clinical focus are often at higher risk of malnutrition and therefore APD involvement is essential. Both food and fluids may be fortified or enhanced to achieve optimal nutritional intake. Menus should be carefully planned to ensure meals are high in protein and energy to maximise the nutritional value. Fortification of meals can also assist, particularly when intake is poor. Butter, cream, oil, cream cheese, cheese, and milk powders are all great examples of easy meal fortifiers. An APD can assist with individualised meal plans for residents who struggle to maintain weight.
AN SP or APD can also advise on the correct feeding strategies to assist residents at meal times, yet another important step to ensuring optimal nutritional intake.
In 2007, the Dietitians Association of Australia and Speech Pathology Australia joined forces to standardise terminology across the country in an effort to reduce confusion and improve the understanding of texture modified diets. The standards outline regular, unmodified routines,
along with the following diets and fluids.
Texture-modified diets: soft diet( texture a), minced and moist diet( texture b), smooth puree diet( texture c)
Fluid consistencies: mildly thick fluids( level 150), moderately thick fluids( level 400) and extremely thick fluids( level 900).
Managing dysphagia in aged care is a little like walking a tightrope. Workers are balancing resident safety, nutrition and hydration, and quality of life. Without the appropriate management from all team members, it is easy to have a fall. An effective management plan requires an interdisciplinary approach, which includes the speech pathologist, APD, nursing staff and care staff, as well as food services – and of course the resident.
The idea behind an interdisciplinary approach to dysphagia management is that all parties are working together to achieve the ultimate goals. Many facilities like to adopt a multidisciplinary approach, where allied health professionals work within their own discipline to achieve separate goals for a resident. That is the wrong approach against dysphagia. When attempting effective management of this issue, working together to achieve a shared goal is fundamental.
All members of the team need to understand dysphagia and the risks of inappropriate meal provision. If a dietary change is made without consultation of the other team members, it can often result in negative outcomes for quality of life, nutrition, hydration and pulmonary status. In contrast, working within a team can help keep residents in balance and maintain and optimise nutrition, hydration, safety, and, ultimately, quality of life. ■
Samantha Murray is an accredited practising dietitian and accredited nutritionist. She is the founding director of Food Solutions Diet Consultants. Kelly Rodgers is a certified speech pathologist. To find an accredited practising dietitian, visit the‘ Find an APD’ section of the DAA website at daa. asn. au or call 1800 812 942.
OPTIMISE CARE TO THE ELDERLY WITH THE 2016 AMH AGED CARE COMPANION
2016 Aged Care Companion Book Release.
This companion is a trusted, practical reference for healthcare professionals who work with older people. It contains the latest evidence-based information and is useful when conducting medication reviews and other activities( eg case conferencing) aimed at improving patient outcomes. There is also information on the management of more than 70 conditions common in older people, including dementia and its behavioural symptoms, delirium, cardiovascular diseases, fall prevention, osteoporosis, COPD, insomnia, depression and wound management. It also contains general principles on the use of medicines in older people.
The 2016 release contains new content including a topic on actinic keratosis, information on the process of deprescribing, which is important for optimising the use of medicines in older people, along with a simple diagrammatic guide to inhaler devices with links to instructions for use and considerations for choosing a suitable device in older patients. Other topics reviewed include asthma, COPD, gout, hypertension, dyslipidaemia and dyspepsia.
Online version also available. For more information go to www. amh. net. au. agedcareinsite. com. au 23