Adding to another series of Nutrition Care Plan Example, we’re going to focus on Dementia!  Specifically loss of independence with eating.  Loss of independence with eating will happen to almost every single Dementia patient you will have.

Building a nutrition care plan for Dementia will be a constantly evolving process.  A Dementia patient will change constantly over time.  Your nutrition diagnosis, interventions, and monitoring/evaluation will continue to change.

In this example, I will only focus on one aspect of how Dementia affects nutrition.  But Dementia is one of the MOST evolving and impactful diagnoses on a patient.  

Coming soon I will be releasing a course on how Dementia impacts your patient’s nutrition, how to manage their care, nutrition interventions you need to look at, and how to continue to monitor them!  If you want to sign up for the course waitlist, simply sign up below!

Building a Nutrition Care Plan for Dementia

If we look at how a Dementia patient loses their independence with eating, the Dietitian needs to build a nutrition care plan that reflects the nutrition interventions needed.  

If you haven’t read the basic building block for a nutrition care plan article, I recommend checking that one out here.

But here are the basic building blocks for a nutrition care plan.

A nutrition care plan will always include:

1. Nutrition Problem/Diagnosis
2. Nutrition Goals
3. Nutrition Interventions

Does that look familiar?  

It’s because it’s basically just the Nutrition Care Process.  

If you have performed the Nutrition Care Process for your patient, then you will just restructure it for your nutrition care plan.

Nutrition Care Plan Example:
Loss of Independence With Eating

We start this care plan and we already know what our nutrition problem is:

Loss of Independence with Eating.

We DO NOT put Dementia as the nutrition problem/nutrition diagnosis.  The Dietitian can’t cure/resolve Dementia.  The nutrition problem/nutrition diagnosis is what you are going to try to reduce the effects.

You may find that there are multiple nutrition diagnoses or problems.  For the nutrition care plan, you will deal with each one separately.

For this example, we’re just going to focus on one.

So what is the nutrition diagnosis using the standardised nutrition terminology?

Self-feeding difficulty.

Nutrition Diagnosis:
Self-Feeding Difficulty

Self-feeding difficulty is a really common nutrition diagnosis.  Especially in elderly individuals with Dementia.  

When you build your nutrition care plan, your entire goal is essentially to manage their ability to feed themselves.  You want to promote independence as long as you can.

How to Phrase a Nutrition Problem/Nutrition Diagnosis:

Nutrition Problem:

Mrs. Smith has self-feeding difficulty.

You can keep these short and sweet.  Some will teach you to write it in first person, PES statement style, sentences.  But that’s not my style and I’ve always passed audits.

I prefer to be straight to the point, I include the patient’s name, the nutrition diagnosis, and if I can I include some objective data.

Like I said earlier, you can have multiple nutrition problems/nutrition diagnoses, but we are just focusing on one in this article.

Nutrition Goals

This is where you can really expand on your nutrition goals for your NCP.  

I typically recommend having more than one nutrition goal, but sometimes you can only come up with one.  That’s okay.

Typically I promote having more than one nutrition goal, but for something like self-feeding difficulty.  I only have one. 

You want to find out (if able) what the patient wants their nutrition goals to be.

Maybe your patient just wants full assistance at meals, that’s okay.

Maybe they want to feed themselves.  You need to find out before you set nutrition goals.

How To Phrase Nutrition Goals:

1. Mrs. Smith will have the ability to feed herself at all meals.

If you notice our nutrition goal has:

1. Personalised – name included.
2. A nutrition goal focused on weight promotion.
3. A measurable aspect to it – can be a date, a weight number, a percentage.  All are designated to Mrs. Smith.

You want your nutrition goals to have a central focus based on the nutrition diagnosis.

Don’t go on a tangent and include something related to her chewing and swallowing.  If you have a chewing/swallowing goal, that is unlikely to relate to weight.  

If you have chewing and swallowing as a goal, you should have some type of chewing/swallowing impairment in your diagnosis/problem list.

If you want to read more about a Dysphagia care plan, click here to read the article.  

Nutrition Interventions

The nutrition interventions are all going to be focused on promoting independence at meals, as best you can.

You are transcribing what your nutrition interventions are into the nutrition care plan.  It’s as simple as that.

You do not need to overthink this, just write exactly what you prescribed.

How to Phrase Nutrition Interventions:

1.  Mrs. Smith will be provided with wide-handled utensils at all meals.
2. Mrs. Smith will be provided with soup in a two-handled mug at all meals.
3. Mrs. Smith will be provided with a grip mat under her plates at all meals.
4. Mrs. Smith will be offered meal time assistance at all meals. 

Do you notice that every nutrition intervention listed here has been tailored to be specific to Mrs. Smith?

All of the nutrition interventions are also specifically aimed at increasing her independence at meals.

If an auditor came through and read through Mrs. Smith’s nutrition care plan, they would know exactly:

1. How to serve Mrs. Smith meals
2. What her diet type is
3. Where she eats her meals
4. Her weigh schedule
5. Where her meal intake is recorded and how frequently
6. How much food and fluids she receives daily
7. Her snack and snack schedule
8. Specific diet instructions

All of these nutrition interventions acknowledge and address that Mrs. Smith has self-feeding difficulty, and how the facility is addressing it.

Closing Thoughts

Dementia is the biggest problem that a Dietitian will face managing.

Your patient’s will change over time.  With Dementia, it may change rapidly or slowly over time.  It’s very hard to understand.

If you’re a Dietitian working with the elderly, you NEED to understand Dementia and how to manage nutrition care.

The Long Term Care RD will be releasing a Dementia & Nutrition course coming very soon!  If you are on the course waitlist, you will be the first to have it available!

Sign up below and you’ll be added to the list!