Caregiver person-centeredness and behavioral symptoms during mealtime interactions: Development and feasibility of a coding scheme

Abstract

Mealtime behavioral symptoms are distressing and frequently interrupt eating for the individual experiencing them and others in the environment. In order to enable identification of potential antecedents to mealtime behavioral symptoms, a computer-assisted coding scheme was developed to measure caregiver person-centeredness and behavioral symptoms for nursing home residents with dementia during mealtime interactions. The purpose of this pilot study was to determine the acceptability and feasibility of procedures for video-capturing naturally-occurring mealtime interactions between caregivers and residents with dementia, to assess the feasibility, ease of use, and inter-observer reliability of the coding scheme, and to explore the clinical utility of the coding scheme. Trained observers coded 22 observations. Data collection procedures were feasible and acceptable to caregivers, residents and their legally authorized representatives. Overall, the coding scheme proved to be feasible, easy to execute and yielded good to very good inter-observer agreement following observer re-training. The coding scheme captured clinically relevant, modifiable antecedents to mealtime behavioral symptoms, but would be enhanced by the inclusion of measures for resident engagement and consolidation of items for measuring caregiver person-centeredness that co-occurred and were difficult for observers to distinguish.

Impact of Cognition and Handfeeding Assistance on Nutritional Intake for Nursing Home Residents

“…Possible reasons for this include that CNAs may overestimate a resident's ability to manage meals independently and/or they may have competing demands during mealtimes that don't allow for spending adequate time with individual residents to ensure meals are completed. 31 Another potential explanation could be a lack of understanding for how to manage feeding behaviors such as not opening the mouth or turning the head way. 29,32 The majority of residents in this secondary analysis that required feeding assistance were residents with dementia (59.92%); feeding behaviors are often interpreted by CNAs as care resistance and feeding attempts cease or persistence just exceeds available time.…”

Ease of use, feasibility and inter‐rater reliability of the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video‐coding scheme

“…Data obtained from this type of scoring, rather than second‐by‐second behavioural coding, does not allow sequential analysis to examine temporal relationships between behaviours and intake. Only a few tools are developed for videotaped observations, including Feeding Traceline Technique that captures limited dyadic behaviours in the intake process (Phillips & Van Ort, 1993) and the behavioural coding scheme for caregiver person‐centredness and resident agitation during mealtime that does not capture resident verbal behaviours and positive/neutral nonverbal behaviours (Gilmore‐Bykovskyi, 2015).…”

A qualitative study of professional caregivers' perceptions of processes contributing to mealtime agitation in persons with dementia in nursing home wards and strategies to attain calmness

“…1989, Gilmore‐Bykovskyi 2015). Examples of mealtime agitation can be shouting or screaming, asking questions constantly, being aggressive, resisting eating, being restless, or wandering, including leaving the table before the meal is finished (Cohen‐Mansfield et al .…”

“…Examples of mealtime agitation can be shouting or screaming, asking questions constantly, being aggressive, resisting eating, being restless, or wandering, including leaving the table before the meal is finished (Cohen‐Mansfield et al . 1989, Denney 1997, Gilmore‐Bykovskyi 2015). Not understanding the ‘meal situation’ or not understanding the help offered by staff can result in various types of agitated behaviours during mealtime (Aselage & Amella 2010).…”

“…A specific type of mealtime difficulty is mealtime agitation, which is when residents have inappropriate verbal, vocal or motor activity not explained by needs that are evident to the observer (Cohen-Mansfield et al 1989, Gilmore-Bykovskyi 2015. Examples of mealtime agitation can be shouting or screaming, asking questions constantly, being aggressive, resisting eating, being restless, or wandering, including leaving the table before the meal is finished (Cohen-Mansfield et al 1989, Denney 1997, Gilmore-Bykovskyi 2015. Not understanding the 'meal situation' or not understanding the help offered by staff can result in various types of agitated behaviours during mealtime (Aselage & Amella 2010).…”