, Queen Margaret College, in 1986 and started my first job at Stoke Royal Infirmary. It was a rotational basic grade post so covered renal, paediatrics and community; which provided me with a really solid platform to build on. I then went to Stafford District General and worked as the Senior 1 dietitian where I again managed a complex and varied workload within primary and secondary care. I then made the decision to move back to Scotland in 1992 and was successful in getting the renal dietetic post at the Royal Infirmary in Glasgow. This was my first experience of working outside of a dietetic department and within a wider multi-professional team. This was when I really began to extend my scope of practice. My final dietetic post was as the Chief Dietitian within the Southern General Hospital in Glasgow, after which I moved to work as the Senior Professional Advisor at the Care Inspectorate. In this position I had responsibility for the regulation of independent hospital and hospices in Scotland. This was where my interest in integration started as I lead teams of officers who had professional backgrounds from education, social care, policy and health.

I was awarded the IBEX Award for Professional Achievement in 2003 by the BDA, and in 2005 I completed my Masters in Healthcare Management at Strathclyde University and my Postgraduate Certificate in Social Services Leadership, from Robert Gordon’s University – phew!!

In 2009 I had the opportunity to join the Scottish Government and I’m presently the Associate Chief Health Professions Officer.

How would you describe the work of a dietitian to someone who has never witnessed what we do?

Dietitians use the most up to date health and scientific information on food and health and interpret it in to practical advice so they can support people of all ages to make informed lifestyle and food choices.

With regards to profile, who should dietitian’s/the profession be engaging with and what should their key messages be?

Population health and reducing inequalities is a huge priority for us in Scotland. I believe that the dietetic workforce has a vital role to play by having healthy conversations at every opportunity and interacting with people who use our services, their families or carers, promoting healthy lifestyle choices and signposting to relevant health, voluntary and/or social care services.

In your opinion what makes a good leader?

Someone who can influence outside of their sphere of influence

How can dietitian’s/the BDA encourage leadership within the profession?

We need to build up an evidence base which illustrates the impact of dietary interventions, shows the added value of dietetic input and tells the story of what is the unique skills of a dietitian. I believe that building a dietitian’s knowledge of improvement methodologies and how to apply them is key.

What do you think are the key challenges for the profession over the next few years? And how do you think we can work collectively to address these?

We are living in a challenging economic time with real financial constraints whilst moving forward to working in a more integrated way. People are living longer now and demands on our services will become greater, so we need to deliver services differently and we need to spread and sustain good practice throughout Scotland

The incoming BDA chairman’s theme is ‘Workplace Health’ – why is this an important agenda item and how can dietitian’s lead the way/make an impact on this?

Building up and maintaining our own self resilience is important in maintaining good health; especially considering the pressure we all face. Again dietitains are well placed to sign post work colleagues & friends to resources which can help the person make a more informed decision about their lifestyle; they also have a great deal of practical knowledge and expertise which can be utilised to encourage behaviour change and enable people to adopt healthy lifestyles.

If you could give one piece of advice to a newly qualified dietitian, what would it be?

Remember you can do anything you want to do, as the skills that you have built up are transferable across the public sector.

Some of the Dietitians who attended the Scottish Parliament
Some of the Dietitians who attended the Scottish Parliament

You were able to attend the BDA Scotland Boards event at the Scottish Parliament on Wednesday, why was this important and what were your reflections from the evening?

I have to say I thoroughly enjoyed the Scottish Parliamentary reception hosted by the BDA Scotland Board, it was one of many activities being held throughout the country as part of the BDA’s International Dietitians Week 2015

It was a great opportunity to share with MSPs the vital role that dietitians play in dementia care, and to highlight the many examples of good practice from across Scotland. My congratulations to Marjory and the rest of the team for pulling the reception together

The BDA Scotland Board would like to say a huge thank you to Tracy and all of this week’s bloggers. We would also like to thank AHP Scot Blog for providing the platform and to all of our readers who stopped by and got involved in #DietitiansWeek 2015.

