Does he like fairy cakes? Facilitating involvement in care

We are very grateful to Mary Walsh, Senior Speech and Language Therapist at St Mary’s Hospital in Dublin, for her Blog ;Does he like fairy cakes? ‘ It has been taken from her report on a project which looked at how speech and language therapists can facilitate the involvement of people with dementia to become more active participants in the decision making process around dysphagia management at the end stage of dementia. The project was funded by the Irish Hospice Foundation Changing Minds Programme

 The project aims were:

1. To improve person centred care in relation to residents’ food and drink preferences and dislikes
2. To actively involve the residents of the dementia specific unit in the decision making process around their dysphagia (swallowing) management particularly at the end stage of their lives.

In order to find out the food and drink preferences and dislikes of the residents, the team carried out staff questionnaires and family questionnaires. They found that, although these were useful in getting a quick overview, there were a lot of unanswered questions.

The team also used Talking Mats and found it to be a powerful way to explore the residents’ food and drinks preferences and dislikes when used with suitable candidates. Participants appeared to really enjoy the experience including looking at pictures of the completed mats afterwards. This may be because they felt heard, that their views mattered and/or that they felt empowered. The information was important for current Dysphagia management, and also as an advanced directive in the documented evidence of the residents’ wishes in the recorded pictures of completed mats.

 Brief Case Study:  Does he like fairy cakes?

Talking Mats was used with a gentleman who may have been assumed to be unsuitable to use Talking Mats as he was assessed as having late stage dementia. However, this man engaged readily in the Talking Mats interview and appeared to be happy to have his views recorded. Also, there was a much higher level of correlation than variance with Talking Mats and both the staff questionnaire and the family questionnaire thus further indicating that he was a suitable candidate. ‘Fairy cakes’ was something that this resident reportedly liked in both the staff questionnaire and the family questionnaire. However, the gentleman indicated twice on Talking Mats that he disliked fairy cakes.

 A number of actions are proposed in the report including :

1. Continue to use Talking Mats as appropriate in the dementia specific residential unit and the rehabilitation wards of St. Mary’s Hospital.
2. Inform the multi-disciplinary team of the merits of Talking Mats. This tool can also be used to explore other important issues for suitable residents/ patients on a case by case basis.

Conclusion:

It is essential to challenge our assumptions in our dealings with people with dementia. Truly person centred care takes time and patience where assumptions are challenged. Also, it is essential to listen to what residents tell us verbally, or through a supported communication system such as Talking Mats or non-verbally through tone of voice, facial expressions or gestures, and to act according to what is being communicated.