Working with clients with dementia and in the Residential Care Environment
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Meal time environment
The page titled Introduction to Clients with Dementia discusses the residential care environment. The meal time environment within these facilities tends to be a communal eating environment with residents eating in a shared dining room. These environments tend to be busy with many patients and staff members moving around. This can increase distractions for clients with dementia and therefore increase the chance of food refusal. This will make the intervention strategies discussed in the page mentioned less effective and increase the chance of malnutrition.
Several things can help to promote greater compliance and food intake in clients with dementia:
Having the same seat and table in the dining room, in addition to having the same caregiver assist them with feeding can help establish a regular meal time routine for the person with dementia (Easterling and Robbins (2008). It is helpful to eliminate distractions from tables and trays and also remove non-food items such as salt shakers and vases from the table. It is important to ensure that the person feeding the client is attending to the client for the entire meal. This is especially important if the client needs cues to maintain attention on the meal and swallowing. Dinning with Dementia (p.18-19) provides some safe swallowing guidelines that describe how to modifiy the environment to promote safe swallow. Their guidelines can be photocopied and therefore can be placed around the dining areas to remind carers and nursing staff of the safety protocols to take with these clients. Working with other professionals
In residential and nursing facilities there are often many different staff members working to help manage the client’s dysphagia. The link below provide more information on the team that a speech and language therapist may work with when providing interventions for a client with dementia.The TeamWith this client group speech language therapist generally work with the actual clients. Instead speech therapists tend to work under a consultative model. They determine the appropriate intervention for each client and provide the knowledge and tools to the nursing staff and nurse aides within the residential home. Working closely with nursing staff is important as these are the people who have the most contact with the clients with dementia. It is especially important that nurses and nurse aides are educated and are aware of the importance of complying with speech language therapist recommendations. A study by Rosenvinge and Starke (2005) in a hospital in London, showed that 73% of non-compliance with speech language therapists recommendations, for safe swallowing and food and drink volume by clients, was due to lack of recommended supervision. It also showed that 54% of inappropriate food consumption was due to the wrong foods been served to the patients by the staff (p.591-592). However, following education of the nursing and food preparation staff, the compliance with regard to speech language therapist recommendations increased dramatically. As clients with dementia are unable to regulate their own food consumption and have lack of insight into their swallowing problems, the responsibility lies with the staff, to know how to monitor their meal times adequately.