A Case Study In Dementia Care

As Marjory MacLeod told us at the beginning of the week, the BDA Scotland Board were hosting a Scottish Parliamentary Reception on Wednesday June 10th to showcase the role of Dietitians and their work in the area of dementia. Last night that event took place, and it was a great success wth key partners displaying resources and examples of good practice to dietetic colleagues and MSPs from across Scotland.

One of those illustrating her work was Sheila Riddoch Lead Dietitian, Acute Services, NHS Sheila RiddochGrampian, and now she has taken the time to share her work further through our blog.

As Marjory said in her blog on Monday approximately 90,000 people are currently living with dementia in Scotland and Dietitians play a vital part in their care.

Eating and having a good meal is part of our everyday life and important to everybody, not least to people living with dementia. However dementia can greatly affect a person’s relationship with food and eating. Whilst the difficulties experienced vary from one individual to another the result is often weight loss and deteriorating health. Undernutrition is common among older people generally; and the consequences include increased frailty, skin fragility, falls, hospitalisation and increased mortality. In people with dementia, undernutrition is particularly common. It also tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace across the disease course. However, whilst weight loss is a common problem for people with dementia, undernutrition can and should be avoided.

Sheila demonstrating the pictorial menus and illustrating colour contrast crockery and trays.
Sheila demonstrating the pictorial menus and illustrating colour contrast crockery and trays at the Scottish Parliament.

The cause of undernutrition in people with dementia is often multi-factorial involving the behavioural, emotional and physical changes which take place as dementia progresses. However one of the common problems which people with dementia encounter is a change in vision and a reduced understanding of what they are seeing. This led to research by a team at Boston University who showed that if we change what we do, and thereby allow people to see their food; they are much more likely to eat it. In context, what the team did was serve food to people with advanced Alzheimer ’s disease on standard white plates and then served the same food to the same client group on red plates. What they found was that people eating from the red plates consumed 25 percent more food than people eating from white plates. The simple reason for this improvement was that the contrast in colours between the food and the crockery allowed people to see their food more easily and subsequently they were more inclined to eat it.

With this research in mind NHS Grampian trialled the use of colour contrast crockery and coloured reusable drinking glasses in a local assessment unit for older people. When compared to the use of the traditional crockery and disposable white tumblers, positive feedback was received.

Since the provision of a good quality eating experience is an integral part of the therapeutic care provided in hospital and the results of the trial were so positive, a decision was taken to introduce the new crockery & tumblers to all hospital wards in NHS Grampian. This is seen to be a very positive move given the fact there is a high number of patients who could potentially benefit from high contrast crockery. This move also serves to ensure that there is a consistent approach across the Board and it supports equitable access whilst eliminating the ‘labelling’ of patients with individual needs.

Key Facts & Case StudiesFor more case study examples which illustrateNDRUK Resource how dietitians are working to improve nutritional care in dementia across Scotland click here.

For more practical information and advice aimed at carers of those with demenia click here.

Finally for more information on Dietitians and Dementia click here.

If you would like to share your case study examples, or your thoughts on the blog, please leave a comment below.

Weight Loss Surgery: The Four Pronged Approach

By
Rona Osborne
Specialist Bariatric Surgery Dietitian, Glasgow & Clyde Weight Management Service
Amanda Hallson
Advanced Dietitian Weight Management, Glasgow & Clyde Weight Management Service

Background

Weigh loss surgery, also known as Bariatric surgery, has been offered as a treatment option for overweight and obese individuals since the early 1980’s. Since then the practice has moved on leaps and bounds with Dietitians and other AHPs’ delivering first rate interventions as part of multidisciplinary services. The three most widely used types of weight loss surgery are:Gastric Band

