Being a Dietitian Working with People Living with Dementia #RDDementia
Susan Alexander Specialist Dietitian @SusanleighRD
Like any first timer, I was a bit nervous about writing a blog. However, I welcomed the opportunity to raise awareness of the work of dietetics in dementia care. As a registered Dietitian, I have been working in dementia and older peoples’ mental health services for 11 years and so far no two weeks have been the same. For that reason I thought I would give you a brief insight into my role and my experience working in this field.
Working as an integrated part of a community dementia team, older peoples’ mental health team and older peoples’ mental health assessment wards my role is to provide a specialist dietetic intervention to individuals using these services. Eating and drinking well is vital in maintaining both physical and mental health, independence and quality of life for people living with dementia. Good nutrition and hydration can help to maximise cognitive abilities, reduce tiredness and depression. People can be referred to me by any team member using the MUST (Malnutrition universal screening tool). The screening tool identifies people who are at risk of becoming, or are malnourished. However, as it is a generic tool it can sometimes lack sensitivity and needs to be used in the context of a holistic assessment as part of a multidisciplinary team discussion. If you would like more information on this tool, you can download it for free from www.bapen.org.uk
My work involves carrying out nutrition assessments with people in a variety of settings: in hospital, in peoples’ own homes, outpatient clinics and care homes. Some of the common nutritional concerns related to people living with dementia include:
– Decreased food intake
– Weight loss
– Low Body Mass Index (BMI)
– Poor appetite
– Increased energy needs associated with high levels of physical movement
– Potential nutrient deficiencies
– Unrecognized infections
– Nutrition-related side effects of medication treatments e.g. memory treatment.
Furthermore, issues such as social isolation, stigma, co-morbid medical conditions and aging compound the nutrition-related problems that can be encountered.
One of the important elements of my role is the adaptable approach needed to work with people. My approach with each individual is tailored depending on how the person can communicate, their level of insight and ability to recall answers. My “detective skills” come in handy when speaking with others who may know the person, observing the individual in their home environment and with permission from the individual I can often be seen going through fridge and bin contents! Multi disciplinary and multi agency working is an essential component of my work and although challenging it is a part of my job which I thoroughly enjoy. Integral to my role in this is training and education of both staff and carers which provides opportunities to promote the nutritional care of people using services.
In my experience an individualised approach is vital in order to appropriately meet the nutritional care needs of a person. For example, when I carry out assessments; previous and current likes and dislikes, routines and preferences are always taken into account in order to produce a personal care plan that is acceptable and realistic to the individual as well as workable in terms of care provision. Recently I became involved in a pilot using talking points, a Patient Reported Outcome Measure (PROM). This is an approach which utilises outcomes focused conversations to identify the aspirations, goals and priorities of the person. I have found the talking points method to be very powerful in gaining a deeper understanding of individual perspectives, their hopes and fears. The advantage of using the approach is that it promotes partnership working and person-centred practice where carers and the person living with dementia can be involved in developing a plan which can guide professionals in how support can be offered. More information on the approach can be found at www.jitscotland.org.uk
Carers and people with dementia have often told me, they would have found written information useful, for example, highlighting issues such as weight loss and taste changes that may happen and providing advice on how to manage these. Through a national network of dietitians in the specialism I was made aware of an information leaflet, created by a colleague in a different board area, for anyone who is caring for someone with dementia on ways to tackle problems which can occur with eating and drinking in everyday life. The guide provides practical advice on overcoming challenges that can occur. It is hoped this will be available shortly through NDR-UK (Nutrition and diet resources). You can find the original leaflet on the AHP dementia community of practice website. Click here to visit the site.
I hope you have enjoyed reading this snap shot of my life as a Dietitian working across dementia services.
Some questions to consider: