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How to Feed Someone With Swallowing Difficulties

As children, we are taught that chicken soup will make us well, but when someone has trouble swallowing, eating or drinking can become dangerous. It is known medically as dysphagia when a person has difficulty swallowing. Aspiration pneumonia can be caused not just by choking, but by liquids or food particles sliding down the windpipe and infecting the lungs.

When a loved one has difficulty swallowing, avoiding these dangers can prove challenging, but there are some ways to make it easier and more enjoyable.

Creating the right environment is essential. 

When it comes to eating, prepare ahead of time for someone who has difficulty swallowing. Disconnect from television and focus on food. Encourage your loved one to sit upright while eating. Give them enough time to chew and swallow. Pay attention to your loved ones as they eat. When it’s time for them to bite or sip, make eye contact and open and close your mouth. You should be especially aware if your loved one appears to be choking or retaining food in their mouth.

Learn what foods they like.

Before becoming ill, your loved one enjoyed a wide variety of foods. With fewer options, it may be useful to explore new ways to enjoy the flavours that your loved one enjoys as well as to try new flavours. Consider foods with thicker sauces. This will make swallowing easier.

When swallowing is difficult, the following foods can be eaten:

  • Custards, puddings, and yoghurt
  • Fruits that have been purified
  • Bread that is puréed
  • Meats that have been purified
  • Purified vegetables
  • Pureed soup

Butter, milk, cream, sour cream, honey, and jelly can be added to these foods to add calories. Protein can be added to recipes by substituting milk for water and by making smoothies with yoghurt or peanut butter. Dry foods, particularly those containing crumbs, such as non-pureed bread, pastries, and non-pureed meats or beans, should be avoided. Be particularly careful with foods that have a mixture of textures.

Add thickening agents. 

Many favourite foods can be pureed or chopped into small pieces for people with difficulty swallowing, but liquids are a different matter. Thicker liquids pass down the throat more slowly, preventing aspiration. Thicken soups naturally with powdered mashed potatoes or gelatin.

It is good to keep a food journal to keep track of foods and recipes that work for you. Keeping track of what your loved one ate at each meal can also be helpful. A couple of small meals throughout the day is usually easier than just one or two big meals.

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Keeping someone with dementia safe from Coronavirus

Coronavirus restrictions continue to be lifted now that most adults in the UK have received vaccinations and pressure on the NHS has decreased. However, keeping safe and minimizing risk will always be important for people with dementia.

COVID-19: How to stay safe

Coronavirus vaccination offers the best protection against COVID-19. In addition to strong protection for you, the vaccine helps prevent the spread of Coronavirus to others. In the case of newer variants of the virus, a single dose will only provide limited protection, so it is very important to have both doses.

It’s still imperative that you keep yourself and others safe, even after getting both vaccines against Coronavirus. There will likely be a large increase in the amount of virus spread throughout the community as people begin mixing more over the coming weeks and months.

People in the UK are being advised to remain cautious and act responsibly. England has, however, removed all legal restrictions. Face covering is no longer a legal requirement everywhere. Yet there may still be a requirement to enter some places, such as on public transport in London, Scotland, and Wales. You can still wear a mask if you wish to, despite the lifting of legal restrictions.

Even after social distancing measures are loosened, Coronavirus is still in circulation, including easily transmissible strains. In crowds and when meeting other people, it is still important to be cautious to reduce the risk of getting or spreading Coronavirus. 

Coronavirus guidance with dementia

Dementia makes this more difficult. A person may not understand what guidance means, or they may forget how to remain safe.

Describe the guidance clearly in a calm manner to the person. Consider our suggestions for effective communication. Perhaps mentioning that the advice is from the NHS, GP, or someone the person trusts can help. By following the guidelines, Coronavirus rates are likely to remain low thus fewer people become seriously ill.

During the time you are with the person, you may need to reiterate this information to remind them why they should follow the guidelines. 

Assisting the person in feeling confident about getting out

Everyone can now go out more as there are no restrictions on exercising or leaving the house. Many people with dementia enjoy walking, and physical exercise is good for all of us.