  1. gastric band – where a band is used to reduce the stomach’s size, so a smaller amount of food is required to make you feel full
  2. gastric bypass – where your digestive system is re-routed past most of your stomach, so you digest less food and it takes much less to make you feel full
  3. sleeve gastrectomy – where some of the stomach is removed to reduce the amount of food that’s required to make you feel full

Bariatric surgery cGastric Bypassan effectively reduce body weight and treat obesity associated metabolic diseases such as diabetes mellitus. There are also significant benefits to individuals’ functional status and psychological health. “Overall mortality is 29-40% lower in the seven to ten years post surgery in patients receiving Bariatric Surgery compared with BMI-matched subjects not receiving surgery”1.

This proven surgical approach has fuelled the number of bariatric surgeries performed in the last 20 years, however it is paramount that weight loss surgery is not seen as a single stand alone intervention but included as part of a supported programme involving a multi-disciplinary team including dietitians, clinical psychologists, physiotherapists, nurses and surgeons.

The four pronged approach

The use of the four pronged approach model illustrates the importance of surgery being 4 Pronged Approachonly one element of a successful weight reduction outcome. At the Glasgow and Clyde Weight Management Service this model is used at all stages of the patient’s surgery pathway, including the initial surgery information session, the preparation for surgery education programme and the post-operative group review sessions. The 4-pronged approach enables patients to obtain clearer insight into what aspects of their lifestyle surgery will help with, and allows the team to explore and ensure realistic expectations.

Weight loss surgery results in an overall reduction in total quantity of food as well as impacting on food choices. Patients learn through the four pronged approach that weight loss surgery does not necessarily impact on other areas of their lifestyle i.e. a patient that struggles with emotional eating will not automatically change this behaviour following a surgical intervention. And likewise a patient that is suffering arthritic pain will not necessarily have relief of pain following a weight loss procedure enabling them to be more active.

Using this 4 pronged approach model helps to demonstrate the importance of the individuals’ involvement in the entire process. This can help in two ways, the patient becomes more empowered knowing that much of the success of the procedure is dependent on them; and secondly it highlights to the patient if they may benefit from additional support from members of the MDT such as psychology or physiotherapy

Those individuals that believe surgery is the easy answer to weight loss often find out early on that this is a gross misconception. In practice it appears that those patients who are well informed about the surgical procedure itself, as well as the necessary dietary and lifestyle changes that are required to go alongside the procedure tend to have better weight loss outcomes. This coincides with the current guidance that highlights that patients who receive, preparation, education and pre and post-surgery support are more likely to be successful.

At the Glasgow and Clyde Weight Managemenet Service the bariatric Dietitian is integral to the surgical service and to clinical decision making.

Where does the Dietitian fit in your local bariatric surgical service?

References

1. SIGN 115 (Feb 2010). Management of Obesity. A national clinical guideline.

“A blog a day blether” for #DAW2015 Allied Health Professionals Q&A Day 5 “Ask a Speech & Language Therapist”

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 5 “Ask a Speech & Language Therapist”

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Previously published this week on ‘Let’s Talk About Dementia Blog’

Communication and eating, drinking and swallowing are fundamental to our well-being, and it is the speech and language therapist’s role to help with these skills for people with dementia at all stages of the illness. The following questions highlight many common areas of difficulty and I hope that the answers provide people with ideas on how to work around the challenges.

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Question 1 – Do speech and language therapists work with people to learn to sign some words when speech is going?

Answer – This would be very unusual, unless the person had signed previously. It is recognised that it is generally difficult to learn new skills. However, increased use of body language and natural gesture is fully recommended. Most of us have highly developed skills at reading body language that we developed as babies and toddlers before we even started speaking. It is likely that the person with dementia is reading body language (which includes facial expression, tone of voice, posture etc.) long after language comprehension has deteriorated. It is therefore important to be aware of what you are communicating non verbally and to enhance natural gesture to facilitate comprehension. The person with dementia can also be encouraged to increase their use of gesture to aid their expression when words are difficult to find. Playing miming games such as charades may be a way of encouraging this skill.

