Learning Disabilities
The positive outcomes of using dietetic services on patients with learning disabilities are outlined within two case studies below:
Case Study 1
A male patient was referred to the LD dietetic service for advice on promoting weight gain as care staff were concerned that he was losing significant amounts of weight. This patient was in 24 hour supported living. Weight and height measurements gave a BMI within the healthy range and a review of previous weights showed that his current weight was not unusually low.
Prior to the domiciliary visit a four day food and fluid diary had been completed by care staff. On review of this diary the Dietitian observed that at least 5 litres of fluid per day was being taken as coffee alone. On further discussion with care staff the Dietitian was informed that the patient suffered loose bowel movements with occasional accidents, had trouble sleeping, was prescribed salt tablets by GP for electrolyte imbalance and was very anxious having regular outbursts of challenging behaviour.
The Dietitian informed care staff that this excessive amount of caffeine and fluid had a causal role in all of these conditions and needed to be reduced. The support staff felt it was the patient’s right to choose unless he was shown to not have capacity. Being aware of the Mental Capacity Act (MCA) the Dietitian explained that the MCA only needed to be evoked if the patient refused to comply as this behaviour was having such a detrimental effect on his health; if he chose to continue it was vital to establish capacity. The Dietitian, having met and talked with the patient, had no reason to suspect he did not have capacity to make this decision. Furthermore it was being proposed that caffeinated drinks be gradually replaced with decaffeinated drinks not that he would be unable to have coffee. On discussion and explanation the patient was happy to comply, once he understood how unwell this amount of caffeine was causing him to feel. A gradual replacement of caffeinated to decaffeinated drinks was agreed.
One of the things he enjoyed the most was filter coffee only available to him when he was outside of the home. So it was agreed that the home would buy a filter coffee machine to use with decaffeinated filter coffee and the home developed a token system so that the patient was in control of when he could have a coffee. Previously he would ask every 10 minutes or so but once he felt more secure with the token system this decreased to such an extent that on some days he did not use all of the tokens.
The result of removing the caffeine from this patient’s diet and reducing fluid intake to less than 3 litres per day was reduced levels of anxiety, episodes of challenging behaviour decreased, sleep improved, electrolyte balance improved, regular bowel habits were established and smoking was reduced. A positive indirect effect was a reduction in smoking as the patient had the habit of having a cigarette with his coffee.
Case Study 2 – Importance of Training
Care Staff attended a training session on swallowing problems (dysphagia) delivered by LD Speech & Language Therapist and Dietitian. Due to awareness during the session staff then identified that one of their patients had possible signs of aspiration. A referral to the team was made and assessments carried out. The assessments showed that there were behavioural problems, food refusal issues, fatigue, long feeding times, constipation, poor fluid intake and unplanned weight loss. Joint intervention resulted in texture modification, improved hydration and bowel function and weight gain.
This leading to long term health benefits, improved quality of life and physical well-being.
