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Wednesday, 15 March 2017

Observing People Living with Dementia at Mealtimes



The Edith Ellen work in partnership supporting people with Dementia, one of our Partnerships is with The DMAT team

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The DMAT Team have kindly agreed to us using their article Observing People Living with Dementia at Mealtimes which provides a useful download for Observing People with Dementia at Mealtimes.
When I was working as a dietitian in the NHS one of my roles was visiting people living with dementia in care homes. The hardest part of my job was getting them to eat! I tried many interventions over several months, talking to the staff and relatives as well as the dementia residents in the care homes. Despite putting dietetic care plans in place many of them continued to lose weight.
I therefore decided to try a new approach and over a few days I simply sat in the dining room and observed some mealtimes. I learnt more in these few hours than I had the last few months working in the care homes. I observed many dementia related eating difficulties and environmental problems that were contributing to the person finding it hard to feed themselves and preventing adequate nutritional intake. Since I did these observations I cannot recommend enough the benefits of taking a step back from your normal way of working to simply observe not only the person but the environment the person with dementia finds themselves in. It is a skill rarely used in very busy caring settings nowadays but it is a vital skill in dementia care. I think the article by Beth Britton called Harnessing the power of observation describes the importance of this skill brilliantly and is really worth a read.    
I realised that until these environmental and behavioural eating difficulties were resolved my dietetic advice would not be effective. This became my motivation for creating the first version of the DMAT in 2011. The DMAT works in 3 stages with the first stage being the observational stage. A carer would use the DMAT ‘Initial Measurement Form’ to observe a mealtime and record the eating difficulties observed.
The DMAT Initial Measurement Form is free to download Please take a look and share with those involved in the nutritional care of people living with dementia
Observation sheet

The DMAT Initial Measurement Form helps carers to identify which environmental issues and eating difficulties are preventing the individual from consuming their food. The DMAT has not undergone psychometric evaluation for validity or reliability but provides a much needed resource to quickly and easily capture the most common eating difficulties an individual with dementia may present with. Feedback from pilot projects of the DMAT suggest it takes 7 minutes to observe someone at a mealtime and record all the eating difficulties.
Once the carer has gathered this initial observational information they enter the results into the online DMAT system which will automatically provide a range of interventions to choose from.  The carer can simply tick the box of the interventions they wish to implement and the DMAT system will generate a care plan based on this. The care plan will show which mealtime eating difficulties have been identified and what interventions are to be implemented to overcome these difficulties. Everyone caring for the individual will then have a care plan sheet explaining how to help make that persons mealtime more dementia friendly.
The aim of the DMAT is to reduce the amount of mealtime eating difficulties and also improve the independence of the person at mealtimes. This can help the person feed themselves for longer and maintain their nutritional status therefore improving their quality of life.
IMPORTANT PLEASE NOTE – When using the ‘DMAT Initial Measurement Form’ if you observe any ‘Oral Difficulties and Behaviours’ that are thought to compromise the safety of an individual (i.e. you witness signs of aspiration) when eating or drinking, please liaise with a speech & language therapist (SLT) immediately. If you are unsure of the warning signs for swallowing difficulties please discuss with a SLT or refer to your local guidelines and policies before using the DMAT. When using the online DMAT system you will be reminded about the importance of not delaying referral to health professionals for further advice if certain eating difficulties are witnessed.
The DMAT does not try to replace the advice from a healthcare professional. Nothing can better the personal advice from an expert tailored to the individual. Instead the DMAT tries to provide common sense, practical and cost effective solutions to mealtime problems based on the available evidence.
*The DMAT is not a substitute for good clinical care*

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