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      Factors influencing the pace of food intake for nursing home residents with dementia: Resident characteristics, staff mealtime assistance and environmental stimulation

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          Abstract

          Aim

          To examine the association of resident characteristics, staff mealtime assistance and environmental stimulation with the pace of food intake.

          Design

          A secondary analysis of 36 baseline eating videos involving 19 nursing assistants and 15 residents with dementia in eight nursing homes from a communication intervention study.

          Methods

          The outcome variable was the pace of food intake (the number of bites and drinks per minute). The exploratory variables were resident characteristics (age, gender, dementia stage and eating performance), staff mealtime assistance (frequency of verbal, visual, partial and full physical assistance) and environmental stimulation. Multi‐level models were used to examine the association.

          Results

          A faster pace of food intake is associated with being male, better eating performance, staff provision of visual and physical assistance and better quality of environmental stimulation that involved interaction. The pace of food intake was not associated with resident age, staff verbal assistance or partial physical assistance.

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          Most cited references43

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          Functional Assessment Staging (FAST) in Alzheimer's Disease: Reliability, Validity, and Ordinality

          Barry Reisberg, Steven Sclan (1992)
          Article 0 comments Cited 93 times – based on 0 reviews     Review now
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            Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis.

            Rebecca A. Abbott, Jo Thompson Coon, Obioha Ukoumunne … (2013)
            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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              Interventions on mealtime difficulties in older adults with dementia: a systematic review.

              Wen Liu, Jooyoung Cheon, Sue A. Thomas (2014)
              To evaluate the effects of interventions on mealtime difficulties in older adults with dementia. A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. Pubmed, Medline (OVID), CINAHL (EBSCOHost), EBM Reviews (OVID) and PsychINFO (OVID) were searched between January 2004 and September 2012 by using keywords as dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, nutrition, intervention, experimental, quasi-experimental and any matched terms. Other sources included Google Scholar and relevant bibliographies. Eligibility criteria were established by defining the population, intervention, comparator, outcomes, timing and setting of interest. Studies were reviewed by title and abstract screening, and full-text assessing for eligibility. Data were abstracted from eligible studies using a self-made structured tool. Eligible studies were classified by intervention, accessed for quality using the Quality Assessment Tool for Quantitative Studies, and graded for evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group criteria. Twenty-two intervention studies (9 RCTs), including a total of 2082 older adults with dementia and 95 professionals from more than 85 long-term care facilities, were selected, and classified into five types: nutritional supplements, training/education programs, environment/routine modification, feeding assistance and mixed interventions. Eight studies were strong, eleven moderate and three weak in quality. Limitations of body of research included lack of randomization and/or control group, small sample size without power analysis, lack of theory-based interventions and blinding, inadequate statistical analysis and plausible confounding bias. "Nutritional supplements" showed moderate evidence to increase food intake, body weight and BMI. "Training/education programs" demonstrated moderate evidence to increase eating time and decrease feeding difficulty. Both "training/education programs" and "feeding assistance" were insufficient to increase food intake. "Environment/routine modification" indicated low evidence to increase food intake, and insufficient to decrease agitation. Evidence was sparse on nutritional status, eating ability, behavior disturbance, behavioral and cognitive function, or level of dependence. This review provides updated evidence for clinical practice and points out priorities for nursing research. Current evidence is based on a body of research with moderate quality and existing limitations, and needs to be further explored with more rigorous studies. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Wen Liu:
                ORCID: https://orcid.org/0000-0002-1491-7384
                wen-liu-1@uiowa.edu , liuwenring18@gmail.com
                Journal
                Journal ID (nlm-ta): Nurs Open
                Journal ID (iso-abbrev): Nurs Open
                Journal ID (doi): 10.1002/(ISSN)2054-1058
                Journal ID (publisher-id): NOP2
                Title: Nursing Open
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2054-1058
                Publication date (Electronic): 06 March 2019
                Publication date Collection: July 2019
                Volume: 6
                Issue: 3 ( doiID: 10.1002/nop2.2019.6.issue-3 )
                Pages: 772-782
                Affiliations
                [ 1 ] College of Nursing The University of Iowa Iowa City Iowa
                [ 2 ] College of Nursing Pennsylvania State University University Park Pennsylvania
                [ 3 ] School of Nursing University of Kansas Kansas City Kansas
                Author notes
                [*] [* ] Correspondence

                Wen Liu, College of Nursing, The University of Iowa, Iowa City, IA.

                Emails: wen-liu-1@ 123456uiowa.edu ; liuwenring18@ 123456gmail.com

                Author information
                https://orcid.org/0000-0002-1491-7384
                Article
                Publisher ID: NOP2250
                DOI: 10.1002/nop2.250
                PMC ID: 6650688
                PubMed ID: 31367399
                SO-VID: d9e1fbce-2937-4dbb-b8d8-092435506702
                Copyright © © 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 July 2018
                Date revision received : 03 December 2018
                Date accepted : 14 January 2019
                Page count
                Figures: 0, Tables: 4, Pages: 11, Words: 8571
                Funding
                Funded by: NIH grant
                Award ID: NR011455‐04
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id nop2250
                cover-date July 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.6.2 mode:remove_FC converted:24.07.2019

                Keywords: dementia,eating performance,environmental stimulation,food intake,mealtime assistance,nursing home,older adult
                Data availability:
                Keywords: dementia, eating performance, environmental stimulation, food intake, mealtime assistance, nursing home, older adult

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