Transcript The role of the Dietitian in Caring for People with

The role of the Dietitian
in Caring for People with
Learning Disabilities
Pat Redfern, Specialist Dietitian
The main areas of work




Nutritional support of the malnourished client
Specialist support to clients with chronic
disease.
Facilitating access to main stream dietetic
care where appropriate
Keeping the well - well
One to one. Assessment,
intervention plan, Complex
capacity and consent issues
Assessment, intervention
plan, support and training
for care staff, facilitate
access to main stream care
Training and Support to staff,
ensuring inclusion in public
health/health promotion
strategies and initiatives. One
to one support where needed
Malnourished
BMI<15
Swallowing problems
‘Extreme’ food
related behaviours
Chronic disease eg diabetes
constipation
IBS, food allergies
Weight management
Healthy eating, disease prevention
Guiding principles and policy
Valuing People: A New Strategy for Learning Disability for
the 21st Century
The four key principles underpinning the White Paper are stated as
being :
rights,
independence,
choice
inclusion
And nowhere are these more applicable than when it comes to food
eating and drinking and dietetic care.
 Valuing People Now
2009

Nutrition Guidelines

There have been a whole range of NICE
guidelines that cover dietary issues and all
address the issues of ‘inclusion and supporting
‘the hard to reach’.
Of particular significance :
 Nutrition support in adults: oral nutrition support,
enteral tube feeding and parenteral nutrition (
Feb 2006)

Obesity: the prevention, identification,
assessment and management of overweight and
obesity in adults and children (December 2006)
NICE guidelines (malnutrition)

People in care homes should be screened on admission and when
there is clinical concern.

Nutrition support should be considered in people who are
malnourished, as defined by a BMI of less than 18.5; unintentional
weight loss greater than 10% within the last 3–6 months; or a BMI of
less than 20 and unintentional weight loss greater than 5% within the
last 3–6 months.

Nutrition support should be considered in people at risk of
malnutrition, as defined by having eaten little or nothing for more than
5 days and/or are likely to eat little or nothing for the next 5 days or
longer; who are unable to take in nutrients properly, and/or who have
increased nutritional needs.
Supporting the Malnourished
client




FS lives in a home with a number of other
people.
His low body weight had been long accepted
as the norm.
Eating and drinking is a stressful experience
but food is a real pleasure for this gentleman
His family have ambivalent feelings about the
best thing to do.
Role of the dietitian in managing malnutrition






Screen and ensure low body weight is not
accepted as the norm.
Work with the MDT in developing eating and
drinking plans
Awareness of MCA
Oral nutritional support.
Nutritional support via PEG.
Training for all involved
Specialist Support to People
with Chronic disease







Range of clients including those with:
Diabetes
Raised cholesterol levels
Dementia
Constipation
Obesity
Food intolerances and IBS
Specialist Support to People with Chronic disease ……
cont.

Awareness amongst carers of symptoms and impact on health.

Providing information to the client in a form they can understand
where ever possible.

Providing information to carers on the main principles of dietary
treatment

Supporting carers to work through the conflict between ‘freedom
of choice’ and ‘duty of care’

Ensuring appropriate investigations are undertaken to determine
cause of symptoms.
Diets specific to learning disabilities





Diet and Austistic Spectrum Disorder
Sensory issues and ‘faddy eating’.
Are they meeting their nutritional requirements ?
How can they be met ?
Can the person be supported to try new foods?
Diet as Treatment
-Gluten and Casein Free
-Exclusion of food additives and colourings
-Exclusion of phenolic compounds and foods high in salicylates
-Yeats free
Supplements
Range of vitamins and minerals in particular B6, Vitamin D, iron, zinc and
magnesium
Fish Oils
5 steps for a new “Gold standard” for dietary
evidence
1. Is there evidence of marginal or excessive intakes at the
population level?
2. Are there plausible mechanisms through which the
nutrient, food or diet might help?
3. Is the food, nutrient, or diet broadly consistent with
“healthy eating” messages?
4. Are there populations who consume this nutrient, food or
diet at this level, without obvious harmful effects?
5. Is there some evidence from clinical trials in favour of
the proposed nutrient, food or diet?
General principals for ASD
1.Eat regularly
2. Insist on breakfast
3. Additive audit
4. Eat oily fish or take a supplement
5. Consider vitamin D supplement
6. Eat at least 5 portions fruit and veg a day
7. Eat beef, lamb or venison twice a week for Iron
8. Have pure fruit juice with toast or breakfast cereal
9. Check Iron and ferritin if fruit/veg/red meat intake is poor
10. Consider sensitivity to “natural” foods, but seek advice
Facilitating Access to main stream
care




Principles of Inclusion
Support and education to other dietetic
practitioners.
Clear referral criteria to specialist team and
dietitian
Work with other members of the primary care
team and liaison nurses
Keeping the ‘Well’ the Well

Change in provision of Care

No standards across all homes

Managing the conflict between ‘freedom of choice’
and ‘duty of care’

Dependant on individuals knowledge and interest in
food.
Role of the dietitian in maintaining
health through healthy eating





Inclusion of meaningful and monitored
catering standards in contracts with care
providers
Assessment tool for menus
Teaching and user - friendly menu planning
guides for care staff
Support to clients preparing their own food
Links with HP - Eatsome project, CHEFS
References
PROFESSIONAL CONSENSUS STATEMENT

The Nutritional Care of Adults with a Learning Disability in

Care Settings
Adapted from QIS Food, Fluid and Nutritional Care Standards (September 2003)
Produced By: Dietitians working with Adults with a Learning Disability and members of
the Scottish Dietetic Learning Disability Forum supported by The British Dietetic
Association Specialist Mental Health Group
Principal Authors: Fredrica DiMascio, Kirsty Hamilton and Lorna Smith
Date of Issue: December 2004


Valuing people now: a new three-year strategy for people with learning disabilities
Published: 19 January 2009

Home Enteral Tube Feeding for Adults with a Learning Disability: a professional
consensus statement produced by: The Enteral Tube Feeding in the Community for
Learning Disabilities (ETFiC4LD) Group, a sub-group of the Specialist Mental Health
Group of the British Dietetic Association (September 2008).

Easy health web site for easy to read information

Caroline Walker Trust. Eating Well . Supporting adults with Learning Disabilities with

Diet and Autistic Spectrum Disorder. British Dietetic Association (2006)
www.epilepsy.org.uk/info/ketogenic.