During the pandemic, many individuals living with dementia lost skills or independence. Staying active helps those living with dementia maintain their independence. By doing so, they can regain the skills and motivation that they may have lost during the lockdown. 

You might find it helpful to:

  • Rather than focusing on what they can’t do, encourage the person to rebuild their confidence by focusing on what they can do
  • To ease the person back into their former favourite activities, support them in returning to them. This might require adjusting the way they do things, or reducing the time they spend doing them
  • Help them to go at a pace that is most comfortable for them.

While out and about, however, it is important to follow the safety guidelines and minimise the risk of injury. 

You might also find the following suggestions helpful:

  • By placing a simple poster near the front door, they’ll be reminded to carry a face shield when necessary (unless exempt) and to be careful in crowded places
  • Consider using assistive technology, such as a device that plays an automated reminder that you can customise, telling you the pandemic is still ongoing and that you need to use caution when outdoors 
  • Walking in quieter areas and at quieter times.

Maintaining an active lifestyle 

In addition, you and the person you care for should stay: 

  • Taking part in physical activity – whether indoors or outdoors 
  • Engaging mentally – by trying a new activity (online or off), or learning a new skill 
  • Stay in touch with your friends and family to stay socially active. 

Engage the person in choosing what you do at home and in the community. Activities should be enjoyable, meaningful, and tailored to a person’s interests and preferences. Feelings of stress, anxiety, and low mood can also be eased by physical exercise and having a sense of purpose.

Maintaining good hygiene 

To prevent Coronavirus from spreading, it is still important to keep hands clean and follow good respiratory hygiene. Examples include: 

  • It is recommended that you wash your hands often with soap and water (or, if this is not possible, you must use a hand sanitiser) 
  • If you don’t have a tissue, cough or sneeze into your elbow rather than your hands.  
  • Dispose of used tissues as soon as possible  
  • Keep your hands away from your face.  

The importance of handwashing cannot be overstated. When you come home from being outside or shopping, after blowing your nose, coughing or sneezing, and before you eat or handle food, wash your hands. As soon as you arrive at work and as soon as you leave, wash your hands.  

Alzheimer’s patients may not be able to remember how to take care of themselves if they have memory problems or are confused.

Encourage them to stay safe by following these tips:

  • You can hang reminder signs or posters near hand basins.
  • Set reminders such as: “Time to wash your hands.” using digital devices.
  • Encourage the person by washing your hands together.
  • You can simplify the task if this makes it easier for them to follow.
  • Talk to the person while handwashing to find out how this makes them feel
  • Observing what’s going on around the person can help with anxiety.
  • Instead of criticising errors, offer encouragement and praise.    

If a person is not familiar with liquid soap, it may be helpful to use a traditional soap bar in a colour different from the sink.

Hand moisturisers and barrier creams will help keep skin healthy if you wash or use hand sanitiser more frequently.

Fresh air 

It is much easier to spread Coronavirus inside than outside. When someone in the household has a Coronavirus or someone is visiting, it’s especially important to ensure that the indoor spaces have a supply of fresh air. 

The easiest way to get fresh air is to open the windows, as long as it is safe for you to do so without cooling the room too much. Make sure any vents or grilles on the top of your windows are open. 

The availability of medicines

Each member of the household must have the necessary medication to remain healthy.

Repeat prescriptions should be available to you, or the person you care for, through your GP surgery or a pharmacy as they were before the restrictions.

You can order repeat prescriptions online if you can – or have someone who you trust do it for you – if you do not feel comfortable going out for now. For help or if you cannot order online, contact your GP surgery or local pharmacy. They may offer a delivery service to assist you.

If you don’t live with the person 

Ensure the person with dementia knows how much help is available if you live apart from them. You should know who to contact if they don’t have a plan. Put important contact information near the phone. You can also:

  • Find local community support groups. 
  • Stay in touch with them if you or they are isolating themselves or minimizing social contact. Social media platforms such as Skype, WhatsApp, and Zoom allow people to stay in touch via video calls. This approach isn’t for everyone. Instead of using these tools, you could call, text, write letters, or post family photos. Establishing regular times and days for calls can give a person structure and something to anticipate. Connecting with the person will make them feel loved and may keep you in their thoughts. Their feelings of sadness and loneliness will be reduced if they feel connected to you.
  • Discuss scams with the individual. They need to be informed about the scams involving Coronavirus so that they know what to look out for.
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Face coverings – How caregivers can overcome the barrier to communication.

