By Susan Merrick
Specialist Macmillan Dietitian.
Dr Daryl Leung, Clinical Director
Care of the Elderly
New Cross Hospital.
This article discusses the role of the dietitian in an acute hospital working with dementia patients who may have a reduced ability and desire to eat and drink resulting in a decline in their nutritional status. The article outlines various causes of the common dietary problems experienced by dementia patients and suggests some strategies for overcoming these difficulties.
A case-study about a patient with Down’s dementia suffering from dysphagia and aspiration pneumonia is used to highlight the need for individualised treatment planning. This case-study offers an insight into the broad principles of the new model of dementia care in general hospitals developed by the Royal Wolverhampton Hospitals NHS Trust (RWHT), sponsored by NHS West Midlands and supported by the University of Worcester’s Association for Dementia Studies.
The New Cross Hospital “care bundle” adopts a composite approach to improving the quality and safety of dementia care. This promotes a person-centered concern for the needs of each patient, facilitated by a multi-disciplinary team (MDT) approach, and the active encouragement of involvement from family and carers both before and after hospital discharge. The multi-disciplinary team approach pools the insights of the consultant geriatrician, a team of doctors and nursing staff specialising in dementia, representatives from the community care services, speech and language therapy (SALT) staff, physiotherapists and the dietitian.
The teamwork is concentrated on Ward D22 – which was developed specifically for the care of acute medical patients with dementia in addition to other physical illnesses – complemented by a Dementia Outreach Team which supports patients and healthcare professionals on other wards.
The case-history reported in this article provides details regarding a decision to use an enteral feeding approach for the treatment of dysphagia. While this is atypical of the usual approach to nutrition support for Down’s dementia patients, it illustrates the scope of the RWHT model of dementia care to arrive at individualised treatment decisions in the patient’s best interests. A case is made for the potential of gastrostomy feeding in some dementia patients as a means of working towards successful hospital discharge, thereby maintaining their general quality of life at home for as long as possible following discharge, helping avoid further aspiration pneumonia and preventing hospital re-admissions.
The article concludes with some considerations which may be helpful to dietitians working with dementia patients in an acute hospital.
Merrick, S. Leung, D. (2012). Nutritional care of patients with dementia in the acute setting. Complete Nutrition, May 2012, Vol.12(2), pp.12-14.