Assisting demented patients with feeding: problems in a ward environment. A review of the literature

Abstract

A critical review of the literature on assisting demented patients with feeding difficulties identifies that care at mealtimes is often task-centred, causing stress in both patients and staff and inadequate patient care. Nurses may even be inducing dependency in this vulnerable patient group. The staff to whom this care is most often delegated do not receive sufficient education or training to enable them to achieve a sufficient degree of empathy with the patient although there is evidence in the literature to suggest that this is a necessary requirement. It is also apparent that nurses use inadequate assessment criteria, perhaps due to the fact that there is an element of commonality in the feeding behaviour of demented patients which nurses feel they have seen many times and are able to deal with. The introduction of primary nursing, increased education of nursing assistants and improved assessment procedures to combat these problems are recommended. The process of change is briefly outlined and in conclusion some areas for future research are stated.

Insights Regarding Mealtime Assistance for Individuals in Long-term Care

“…Indeed, one recent review article on the topic of feeding practices for individuals with dementia concludes that observations of current feeding situations in healthcare facilities reflect a failure to integrate best practice suggestions that have been documented in the literature for more than 10 years. 23 In particular, the current data underscore the power of the assistant-recipient relationship as a mechanism for encouraging optimal mealtime care, and challenge the conventional assumption that patients at higher levels of risk should preferentially be fed by nursing staff, rather than volunteers. Clinical and nonclinical staff from all areas within the organization came forward as volunteers in a time of crisis and quickly developed the necessary familiarity with IRMAs that enabled them to be effective mealtime assistants.…”

Nursing practice and oral fluid intake of older people with dementia

“…An important finding to highlight from this study was that the nursing staff who determined the content of the care plans (the registered nurses and enrolled nurses) were not the predominant group who implemented these initiatives. The practice of primary nursing may be viable (McGillivray & Marland 1999), in which a nurse is responsible for assessing, planning and evaluating care of the resident although any member of the team may implement the care. However, to operate effectively, the primary nurse needs to allocate identified members of staff to ensure that the care is carried out consistently.…”

Healthcare Costs Associated with Percutaneous Endoscopic Gastrostomy Among Older Adults in a Defined Community

“…This would still be less than the charges of PEG tube feeding unless one could assign specific complications to spoon feeding. Unfortunately, hand feeding in skilled facilities is often rushed and is often a negative experience for both the patient and the staff member 11 . Prior studies in these settings have documented that as little as 6 minutes per meal may be spent feeding a patient 11 .…”

“…Unfortunately, hand feeding in skilled facilities is often rushed and is often a negative experience for both the patient and the staff member 11 . Prior studies in these settings have documented that as little as 6 minutes per meal may be spent feeding a patient 11 . Thus, the true labor costs of hand feeding is perhaps as low as $2,500 per year.…”