During the last 10 days, the Maggie Beer Foundation team ran a series of workshops for chefs and cooks working in aged care in Northern NSW; as well as their managers and CEOs. These workshops were filled with round table discussions and one initiative which was mentioned several times was the Eden Alternative; a philosophy around transforming care environments into habitats for human beings that promote quality of life for all.
The Eden Alternative is a philosophy of person-directed care that focuses upon empowering residents, clients, staff, families, volunteers and other stakeholders to provide a better life for residents and clients. The Eden Alternative is a powerful tool for inspiring well-being for Elders, residents or clients and those who collaborate with them as Care partners.
There are Ten (10) Eden Principles associated with the Eden Alternative. These 10 Eden Principles are the foundation for fundamental culture change for individuals, communities and organisations. The aim is to shift from an institutional / medical model of care, to one that is more about the person. By embedding the 10 Principles into an organisation or home's environment you will begin to eliminate the three plagues of loneliness, helplessness and boredom.
Loneliness is a reason why many people give up the will to live. This can happen in the community, in your own home or in an aged care home.
Secondly, many of the practices we have in aged care rob people of the opportunities to provide care, creating a sense of helplessness, and our sense of purpose fades along with the reason for living.
Thirdly, although we provide programs and activities that many elders have not previously partaken in, there is a sense of sameness or lack of control that often leads to boredom in the lives of those we care for. Meaningless activity destroys the human spirit.
The Eden philosophy recognises that loneliness, helplessness and boredom are the real killers of older age, not physical ailments. The philosophy promotes a holistic approach to maintaining the wellbeing of elders, promoting participation in a healthy community and improving spiritual and emotional wellbeing.
Find out more about how you can implement the Eden Alternative here
Play is an essential part of living and learning at all ages. People living with dementia still find joy and reawakened expression through playful experiences and playing with new ideas can help us find innovative answers to the unique needs of residents.
The Maggie Beer Foundation would like to acknowledge the fantastic 12 week pilot ‘Play Up Program’ (an Arts Health Institute Initiative) that Blue Care introduced across 7 of their residential homes in Queensland.
Humour therapy was used to reduce agitation and increase happiness and positive behaviours in residents living with dementia. The aim of the program was to increase morale, promote team work and a happy work environment for all.
Performers used playful energy, props such as balloons and musical instruments to engage the residents in a caring and gentle way. Some residents responded immediately through song and dance, others took a little longer but after 15 minutes, all residents were engaged!
The evaluation showed that...
residents felt happier after each session
48% of residents with a history of falling had fewer falls
staff improved confidence to communicate, build relationships and engage with residents
staff reported feeling more enthusiastic of their work and its purpose and the workplace had a positive atmosphere.
The sessions were held weekly for 2 hours involving 10 residents per session. The Blue Care South Coast General Manager Linda Taylor said ‘The program gives our residents sunshine, hope and laughter in what can sometimes feel like a cloudy day’.
Play Up is now being delivered across seven aged care facilities in Blue Care's South Coast cluster and six in Metro North, with monitoring and reviewing underway to best tailor the program to meet each service’s individual needs.
Residents in aged care are currently one of the highest risk groups for oral health (OH) issues in Australia today. Jo Purssey, representative of the Dental Hygienists Association of Australia Ltd (DHAA) shared some very interesting information with the MBF team about the relationship between oral health and diet. She noted that aged care is one of the biggest focus areas for care and service by the DHAA Ltd.
Poor muscle control, missing teeth, tooth aches, ill-fitting dentures, bacterial infection and limited ability to communicate in general, all add to the poor outcomes some residents face. Residents can struggle to maintain a healthy diet resulting in lowered immunity, weight loss and overall deterioration of mental and physical health.
Some oral issues that can have an impact on diet include:
Dentures, tooth decay, gum disease, oral ulcerations, other soft tissue infections which may be causing pain or discomfort and can affect how or what an individual can eat
Chewing difficulties – often residents can’t chew adequately, which can lead to inhalation of food or choking. Some may also be unaware of the temperature of the food, which can cause oral burns?
Many medications cause significant dehydration and stomach upset – poor saliva flow directly affects overall oral health status, development of oral disease and inhibits food break down and swallowing – this is a major problem with the aged!
Hydration – keeping up healthy levels of water intake to ensure adequate hydration and saliva function, can be difficult with the aged.
Food content– foods and/or drinks with a high sugar content or low pH are high risk foods for oral diseases.
Food texture – softer foods involve less chewing which in turn reduces saliva production, muscle action and oral clearance; harder foods are more difficult to chew and swallow safely and effectively.
Poor oral clearance; ineffective mastication muscle action – can cause food and debris buildup in parts of the mouth, over extended periods of time, leading to oral disease development.
Grazing patterns – a neutral pH 7 is ideal for oral disease prevention – this pH level is affected every time food or drinks are taken into the mouth. Current recommendations suggest ‘grazing’ (or small regular food and drink intake) is detrimental to maintaining good oral health, as the pH level is kept at a low ‘acidic’ level over a long period of time – this is very important factor to consider when planning what types of foods and drinks are arranged at various meals times for the aged.
You can find out more about the work of the DHAA here.
Sometimes trying a new dish or making a change to how you prepare food for those in aged care can increase the overall enjoyment of the meal.
Some things you might like to try are:
Boosting the flavour of your food by using different herbs and spices. Even adding a small garnish can really add to the appeal of a dish (even if it's not eaten!)
Combining foods from the food groups in different ways – e.g. baked pear salad
New recipes – collect these from friends, old magazines, websites and cooking shows
Cooking classes – host your own in your aged care home, contact your local community center or look for advertisements in your newspaper to find out what classes are available.
Did you know that dementia is the leading cause of disability in older people and there are more than 342,800 Australians living with dementia? Each week, there are more than 1,800 new cases of dementia across the country; that’s approximately one person every 6 minutes.
Last month, the MBF team went along to a seminar based on dementia and nutrition, lead by the team at Leading Nutrition (the largest private practice of professional aged care dietitians in Australia).
The seminar specifically focused on managing mealtimes and addressing nutrition challenges in residential and community settings.
Some topics that were covered:
Nutrition related symptoms of dementia
- Forgetting to eat
- Forgetting they have eaten
- Reduced appetite / thirst
- Taste changes (meals they previously liked may no longer be enjoyed)
- May be unaware of spoilt foods
Strategies that can be used to overcome dining difficulties
Introducing ‘protected’ meal times - meal times and dining settings free from distractions or intrusions; no doctors, limiting medication rounds during mealtimes, removing TV’s noise etc. A helpful document on ‘protected’ meal times can be found here.
It's important to have whiteboard / blackboard displaying meal times and meals to be served. This can help residents with dementia become more orientated and aware of where they are and what they are doing.
Offer additional hydration rounds to residents rather than always offering water as a hydration method. What about providing other delicious items that are high in moisture content and protien? For example, iced coffees or homemade icy poles packed with fruit? Protein packed smoothies and milkshakes are also a great idea.
How can we make it easier for residents to eat and drink?
Offering a variety of foods - offering options, but not too many so it becomes overwhelming
Using coloured placemats, making it easier for residents to distinguish plates / food
Providing easy to use cutlery
Be experimental with your sauces - think of other delicious sauce ideas that can be added to meals; for people that don’t always enjoy gravy on meat
Incorporate lentils and other proteins into the meals for those who don’t enjoy meat – eg. lentil soups or white bean mash
These are only a handful of valuable tips that we learnt from attending the seminar. If you too are interested in attending one of the wonderful classes lead by the team at Leading Nutrition, visit their website to find out what's on near you.