ACQ Vol 11 no 2 2009

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. Sidenval, B., & Ek, A. C. (1993). Long-term care patients and their dietary intake related to eating ability and nutritional needs: Nursing staff interventions. Journal of Advanced Nursing , 18 , 565–573. Villareal, D. T., & Morris, J. C. (1999). The diagnosis of Alzheimer’s Disease. Journal of Alzheimer’s Disease , 1 (4–5), 249–236. Watson, R. (1990). Feeding patients who are demented. Nursing Standard , 4 (44), 29–30. Chang, C., & Lin, L. (2005). Effects of a feeding skills training programme on nursing assistants and dementia patients. Journal of Clinical Nursing , 14 , 1185–1192. Feinberg, M. J., Ekberg, O., Segall, L., & Tully, J. (1992). Deglutition in elderly patients with dementia: Findings of videofluorographic evaluation and impact on staging management. Radiology , 183 , 811–814. Hammond, C. A. S., & Goldstein, L. B. (2006). Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest Journal , 129 , 154–168S. Kindell, J. (2002). Feeding and swallowing disorders in dementia . Brackley, UK: Speechmark Publishing. LeClerc, C. M., Wells, D. L., Sidani, S., Dawson, P., & Fay, J. (2004). A feeding abilities assessment for persons with dementia. Alzheimer’s Care Quarterly , 5 (2), 123–133. McGillivray, T., & Marland, G. R. (1999). Assisting demented patients with feeding: Problems in a ward environment. A review of the literature. Journal of Advanced Nursing , 29 (3), 608–614. Nailon, C., Scott, A., & Benjamin, L. (2007). Dementia feeding strategies . Paper presented at the Speech Pathology Australia National Conference, Sydney.

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. References Agronin, A. E. (2004). Dementia: A practical guide . Philadelphia: Lippincott Williams & Wilkins. Alzheimers Association of Australia. (2006). Dementia estimates and projections . Retrieved 3 January 2008 from www.alzheimers.org.au Astrom, S., Nilsson, M., Norberg, A., & Winblad, B. (1990). Empathy, experiences of burnout and attitudes towards demented patients among nursing staff in geriatric care. Journal of Advanced Nursing , 15 , 1236–1244. Beattie, E. R. A., Algase, D. L., & Song, J. (2004). Keep wandering nursing home residents at the table: Improving food intake using a behavioural communication intervention. Ageing and Mental Health , 8 (2), 109–116. Berkhout, A. M., Cools, H. J., & Van Houweligen, H. C. (1998). The relationship between difficulties in feeding oneself and loss of weight in nursing home patients with dementia. Age and Ageing , 27 , 637–641. Brockett, R. (2006). Medical management of patients at risk of aspiration. In J. Cichero, & B. Murdoch (Eds.), Dysphagia: Foundation, theory and practice . New York: John Wiley & Sons.

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: crystal.ensell@health.wa.gov.au

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 • 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 • 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

Spitting out food and fluids

Food/drink refusal

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ACQ Volume 11, Number 2 2009

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