The use of face coverings is likely going to be in use for quite a while and this can present an additional communication barrier for caregivers. It is now compulsory to wear face coverings in hospitals, on public transport and in places where social distancing is not always possible. This increases the importance of us all finding new ways to communicate with each other, effectively.

This is crucial in health and social care. It is important to be mindful and quick to recognise communication difficulties, while becoming innovative in overcoming them to treat patients effectively.

Most of us find the use of face coverings an extra challenge, some will find it more difficult than others however, especially those who are deaf, have dementia or cognitive impairments, learning disabilities or other conditions such as, COPD, asthma or strokes.

The barrier to communication has been made even more challenging in the health and social care setting as most people are required to attend appointments or seek medical help alone, meaning they cannot have an individual there to provide help and support with communication.

Wearing a face covering can alter the sound and quality of a caregiver’s voice, prevent visual prompts and can make even mild hearing difficulties more apparent. Individuals who are deaf, have slight hearing loss and the elderly can rely upon lip reading to fill in gaps of speech that they miss, this cannot be done whilst a caregiver is wearing a face covering. This means many individuals will be at risk of not understanding basic information or instructions being given to them by caregivers or medical professions. For some, it can cause mental exertion as they try to hear and understand over background noise.

Some people can feel uncomfortable acknowledging they have missed what someone has said and can be embarrassed asking someone to repeat themselves. Being hard of hearing, cognitively impaired or suffering with Dementia can already feel isolating to some people, particularly when now it is harder to understand what those around you are feeling or saying. It can be extremely useful to relay important messages through pictures or written communication in these situations.

Face coverings come with other struggles too. They can make a lot of us feel uncomfortable as our glasses steam and we become hot and bothered. For those that wear behind-the-ear hearing aids, there is a risk of becoming tangled, and the increased risk of losing aids or damage after they have become tangled in the elastics.

All this becomes apparent in an already stressful situation and can in turn make patients feel more anxious or agitated. This is where caregivers can show their understanding and learn new techniques of communication to help resolve and overcome these barriers, helping to eliminate added stressors on their patient.

Unspoken communication has always provided unique opportunities and can be an effective way of connecting with someone. The use of face coverings unfortunately hides people’s feelings of sadness, frustration, pleasure, fear and annoyance – our emotions show on our faces without the need of verbal communication.

People who are living with Dementia or those who are deaf, are often skilled at interpreting facial signals and someone’s feelings so rely on this ability.

It is our responsibility to become more aware of how we come across when people cannot see our facial expressions and when we cannot see theirs. We all must learn to pay greater attention to patients and our own non-verbal cues.

How to communicate effectively:

• Be self-aware – when we are stressed this becomes reflected within our voice, body language and eyes. It is important to think about the information you need to relate and whether you need to use any other additional tools; drawing, writing, visual cues etc. Focus on your patients’ needs and allow enough time to complete interventions without rushing patients or ourselves.

Show respect – use your eyes, eyebrows and smile. Even when a person cannot see your mouth, your smile will be reflected in your eyes. Use your body language positively to create a calm situation and try not to move suddenly.

Speak clearly… but don’t shout – our lives can be noisy environments and background noise can make it difficult for people who are hard of hearing. Pronounce words more clearly and speak loudly enough, but without the use of a raised voice as this can change our tone and shouting can feel patronising to some individuals.

Use friendly body language – as most of our faces are hidden behind face coverings, our body language can be used to show calm and friendliness. This can be comforting if you are having to give difficult, upsetting or sad messages to the patient.

Observation – look carefully, listen to your patients and take note of what they are trying to communicate to you. This can be used to help you communicate more effectively and used to shape your behaviour accordingly.

Embrace technology – you can make use of specialist apps that have been created such as a speech recorder on smartphones which can turn your voice commands into written text.

www.homecaremellor.co.uk

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Thyroid Awareness Month – small but very important.

