Menu specifically for people living with dementia

The Academy of Fabulous Stuff | 25 March 2021| Menu specifically for people living with dementia

 A tasty new menu specifically for patients living with dementia has been launched by University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT).

Dianne Smith, Dementia Matron for UHMBT, has been working closely with colleagues from the Catering Teams and Dietitians at all three of the Trust’s main hospital sites to develop a menu that is even more ‘dementia friendly’ for patients.

As people with dementia can often find it difficult to eat a full meal, Dianne and the team have revamped the existing menu and incorporated more tempting ‘finger foods’ and mouth-watering snacks. Dianne and collaegue Hannah presented their idea of menu for patients with dementia at the National Dementia Congress in Birmingham and the concept is now widely used to support patients living with dementia. Examples of options on the menu include  a ‘spicy box’ with samosas, onion bhajis and other treats, a ‘picnic plate’ with delicious sandwiches, mini quiches and more, as well as hot finger foods such as burgers and mini pies. 

Dianne said: “People living with dementia can find it hard to eat much at one time. Finger foods aren’t as over-facing as a three course meal. It helps people to be more independent and to feel relaxed. It also promotes self-care and makes meal times less challenging.

“It can be hard for people with dementia to use cutlery so finger foods are ideal. Finger foods help people to eat little and often which is more manageable for them and, together with snacks, it keeps up their calorie intake. We consulted with numerous people over the new menu and asked what they wanted. We’ve had great feedback from patients, families, carers and ward staff who have all said they like the options on the new menu.”

Adapted from news story Menu specifically for people living with dementia

Cochrane Systematic Review: Medicines to treat people with vascular dementia and other vascular cognitive impairments

Battle,  C.E., Abdul-Rahim,  A.H., Shenkin,  S.D., Hewitt,  J., Quinn,  T.J. Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: a network meta‐analysis. Cochrane Database of Systematic Reviews | Issue 2. Art. No.: CD013306. DOI: 10.1002/14651858.CD013306.pub2. Accessed 23 March 2021.

This systematic review explores the question: What is the evidence for cholinesterase inhibitors (medicines designed to improve memory and thinking in people with dementia), when used with people who have vascular dementia?

Plain Language Summary

The reviewers found 8 studies including a total of 4 373 people with vascular dementia (or vascular cognitive impairment). The studies tested the drug donepezil at two different doses (5mg and 10mg daily), against each other and against placebo. Rivastigmine and galantamine were tested against placebo only. Rivastigmine is available as a skin patch, but the studies only tested the pill version. All eight studies evaluated participants when they first started taking the medicine or placebo and again six months later. Different tests were used to measure the effects. All studies included tests of memory, thinking and reported side effects.

People taking donepezil or galantamine had better scores on memory and thinking tests than people taking placebo, but the benefits were modest and may not be large enough to be evident in daily life. 

There was no evidence of a difference for rivastigmine, but the evidence was less certain, and the doses taken by some participants may have been too low to show an effect. We found evidence that when compared to placebo, side effects such as nausea and diarrhoea, were more common in people taking donepezil 10mg and galantamine, but probably not donepezil 5mg. We were unable to draw conclusions about side effects of rivastigmine from the studies.

No vascular dementia trials comparing the different cholinesterase against each other have been conducted. Using the information from the individual studies, we made indirect assessments of how the drugs would perform if tested head‐to‐head. The results suggested that donepezil 10 mg had the greatest effect on memory and thinking, but caused more side effects than donepezil 5 mg or galantamine.

There were only a small number of studies for each drug. Certainty in the results varied between drugs and between outcomes, from high to very low certainty. The studies showed only a small benefit at most; however, in the absence of any other treatments, people living with dementia may still wish to consider use of these drugs.

The review is available in full from the Cochrane Database of Systematic Reviews 

High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis

Yeh, S.W. et al. | 2021 | High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis | Clin Rehabilation | 35| 2 | P.169-181| doi: 10.1177/0269215520961637. Epub 2020 Oct 11. PMID: 33040592.

Abstract

Objective: This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia.

Methods: In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer’s program.

Results: We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer’s program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31-0.83). Hauer’s program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none.

Conclusions: High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.

For access to the full paper contact The Library & Knowledge Service

NIHR: low-cost video technology may help care home residents feel more connected to peers

NIHR | March 2021 | Virtual quizzes involving several care homes are feasible and might reduce loneliness and social isolation

Twenty-two care home residents, from three homes, volunteered to take part in virtual quizzes (8), which included conversation of around fifteen minutes duration before 20 straightforward quiz questions. Care staff helped to facilitate, Skype TV was used in most cases and residents took it in turns to use webcams.

Virtual quizzes involving several care homes are feasible and might reduce loneliness and social isolation

Participants talked about ‘our home’s pride’ and ‘top star’ residents who could answer questions. Many residents participated in multiple sessions and some who initially observed took part in later sessions.

Four themes emerged from interviews with staff and residents:

1. Residents with moderate-advanced dementia remembered faces and conversations but could not recall having seen the technology before. They expressed happiness when remembering conversations with people ‘outside’ of their care home, and answering questions in a ‘game’. They could recall details such as the gender or clothing of people who had spoken.
2. Residents felt more connected with others. Within the same care home, residents learnt more about each other’s backgrounds and interests, and spoke fondly about their ‘teammates’. Across care homes, residents enjoyed comparing features of their environments.
3. Residents re-gained a sense of self by sharing their stories and remembering their pasts with people of a similar age. One resident said the sessions were encouraging her to regain an interest in technology, but two expressed some insecurities, worrying that others may not like their image, and that ‘just anyone’ could see. However, the residents acknowledged that everyone on the calls had been friendly, and that they could move away from the screen if they wished.
4. The virtual quizzes provided relief from loneliness or boredom. Most residents said the video calls helped them to ‘pass the time’ and gave them ‘something to do’. Residents said the quizzes encouraged them to get to know others within the same home more than passive activities, such as watching TV. Across care homes, residents were surprised that there were so many people with similar interests or professions, or who had grown up in the same area as they had.

Full details are available from the NIHR Alert

Primary paper by Zamir et al, 2021 is avaialble from Geriatrics