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Question 2 –My wife has difficulty with her speech. She gets very confused and often uses words that make no sense. She then gets angry with me when I don’t understand what she wants and sometimes throws things at me. I am weary and at times quite frightened. I have no idea how to help her tell me what she wants.

Answer – this is a difficult one. It is obviously important to reduce frustration because more effective communication is always achieved in calmer settings .Firstly, always ensure that distractors such as television, radios, barking dogs, crying grandchildren etc., etc. are reduced to an absolute minimum. One to one communication is always more likely to be effective.

Then I would recommend acknowledging when you do not understand and posing questions such as ‘are you talking about….. (the doctor?  tea? yesterday?)

Alternatively pick up objects, pictures and say ‘is it this?’ Visual materials help to focus the person and helps them to remember what it is they are trying to talk about.

As in the previous answer, encourage the use of gesture to get messages across.

However, if all this increases frustration and inevitably sometimes this might happen, it is vital to acknowledge that frustration and suggest she comes back to it later. Then try to distract her with another activity or topic.

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Question 3 – My wife gets very frustrated when she can’t find words. Should I finish her sentences for her?

Answer – Finishing sentences for people depends very much on individual relationships and there isn’t one stock answer. I recommend that you ask the person whether they would like support on completing sentences and how soon you should ‘jump in’. Be aware that you need to be listening very carefully to be sure that the word you offer is actually what the person is trying to say, because selecting the wrong word can increase frustration.

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Question 4 – I am finding my friends have stopped visiting because it is so hard to have a conversation. Is there anything you can suggest which might help?

Answer- It can often be daunting for friends to continue visiting if they feel conversation is becoming more difficult; however there are several ways that good interactions can still be achieved. Generally speaking, it is better to focus conversation on a tangible object such as a newspaper, photograph, keepsake or newly acquired item from the shops, for example. This is because 1) the focus is taken off the person and put on to the item and 2) the person is more able to keep in mind what the topic of conversation is.

Old photographs are particularly good as very often older memories remain for longer. Remember though that it is not necessary to correct erroneously remembered memories because the focus should be on the quality of the shared interaction and not the truth as you remember it.

Sometimes people find conversation flows more easily if you are both involved in an activity together e.g. arranging flowers, tidying out a drawer etc.  Simply commenting on things such as ‘that is a beautiful flower’ or ‘I had a pen like this once’ may well result in an exchange of comments.

It is important to avoid the use of questions, particularly open-ended ones such as ‘What did you do in the war?’  Even questions that just require a Yes/No response often don’t lead to further conversation easily and should be used as little as possible.

It is also important not to talk too much. Often we fear silence and try to compensate for the reduced conversation from the person with dementia by talking incessantly. Occasional comments and companiable silence, particularly when engaging in some activity is absolutely fine.

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Question 5 – My husband has been put on a soft diet and really misses his favourites. Is it ok to bend the rules a bit?

Answer- There are many different reasons why people are put on a soft (puree diet). It would be very important to discuss with the Speech and Language therapist (SLT) why he was put on this dietary texture in the first place before bending the rules. Modified diets are used to reduce risk of choking and/ or aspiration of food and drink that might lead to chest infections, and it is vital that the level of risk for your husband is fully understood.

SLT’s are always mindful of balancing the risks against quality of life. It is often found that people manage their favourite foods better due to increased stimulation and therefore an informed discussion with your therapist could result in a controlled trial of these foods.

We welcome ideas and comments from our readers about this blog.

Joy Harris, SLT, Clinical Lead for Dementia, Lothian
@joysltdem

Dietitians Week 2015

ByMarjory Photo

Marjory MacLeod

BDA Scotland Board Chairperson

Dietitians Week was established as part of Trust a Dietitian, the latest British Dietetic Association (BDA) campaign, which highlights the work and worth of Dietitians and the dietetic profession in the UK. The world’s first Dietitians Week took place last year: June 2014. It was a tremendous success, and as a result the profession are delighted that it will be repeated this year from the 8th-12th June.