Our Thyroid is a small, butterfly-shaped gland which is located at the base of our neck. Although this gland is relatively small, the thyroid plays a huge role within our body, influencing the functions of many important organs, including our brain, heart, kidneys, liver and skin.

As our Thyroid plays such a vital role of keeping our bodies healthy, it is important to keep an eye on any changes in our loved ones. Our thyroid can become underactive (Hypothyroidism) or overactive (Hyperthyroidism) so it is important to note the differences in symptoms.

Hypothyroidism

Hypothyroidism is caused by your thyroid gland underproducing the relevant hormones that your body requires. This is more common within women but doesn’t fully exclude males.

You should contact your GP if your loved one is showing signs of Hypothyroidism. These can include but not limited to:

• Sensitivity to cold.

• Tiredness.

• Muscle aches and weakness.

• Muscle cramps.

• Pain, numbness or tingling sensation in the hands and feet.

• Slow movement and thoughts.

• Brittle hair and nails.

• Dry and scaly skin.

Elderly patients with Hypothyroidism may develop problems with their memory and be at an increased risk of depression. There are also later symptoms of Hypothyroidism that you can look for which can include a hoarse voice, puffy face, slow heart rate, anaemia and hearing loss. People suffering from an underactive thyroid have usually been diagnosed before these symptoms occur.

Hyperthyroidism

Hyperthyroidism is where our thyroid gland produces an excess of hormones into our bodies. This can cause unpleasant symptoms. These can include:

• Difficulty sleeping.

• Weight loss.

• Trembling or twitching.

• Mood swings.

• Nervousness, anxiety or irritability.

• Sensitivity to heat.

• Unusually fast or irregular heartbeat.

• Persistent thirst.

• Needing to urinate more frequently.

Treatment

Hypothyroidism and Hyperthyroidism can be easily treated once diagnosed, so it isn’t something to be majorly concerned about. Although it is always better to seek medical help as soon as symptoms are noticed.

Hyperthyroidism is commonly treated using medicines, radioactive iodine treatment or through surgery. Medicines called Thionamides are commonly used to help stop the overproduction of hormones. These can take a couple of months to help settle so symptoms may not reduce for a period of time.

Radioactive iodine treatment is a type of radiotherapy and is used to destroy the cells in the thyroid gland to help reduce its production of hormones.

Surgery is where your full gland is removed and is usually only done when other treatments have failed, or your thyroid gland is largely swollen. This would require lifelong medication to replace the production of hormones that the thyroid would usually issue.

Hypothyroidism is more commonly treated with the use of daily hormone replacement tablets. These would replace the thyroxine hormone, which the thyroid isn’t producing enough of. Regular blood tests would be necessary until the correct level of hormone has been reached. This requires a little patience as it can take a little while to maintain the correct dose.

Take the Thyroid neck check:

You can easily check your own or loved one’s Thyroid by taking the neck check, using a hand-held mirror and having a glass of water to hand.

With the mirror in your hand, focusing on the lower front area of your neck, above the collarbone, and below the voice box (this is where your Thyroid gland is located.) Whilst focusing on this area, tilt your head backwards, take a drink of water and swallow. As you swallow, look at your neck and check for any protrusions or bulges. (Don’t confuse these with the Adam’s apple.) If you do notice any unusual bulges, consult your GP.

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Why are CQC ratings important when looking for care settings?

The CQC are an important organisation within the health and social care setting. Their main aim is to ensure that every care provider and setting has a high standard of care and compassion. They rate the establishments based on fundamental standards in which they believe health and social care settings should never fail on. 

Once an establishment has been inspected, they will receive a rating of either outstanding, good, requires improvement or inadequate. It is important to know how and why they have gained their rating.

• Outstanding – The service is performing extremely well, with little or no improvement needed.

• Good – Performing well and meeting CQC expectations, small needs for improvement but not concerning.

• Requires improvement – Performing poorly and not as well as it should be, and improvements have been outlined to show how it must improve.

• Inadequate – Performing very poorly and action has been taken against the person/organisation running the service.

