ACQ Vol 11 no 2 2009

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ACQ Volume 11, Number 2 2009 95
Screening patients post implementation of the education
package is also planned on future wards, in an attempt to
monitor missed referrals to speech pathology for people with
dysphagia. It is possible that implementation of the education
package could lead to generalised use of the strategies on
those that warrant speech pathology assessment. Missed
referrals were not considered in this study.
Conclusion
A large proportion of people with dementia present with
mealtime behaviours that can be difficult to handle. As these
difficulties are a natural progression of this disease they can
not be eliminated altogether, but can be managed with
strategies in place. This project focused on the development
and implementation of an education package for nursing
staff targeting this issue, with the aim to reduce referrals to
speech pathology for mealtime behaviours, as opposed to
dysphagia. A reduction in referrals was noted, and improved
nursing knowledge after implementation of the education
package was statistically significant.
Nutritional status, positive attitude change towards people
with dementia and the potential issue of overgeneralisation of
these strategies to people with dysphagia will be considered
in the future.
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Crystal Ensell is a speech pathologist at Royal Perth Hospital and
manages an acute, adult neurosurgery caseload. She graduated
from Curtin University of Technology in 2004 and has been working
at Royal Perth Hospital since. Natasha Matheson is a speech
pathologist at Royal Perth Hospital and manages an acute, adult
general medicine caseload. She graduated from Charles Sturt
University in 2005 and moved to Perth in 2006.
Correspondence to:
Crystal Ensell and Natasha Matheson
Speech Pathology Department
GPO Box X2213 Perth WA 6847
phone: 08 6477 5212; fax: 08 6477 5127
email:
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Appendix 1. Mealtime behaviours and strategies included in the education package
Holding food or drink in • Provide verbal cues to chew and swallow
the mouth • Bring an empty spoon to the person’s mouth to remind them to swallow the prior mouthful
• Trial a range of tastes and temperatures
Spitting out food and fluids • Offer a variety of food and drink
• Take note of food and drink that is accepted, and offer readily
• Liaise with the dietitian regarding supplements and offer intake in liquid form
Food/drink refusal • Try to stimulate appetite prior to meals by offering fruit juice and encouraging exercise
• Use indirect prompts e.g., “that looks nice”
• Encourage the person to try the first mouthful to “get a taste”
• Offer “grazing” meals or snacks throughout the day
• Attempt to offer the person familiar foods e.g., ask family to supply home cooked meals as able
• Ensure meal is high in calories/protein and liaise with dietitian
• Offer a range of options and cater to preferences
• Offer finger foods if appropriate
• Reduce distractions