Annals of Long Term Care

Best Practices in Nursing Care for Hospitalized Older Adults with dementia
from The John A. Hartford Institute for Geriatric Nursing and the Alzheimer's Association

Issue Number D11.2, 2007
Series Editor: Marie Boltz, PhD, APRN, BC, GNP
Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing

WHY: Inadequate food and fluid intake can result in malnutrition, dehydration, skin breakdown, delirium, and increased morbidity and mortality.1 In the hospital, patients with dementia are more likely than other older patients to lose self-care abilities, including self-feeding, in the hospital and much less likely to regain these abilities after discharge2,3. Consequently providing interventions that are tailored to the patients’ cognitive and related communication abilities can dramatically impact both immediate as well as long-term health and function.

BEST PRACTICE: Best practice requires an individualized plan of care with the dual objectives of providing adequate food and fluid intake and maintaining the patient’s self-feeding ability, to the extent possible1. Since the care will be carried out in part by certified nursing assistants (CNAs) and other staff, the nurse must communicate the plan and oversee and monitor its implementation. A patient’s eating and feeding behaviors often change during a hospital stay, requiring the nurse to reassess regularly and adjust the plan as needed. This Try This provides general guidelines that can be individualized to the patient’s needs.

TARGET POPULATION: Hospitalized older adults with diagnosed or suspected dementia.

REFERENCES:
1. Amella, E.J. (2004). Feeding and hydration issues for older adults with dementia. In M. Mezey, E. Capezuti, & T. Fulmer (Eds.). Care of Older Adults: Nursing Clinics of North America, 39(3), 607-623.
2. McCusker, J., Kakuma R., & Abrahamowicz, M. (2002). Predictors of functional decline in hospitalized elderly patients: A systematic review. Journal of Gerontology: Medical Sciences, 57A(9), M569-577.
3. Sands, L.P., Yaffe, K., Covinsky K., Chren, M., Counsel, S., Palmer, R., Fortinsky, R., & Landefeld, C.S. (2003). Cognitive screening predicts magnitude of functional recovery from admission to 3 months after discharge in hospitalized elders. Journal of Gerontology: Medical Sciences, 58A(1), 37-45.
4. Kayser-Jones, J. & Schell, E. (1997). Mealtime experience of a cognitively impaired elder: Ineffective and effective strategies. Journal of Gerontological Nursing, 27(7), 33-39.
5. Simmons, S.F., & Schnelle, J.F. (2004). Individualized feeding assistance care for nursing home residents: Staffing requirements to implement two interventions. Journal of Gerontology: Medical Sciences, 59A(9), 966-973.
6. Nichols, J.N. (2006). Windows to the heart: Creating an acute care dementia unit. In N. M. Silverstein, & K. Maslow (Eds.), Improving hospital care for people with dementia. NY: Springer Publishing Co., Inc.
7. Amella E.J. (1999). Factors influencing the proportion of food consumed by nursing home residents with dementia. JAGS, 47(7), 879-885.
8. Alzheimer’s Association. (2005). Assisted Oral Feeding and Tube Feeding, available at www.alz.org/Resources/FactSheets/FSOralfeeding.pdf.
9. Finucane, T.E., Christmas, C., & Travis, K. (1999). Tube feeding in patients with advanced dementia: A review of the evidence. JAMA, 282(14), 1365-1370.

MORE ON THE TOPIC:
Best practice information on care of older adults: www.ConsultGeriRN.org. Kayser-Jones, J., & Pengilly, K. (1999) Dysphagia among nursing home residents. Geriatric Nursing, 20(2), 77-82.
Watson, R., & Dreary, I.J. (1997a). A longitudinal study of feeding difficulty and nursing intervention in elderly patients with dementia. Journal of Advanced Nursing, 26(1), 25-32.
Watson, R., & Dreary, I.J. (1997b).