Authors (including presenting author) :
Tse LS(1), Cheung YL(1), Lam KM(1), Wong SY(2), Ip KM (2) ,Koo HW(3), Yung IY(3) , Kenny Wong WM(4), Ng MF(4).
Affiliation :
1 Department of Medicine & Geriatrics (Rehab), Tuen Mun Hospital, NTWC
2 Department of Speech Therapy, Tuen Mun Hospital, NTWC
3 Department of Dietetic, Tuen Mun Hospital, NTWC
4 Department of Medicine & Geriatrics, Tuen Mun Hospital, NTWC
Introduction :
In hospital, there are increasing number of older adults with dementia. Literature review indicated that there are strong association between advanced dementia and feeding problems. However, there were limited sources which address effective interventions such as an individualized feeding plan to address food enjoyment and staff training to promote quality care to this group of patients.
Objectives :
1) To enhance oral intake and promote food enjoyment for patients with dementia associated behavioral feeding problem and poor oral intake;
2) To identify and develop individualized feeding care plan to promote quality care and maintain oral feeding with reference to the food preferences & feeding behavior in patients with dementia;
3) To provide wide variety of food apart from hospital diet to stimulate patients’ appetite.
Methodology :
Geriatric patients with diagnosis of dementia and with poor oral intake for more than three days during hospitalization were recruited to the program. Patients with severe dysphagia were excluded from the program. The multidisciplinary team which included doctors, nurses, speech therapists and dietitians would perform weekly feeding round to discuss and establish individualized feeding care plan;
1) Frontline staff’s feeding skills were empowered through knowledge-enhancement workshops by speech therapist and dietitian.
2) Potential patients were screened and assessed by speech therapist. Recruited patients will be reviewed by the multidisciplinary team weekly. Care plan implementation and skills transfer were closely monitored and fostered by Geriatric specialty nurse.
3) A food bank was established in R9C ward to provide food to stimulate patients’ appetite and promote food enjoyment of recruited patients. Average oral intake and calories intake before and after the program were evaluated as outcome measure.
Result & Outcome :
Results
1) From May 2020 to December 2020, 28 patients were recruited to the dementia feeding program from a female geriatric ward. The mean age of the clients was 91.5± 4.75. The average duration in the program was 12.75 days. An unique care plan which included various feeding strategies was established for each recruited patient.
2) The most three common feeding refusal behavior were refusal of mouth opening (92%), turning head away (88%) and verbal refusal (68%).
3) A Food Bank for dementia feeding program was established since December 2020. Amongst the 13 recruited patients, a total 7 patients were evaluated (till May 2021). After meal adjustment (including nutrition supplements and offering food choices from food bank), patients’ increase in caloric and protein intake upon discharge ranged from 140kcal to 840kcal/d and from 8g to 40g/d, respectively, when compared to baseline.
4) Satisfaction survey for Food Bank program shown all patient’s relatives satisfied with our program.
Conclusions:
The dementia feeding program was effective in enhancing dementia patient’s intake amount during hospitalization. Beside improving staff awareness in caring dementia patient’s feeding problem, the program also cultivated a caring atmosphere to empower them to provide quality care to this population. In future, it is hoped that the program can rollout to more geriatric wards.