CQC ratings are very important when choosing a healthcare setting for you or a loved one. Inadequate ratings show that an establishment is at high risk of being closed if deemed poor enough or they have not taken the relevant steps of action to improve. The overall rating of health care providers is based on five areas:

• Safe – Is this a safe environment for residents? They must be protected from harm and abuse.

• Care – Are the staff caring towards patients? They should always be treated with kindness, dignity, compassion and respect as a minimum.

• Response – Are the residents needs being responded to? Are they organised in order to meet these?

• Effective – Does the care or treatment being offered, achieve good outcomes and help the patients maintain a good quality of life?

• Well led – Does the management team ensure they are providing high quality of care that’s based around the individual needs of the patient?

The above areas would be marked individually during an inspection. The ratings of these five areas would then be combined to give an overall rating to the establishment.

If the overall rating is low, this would notify where there are areas for improvement and highlight actions that needed to take place in order to bring them back up to standard. Once these areas had been worked on and the necessary changes made, they could then ask the CQC to conduct another inspection to re-evaluate on the changes that have been made. If no effort is made by the establishment to make these changes, the CQC could impose time limits, place them in special measures where they will become closely supervised, issue a caution, fines or more severely prosecute where people are harmed or placed in danger.

CQC ratings must be made available by the care provider. These should be placed where they are easily visible and must also be included on their website with their latest report. If these are not readily available, it is highly recommended that you ask for the reports before making a final decision.

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How to help Alzheimer patients during the Covid-19 pandemic.

Lifestyle and routines changed massively during the outbreak of Covid-19. Lockdowns and social distancing became a huge part of helping combat the outbreak and this adjustment has been difficult for most, especially those living with Alzheimer’s. 

Professor Linda Clare, of the University of Exeter Medical School helped research this issue and developed five simple steps, designed to help make things more manageable for your loved ones living with dementia and for carers who help support.

The guidance is built around practical and self-help tips with five key points:

• Staying connected –

Guidelines limit how we can stay connected, face-to-face contact has been limited or deemed unsafe. However, we can stay connected with loved ones through various ways.

Setting up a phone with relevant numbers is a good way to keep you connected with your loved one. The use of speed dials for important contacts can help eliminate any stresses of trying to remember names. Video calls are a great way to engage in face-to-face contact and to help ensure your loved one is looking well and coping. Calling at regular intervals or on certain days can help implement a routine.

Photo albums with relevant stories and backgrounds explaining the memories can also help make your loved one stay connected. This is a great way to help keep their memory active and help them to reminisce fond memories.

• Staying safe and well –

Guidelines have restricted the amount of contact we have with loved ones and this can be a concern for family members.

With memory being the fundamental challenge with Alzheimer patients, flash cards and reminders placed in the house can help keep them safe and well. These could be as simple as a reminder to wash hands more regularly, remain two metres from people outside or the signs and symptoms of Covid-19 and when to seek medical help. It is important to note that they may struggle retaining information about Covid-19 and the placement of these could help them remember why things aren’t the way they remember right now.

• Staying active –

Staying active is important for physical and mental health. A short brisk walk can help massively keep your loved one active. As always it is important to follow guidelines, remaining two metres apart is essential but doesn’t need to be a barrier to exercise. This is also a great way to keep an eye on your loved one and to analyse how they are coping. You could also encourage them to take up new activities like word searches, knitting, gardening, all of which will help keep them physically and mentally active.

• Keep a sense of purpose –

Calendars and notebooks are a good way for your loved one to keep track of things to do or that have been planned. Making note of times and days that loved ones are calling is a good way to keep them focused and give them something to look forward to. This is also a good way to remind them of their favourite programmes that are scheduled on the TV or of any relevant food deliveries/parcels that are due and when.

• Remaining positive –

Being a carer is difficult at the best of times but now more than ever it is important to remain positive for your loved one. Remaining positive and focused will help not only yourself but also your loved one during this difficult period. If you are struggling with care or feel your loved one is struggling, it is important to seek help. You can seek advice from Carers UK, or you can contact your local Council’s adult social team. Remember, there is no shame in asking for help.

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