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      Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e200">BACKGROUND</h5> <p id="P1">Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e205">OBJECTIVES</h5> <p id="P2">To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand (DH), Over Hand (OH), and Under Hand (UH). </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e210">DESIGN</h5> <p id="P3">A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e215">SETTING AND PARTICIPANTS</h5> <p id="P4">30 residents living with advanced dementia in 11 U.S. NHs.</p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e220">MEASUREMENTS</h5> <p id="P5">Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. </p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e225">INTERVENTION</h5> <p id="P6">Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N=540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every two days. </p> </div><div class="section"> <a class="named-anchor" id="S7"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e230">RESULTS</h5> <p id="P7">Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67±15.2%) and UH (65±15.0%) with both significantly greater than OH (60±15.1%). Feeding behaviors were more frequent with OH (8.3±1.8%), relative to DH (8.0±1.8) and UH (7.7±1.8). </p> </div><div class="section"> <a class="named-anchor" id="S8"> <!-- named anchor --> </a> <h5 class="section-title" id="d12177168e235">CONCLUSION</h5> <p id="P8">All three techniques are time neutral. UH &amp; DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding. </p> </div>

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          Most cited references18

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          Vicarious agency: experiencing control over the movements of others.

          Participants watched themselves in a mirror while another person behind them, hidden from view, extended hands forward on each side where participants' hands would normally appear. The hands performed a series of movements. When participants could hear instructions previewing each movement, they reported an enhanced feeling of controlling the hands. Hearing instructions for the movements also enhanced skin conductance responses when a rubber band was snapped on the other's wrist after the movements. Such vicarious agency was not felt when the instructions followed the movements, and participants' own covet movement mimicry was not essential to the influence of previews on reported control.
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            Tube Feeding in Patients With Advanced Dementia

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              Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis.

              The need to improve the nutrition of the elderly living in long term care has long been recognised, but how this can best be achieved, and whether (and which) intervention is successful in reducing morbidity is less well understood. The aim of this systematic review was to determine the effectiveness of mealtime interventions for the elderly living in residential care. Mealtime interventions were considered as those that aimed to change/improve the mealtime routine, practice, experience or environment. Following comprehensive searches, review and appraisal, 37 articles were included. Inadequate reporting in over half of the articles limited data quality appraisal. Mealtime interventions were categorised into five types: changes to food service, food improvement, dining environment alteration, staff training and feeding assistance. Meta-analysis found inconsistent evidence of effects on body weight of changes to food service (0.5 kg; 95% CI: -1.1 to 2.2; p=0.51), food improvement interventions (0.4 kg; 95% CI: -0.8 to 1.7; p=0.50) or alterations to dining environment (1.5 kg; 95% CI: -0.7 to 2.8; p=0.23). Findings from observational studies within these intervention types were mixed, but generally positive. Observational studies also found positive effects on food/caloric intake across all intervention types, though meta-analyses of randomised studies showed little evidence of any effects on food/caloric intake in food improvement studies (-5 kcal; 95% CI: -36 to 26; p=0.74). There was some evidence of an effect on daily energy intakes within dining environment studies (181 kcal/day, 95% CI: -5 to 367, p=0.06). The need to improve the nutrition of the elderly living in residential long term care is well recognised. This review found some evidence that simple intervention around various aspects of mealtime practices and the mealtime environment can result in favourable nutritional outcomes. Further large scale pragmatic trials, however, are still required to establish full efficacy of such interventions. Copyright © 2013 Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                Journal of the American Geriatrics Society
                J Am Geriatr Soc
                Wiley
                00028614
                April 2017
                April 2017
                February 06 2017
                : 65
                : 4
                : e89-e94
                Affiliations
                [1 ]Duke University School of Nursing; Durham North Carolina
                [2 ]College of Nursing; Medical University of South Carolina; Charleston South Carolina
                [3 ]University of North Carolina School of Nursing; Chapel Hill North Carolina
                [4 ]Duke University Medical Center/Durham VA Medical Center; Durham North Carolina
                [5 ]University of Arkansas for Medical Sciences; Little Rock Arkansas
                [6 ]Duke University Medical Center; Durham North Carolina
                Article
                10.1111/jgs.14728
                5397360
                28165618
                d5311768-235c-45ae-b034-6cc473f9de50
                © 2017

                http://doi.wiley.com/10.1002/tdm_license_1

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