Dementia related diseases. One of the silent and often overlooked risks for people living with Dementia is WEIGHT LOSS. The medial temporal cortex, which is involved in feeding behaviour and memory, is affected in the early stages of the disease. In today’s society weight loss is considered a good thing, something to aspire to, but as you become older that changes. Obesity carries its own risks, but for a person living with dementia, and even a healthy elderly person, there is a clear risk to losing weight. Often the weight being lost is muscle loss and not fat. The loss of muscle makes the person unable to carry their own weight and unsteady on their feet and the person becomes a fall risk. Falls can cause anything from skin flaps, broken hips to concussion. The consequence of repeated falls can become severe.
We do not have to accept the weight loss as a normal consequence of the illness. As caregivers, we have some simple tricks in our bag to combat dementia-associated weight loss:
- Keep the person as active as possible, encourage them to exercise in any way that they are able. Swimming, dancing, walking, anything, and as much as what they are able to do. The more active they are the more enhanced their appetite will be. The increased movement will also help to improve their sleep.
- Make sure that the meal with the highest caloric load is served at the time that they are the most alert. For most of Dementia patients this is at breakfast. There are some persons who are more alert later in the day, for them lunch can be the meal with the highest caloric load.
- Don’t give them food they don’t like. This seems like an obvious, easy and silly point but people who live with dementia are often stubborn. If there is one thing on their plate that they do not like they can often discount the whole plate. The happier the person, the more likely they are to eat.
- More herbs, more spices- over time and with age our taste buds ability decreases. This can be exacerbated by dementia. By using extra flavouring when cooking you can combat the problem of flavourless food and give the person more incentive to eat.
- Make sure that the food is cooked to be tender and easily chewed and swallowed. Cutting the food into bite sized pieces before delivering it, will reduce the need to cut or handle the food which can frustrate or irritate the person.
- Reduce the distractions in the dining room and over mealtimes. Turning off the television, making sure that your voice is kept low during meal times and ensuring that the table is clear of all unnecessary clutter will improve the focus on the meal and the eating process.
- Make sure that the food is placed within the visual field of the person and that they are cued to start their meal. A person with a certain level of dementia will not initiate the eating process on their own, they will also stop and start eating and will need to be reminded to eat. Avoid interrupting the process or they might lose interest in the meal. Serve the pudding separately.
- Frequently check the person’s mouth. Pain in their mouth or teeth can cause the person to lose their appetite and refuse to eat. Dentures that do not fit can cause frustration while eating and cause the person to stop eating.
- Another obvious idea is to serve smaller more frequent meals with high calorie snacks in-between.
- Champion independence. As the disease progresses the person will lose their ability to feed themselves little by little. The loss of independence can be devastating and depressing. Every scrap of independence that can be kept or regained will improve the person’s emotional wellbeing and, in turn, their appetite. There are many ways to offer the person’s independence back to them depending on their ability:
- Make sure that the person can see the food i.e. do not put food on an overly patterned plate, this could cause the food to disappear into the pattern.
- Make sure that the food colour contrasts with the colour of the plate.
- Use cutlery crockery and glasses that are easy to lift and grip.
- Give the person one item at a time with the appropriate utensil.
- Make sure that the person is seated comfortably.
- There are specific aids that can be bought to improve the person’s ability to eat on their own, plate guards to help scoop food on to the spoon or fork, utensils with plastic handles that are either molded to the person’s hand or that grip easier and will angle the spoon or fork into a better angle to easily fit into their mouth even with limited range of movement. Neck bibs that catch spills and. Hand wipes to reduce the tactile distraction if the person used their fingers to eat. Conversation may support distraction if they eat reluctantly.
September was World Alzheimer’s month. It was a time to educate and raise awareness about Alzheimer’s and how it affects not only those diagnosed, but also those who have to care for their afflicted family member.
At Brenthurst Residence we believe that, while we care for the elderly and those who suffer from Alzheimer’s and other Dementia spectrum diseases, for those in our immediate care to have the best opportunity at an enhanced and simulated life, family plays a significant role. However witnessing your family member slowly loose more and more of who they are is difficult and often traumatizing. We have found that support groups are a fantastic space for family members to come to terms with an often devastating diagnosis, and find new ways to care for their impaired family member.
We have partnered with Alzheimer’s South Africa to run a support group on the first Wednesday of every month at Brenthurst Residence at 15h00. We believe in fostering a healthy community and therefore our support group is open to anyone affected by a family member’s Dementia. Our current group consists of many family members who are caring for their relatives at home. The group creates a space for questions which are expertly answered by Matron Lizann Painter and our in house occupational therapist Imaan Abdurhaman. Both Matron Painter and Imaan are passionate about Elder care and safety.
If you are affected by Alzheimer’s or Dementia please join our next support group on 2 November 2016 at 15h00 at 9 Brent Road Plumstead Cape Town. For more information feel free to phone us on 021 762 3935 or Matron Painter directly on 076 130 0558.
If you are interested in learning more about Dementia or Alzheimer’s in particular you can visit the Alzheimer’s South Africa website on www.alzheimers.org.za or their helpline 086 010 2681, Tel: 021 979 2724
The following article is an excerpt from the Alzheimer’s South Africa October newsletter and is used with their permission.