Dietitians WeDW2015-Medium-150x150ek serves to demonstrate and promote the great variety of roles within the dietetic profession and the significant impact Dietitians have on public health. This year the BDA Scotland Board are playing their part by co-ordinating blogs from Dietitian’s working across Scotland and posting them here on AHP Scot Blog.

The BDA Scotland Board will also be hosting a Scottish Parliamentary Reception on June 10th following the close of Parliament business. Our event, sponsored by Jamie McGrigor MSP for Highlands and Islands, will be an opportunity to showcase the role of Dietitians and their work in the area of dementia.

This area of work was chosen as approximately 90,000 people are currently living with dementia in Scotland and Dietitians play a vital part in their care. Dietitians:

  • Help with diet and nutrition-related problems
  • Provide advice on appropriate food choices, the importance of hydration and eating environments
  • Help to reduce the stress and distress that can be associated with eating when someone has dementia and
  • Provide advice and support to family and professional carers who are involved in food provision.

Dietitians from acroTAD-Jpeg-Logo1-150x150ss Scotland are participating in the event, and their work with voluntary agencies, industry, health and social care will be illustrated. All 128 MSP’s have been invited to attend along with external list of interested parties and all Scottish Dietitians, so it should prove to be a wonderful evening. To read more about the event and one of the projects illustrated at parliament, come back on Thursday the 11th of June.

In the mean time we will post a blog a day here on AHP Scot Blog which gives you the perfect opportunity to read more about the other areas of work Dietitians are involved in. If you want to ensure you never miss a blog posted by AHP Scot Blog follow the blog by inserting you email in the box on the top right of this page.   Otherwise pop by tomorrow to read a blog from Amanda Hallson and Rona Osborne which focuses on Bariatric Surgery and its role in weight management.

Thanks for reading and have a great Dietitians Week 2015!

“A blog a day blether” for #DAW2015 Allied Health Professionals Q&A Day 4 “Ask a Physiotherapist” by @lynnflannigan1

This blog was previously published this week in LetsTalkAboutDementia Blog

Hello & Welcome 

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Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice (CSP 2015). Physiotherapists are specialists in enablement and rehabilitation who can support people with dementia to remain as active and independent as possible. Physiotherapy can have a significant positive impact on some of the difficulties that people with dementia can have with their walking, balance and muscle strength. See below for what the new Alzheimer Scotland Allied

Health Professionals leaflet Screen Shot 2015-06-01 at 16.33.26has to say about physiotherapy.  We asked people with dementia and their carers what questions they would like to ask a physiotherapist and this is what they asked;

Question 1  Can you offer any hints and tips about keeping the person with dementia mobile? Carer There is an old saying most of us will be familiar with – “if you don’t use it you lose it”. We know that people with dementia are less active than those without dementia. Mobility problems in people with dementia may be caused as much by a lack of activity as by the dementia itself, therefore it is important to try to keep as active as possible. It is important that the person with dementia tries to keep doing the things they enjoy, especially if they involve physical activity and exercise. The main thing is not to sit for long periods of time as this can cause the muscles to waste and the joints to get stiff. Sometimes a person with dementia will lose their confidence to do activities they used to enjoy. Their health or social care professional should be able to offer advice about this. Alzheimer Scotland also has a guide for carers around Activities – the link can be found at the bottom of the page. If a person with dementia is having difficulty with their mobility then a physiotherapist can offer them some advice and may provide some exercises to help.

