Dyadic interactions and physical and social environment in dementia mealtime care: a systematic review of instruments

Abstract

Using valid instruments to measure dyadic interactions and physical and social environment during mealtime care of persons with dementia is critical to evaluate the process, fidelity, and impact of mealtime interventions. However, the characteristics and quality of existing instruments remain unexplored. This systematic review described the characteristics and synthesized the psychometric quality of instruments originally developed or later modified to measure mealtime dyadic interactions and physical and/or social dining environment for people with dementia, on the basis of published reports between January 1, 1980 and December 31, 2020. We identified 26 instruments: 17 assessed dyadic interactions, one assessed physical environment, and eight assessed physical and social environment. All instruments were used in research and none in clinical practice. All instruments were observational tools and scored as having low psychometric quality, except for the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video‐coding scheme rated as having moderate quality. Reasons for low quality are the use of small samples compared with the number of items, limited psychometric testing, and inadequate estimates. All existing tools warrant further testing in larger diverse samples in varied settings and validation for use in clinical practice. The refined CUED is a potential tool for use and requires testing in direct on‐site observations.

Person‐centred and task‐centred care: Impact on mealtime behaviours in nursing home residents with dementia

“…Task‐Centered Behavioral Inventory (Lann‐Wolcott et al, 2011 ), Verbal‐Nonverbal Interaction Scale for Caregivers (Williams & Parker, 2012 ) and Mealtime Scan (Keller et al, 2018 )]. Most of the 17 existing dyadic interaction assessments focus on disruptive or challenging (vs. positive/neutral) interactions (Liu & Kim, 2021 ). A few instruments have some items that assess supportive, positive or facilitative interactions, including the Modified Nursing Child Assessment Scale (Beel‐Bates et al, 2012 ), Marital Interaction Coding System (Gallagher‐Thompson et al, 2001 ), Altus et al’s Observation Checklist (Altus et al, 2002 ), Mealtime Scan (Keller et al, 2018 ), and the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video‐coding scheme (Liu, Batchelor, et al, 2020 ).…”

“…A few instruments have some items that assess supportive, positive or facilitative interactions, including the Modified Nursing Child Assessment Scale (Beel‐Bates et al, 2012 ), Marital Interaction Coding System (Gallagher‐Thompson et al, 2001 ), Altus et al’s Observation Checklist (Altus et al, 2002 ), Mealtime Scan (Keller et al, 2018 ), and the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video‐coding scheme (Liu, Batchelor, et al, 2020 ). Among these tools, the refined CUED was rated highest on psychometric quality (Liu & Kim, 2021 ).…”

The five aspects mealtime environment observation instrument for assessing mealtime environments in nursing homes: Development and validation

“…A review was undertaken of 17 mealtime observation instruments assessing mealtimes in nursing homes, specifically focusing on dementia care [16]. Eight of these instruments were identified as assessing both the physical and social environments.…”

“…Eight of these instruments were identified as assessing both the physical and social environments. The results show that was missing in all the reviewed articles, were reports on whether the instruments were applicable for clinical use [16].…”

Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations

“…Videotaped observations and validated tools are critical for in‐depth coding of characteristics of intake episodes and the time that each intake episode occurs, empowering the investigation of the complex and interactive intake process. The refined Cue Utilisation and Engagement in Dementia (CUED) Mealtime Video‐Coding Scheme was developed and validated to assess characteristics of intake episodes (Part I, focus of this study), staff person‐centred and task‐centred approaches, and resident positive, neutral, and challenging behaviours during mealtime (Liu, Batchelor, & Williams, 2020; Liu & Kim, 2021). The refined CUED has demonstrated ease of use, feasibility, adequate inter‐coder reliability, and good construct and predictive validity.…”