A person with Alzheimer’s or other dementia doesn’t have to give up the activities that he or she loves. Many activities can be modified to the person’s ability. In addition to enhancing quality of life, activities can reduce behaviours like wandering or agitation. In the early stages of dementia, the person may withdraw from activities he or she previously enjoyed. It is important to help the person remain engaged. Having an open discussion around any concerns and making slight adjustments can make a difference. For example, a large social gathering may be overwhelming, but the person may be able to interact more successfully in smaller groups. As Alzheimer’s progresses, you may need to make other adjustments to the activity. Use the following tips:
- Keep the person’s skills and abilities in mind. A person with dementia may be able to play simple songs learned on the piano years ago. Bring these types of skills into daily activities.
- Pay special attention to what the person enjoys. Take note when the person seems happy, anxious, distracted or irritable. Some people enjoy watching sports, while others may be frightened by the pace or noise.
- Consider if the person begins activities without direction. Does he or she set the table before dinner or sweep the kitchen floor mid-morning? If so, you may wish to plan these activities as part of the daily routine.
- Be aware of physical problems. Does he or she get tired quickly or have difficulty seeing, hearing or performing simple movements?
- Focus on enjoyment, not achievement. Find activities that build on remaining skills and talents. A professional artist might become frustrated over the declining quality of work, but an amateur might enjoy a new opportunity for self-expression.
- Encourage involvement in daily life. Activities that help the individual feel like a valued part of the household — like setting the table — can provide a sense of success and accomplishment.
- Relate to past work life. A former office worker might enjoy activities that involve organising, like putting coins in a holder or making a to-do list. A farmer or gardener may take pleasure in working in the yard.
- Look for favourites. The person who always enjoyed drinking coffee and reading the newspaper may still find these activities enjoyable, even if he or she is not able to completely understand what the newspaper says.
- Consider time of day. Caregivers may find they have more success with certain activities at specific times of day, such as bathing and dressing in the morning.
- Adjust activities to disease stages. As the disease progresses, you may want to introduce more repetitive tasks. Be prepared for the person to eventually take a less active role in activities.
If you notice a person’s attention span waning or frustration level increasing, it’s likely time to end or modify the activity.
- Help get the activity started. Most people with dementia still have the energy and desire to do things but may lack the ability to organise, plan, initiate and successfully complete the task.
- Offer support and supervision. You may need to show the person how to perform the activity and provide simple, easy-to-follow steps.
- Concentrate on the process, not the result. Does it matter if the towels are folded properly? Not really. What matters is that you were able to spend time together, and that the person feels as if he or she has done something useful.
- Be flexible. When the person insists that he or she doesn’t want to do something, it may be because he or she can’t do it or fears doing it. Don’t force it. If the person insists on doing it a different way, let it happen, and change it later if necessary.
- Assist with difficult parts of the task. If you’re cooking, and the person can’t measure the ingredients, finish the measuring and say, “Would you please stir this for me?”
- Let the individual know he or she is needed. Ask, “Could you please help me?” Be careful, however, not to place too many demands upon the person.
- Stress a sense of purpose.
- If you ask the person to make a card, he or she may not respond. But, if you say that you’re sending a special get-well card to a friend and invite him or her to join you, the person may enjoy working on this task with you.
- Don’t criticise or correct the person. If the person enjoys a harmless activity, even if it seems insignificant or meaningless to you, encourage the person to continue.
- Encourage self-expression. Include activities that allow the person a chance for expression. These types of activities could include painting, drawing, music or conversation.
- Involve the person through conversation. While you’re polishing shoes, washing the car or cooking dinner, talk to the person about what you’re doing. Even if the person cannot respond, he or she is likely to benefit from your communication.
- Substitute an activity for a behaviour. If a person with dementia rubs his or her hand on a table, provide a cloth and encourage the person to wipe the table. Or, if the person is moving his or her feet on the floor, play some music so the person can tap to the beat.
- Try again later. If something isn’t working, it may just be the wrong time of day or the activity may be too complicated. Try again later, or adapt the activity.
Our residents are important to us.
Each of our residents is rich with wisdom and experience. They have lived long productive and interesting lives. They have built families taken care of spouses and raised children. Some of them have fought in wars and defended their country. Others have taken care of the sick. We have taken care of builders, bakers and candlestick makers. Their families have become our family. Our residents are important to us and so is their care.
In the eve of their lives they need specialized loving care. That is why they are at Brenthurst Residence. Not only because we take care of their medical needs, we also spend time talking to them and getting to know them. We celebrate their lives and birthdays with them. We mourn with them as they loose their friends and mourn them when we say good bye.
Elder care is so much more than just nursing, we are confidants, friends and pastors. Elder care is our passion and we would like to share that passion with you.
Brenthurst Residence will be holding an open day, high tea at 3 pm – 4:30 pm on 10 June 2016. Please join us as we celebrate our residents and the staff who make them family.
If you would like to join us please Phone Marike ( 021 762 3935 ) by the 6th of June to reserve your spot.