Screen Shot 2015-06-03 at 16.30.57Question 2  How can you best help someone out of their bad or chair without hurting them? Carer Unfortunately, it is possible to hurt someone when you are assisting them out of a chair or bed. It is also possible that the carer can be injured when doing this. The main piece of advice would be never to pull someone up by the arms as this can cause serious damage to the shoulder joint. The most common mistake people make is to rush the person with dementia or not to explain what you want them to do well enough. Always explain what you want the person to do, without giving too much information at the one time. It sometimes really helps the person if you show them visually first what you want them to do. Try to encourage the person to do as much for themselves as they can – only provide physical assistance if you have to. Sometimes moving and handling equipment will be recommended if the person with dementia cannot be assisted by another person safely. If you are unsure about how to best encourage someone to be as independent as possible or to assist them where required, a physiotherapist can offer you advice.

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Question 3  How do I prevent my mum from falling? Katy, carer Falls aren’t an inevitable part of living with dementia, however, some of the symptoms can make people with dementia more at risk of falls. People with dementia can also have the same health conditions that increase the risk of falls as people who don’t have dementia. There are lots of different factors that can put a person with dementia at risk of falls. Of course we can all have a slip or a trip, however, there are some factors which will increase the risk of having a fall. These include; problems with mobility, reduced strength or balance, medication side effects, continence problems, problems with feet/footwear, poor nutrition/hydration, a history of previous falls, vision problems, hearing problems, dizziness/fainting, how you interact with the environment and confusion/dementia. It is important that your Mum’s own individual risk factors for falls are identified so that where possible they can be reduced/managed. This is usually done by a health or social care  professional such as a physiotherapist using a multifactorial risk assessment, which is a risk assessment which looks at the most common factors which can cause falls .

A personalised action plan should then be completed. Physiotherapists are commonly involved with providing exercises which increase strength and balance and therefore reduce the risk of falls. Screen Shot 2015-06-01 at 16.33.49 General advice about how to reduce falls can be found in the NHS Scotland Up and About booklets which can be found at the link in the references section. NHS Inform also have a falls prevention webpage with a section on dementia and falls which can also be found in the references section.

Question 4  My mum (Mrs T) walks with a stick and is waiting for a replacement knee operation.  She’s always been independent and likes to do her own shopping, but recently fell outside her local supermarket when carrying her shopping and is now too frightened of falling to go out.  I think my mum is getting very depressed and I was wandering what aids (other than her stick) might be there to help mum keep her balance outside. 

As her daughter has seen a fear of falling is a serious consequence of falls which can lead to low mood, a loss of confidence and a resulting restriction in activities. Restricting activities can then lead to a vicious cycle of further loss of confidence and physical deterioration which can further increase risk of falls. As a physiotherapist I would firstly want to assess why Mrs T is falling to see if I can offer any advice, provide an exercise plan or signpost her to other services to reduce her risk of falls. If her stick is no longer providing Mrs T will enough support and Mrs T was unsafe then I would consider providing her with a delta rollator which is a 3 wheeled rollator. As a physiotherapist I would always rather provide rehabilitation to avoid providing walking aids wherever possible, however, the right walking aid can increase mobility and confidence for some people. Screen Shot 2015-06-01 at 16.34.01

Lynn Flannigan Physiotherapist @lynnflannigan1 I am a physiotherapist with a special interest in dementia. I am currently seconded to the Scottish Government as part of the Up and About in Care Homes Falls Prevention Project. References Alzheimer Scotland Activities: A Guide for Carers of People with Dementia http://www.alzscot.org/assets/0000/0266/activities.pdf CSP (2015) http://www.csp.org.uk/your-health/what-physiotherapy NHS Inform Falls Prevention Page http://www.nhsinform.co.uk/falls/about/ NHS Scotland: Up and About Taking Positive steps to avoid trips and falls http://www.healthscotland.com/uploads/documents/23464-UpAndAbout.pdf

Tomorrows Blog with be by Joy and “Ask a Speech and Language Therapist ” Q & A. 5th June will be by Joy @joysltdem