Environmental and behavioural modifications for improving food and fluid intake in people with dementia

Herke, Max; Burckhardt, Marion; Wustmann, Tobias; Watzke, Stefan; Fink, Astrid; Langer, Gero

doi:10.1002/14651858.cd011542

Cited by 19 publications

(44 citation statements)

References 66 publications

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“…The need to improve food intake in care settings has been acknowledged internationally, resulting in the publication of guidelines . Guidelines include various proposed strategies to improve intake in older adults and particularly adults with dementia; however, little is known about the effectiveness of these strategies with respect to improving oral intake . Evidence‐based recommendations for healthcare promote the provision of adequate support for people who are unable to eat independently and offering food that is appropriate for the person, using a food first approach .…”

Section: Introductionmentioning

confidence: 99%

The use of finger foods in care settings: an integrative review

Heelan

Prieto

Roberts

et al. 2019

J Human Nutrition Diet

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Background Reduced food intake is prevalent in people in residential and hospital care settings. Little is known about the use of finger foods (i.e. foods eaten without cutlery) with respect to increasing feeding independence and food intake. The Social Care Institute for Excellence (Malnutrition Task Force: State of the Nation, 2017) recommends the use of finger foods to enable mealtime independence and to prevent loss of dignity and embarrassment when eating in front of others. The aim of this review is to identify and evaluate the existing literature regarding the use and effectiveness of finger foods among adults in health and social care settings. Methods An integrative review methodology was used. A systematic search of electronic databases for published empirical research was undertaken in October 2018. Following screening of titles and abstracts, the full texts of publications, which investigated outcomes associated with the provision of finger foods in adult care settings, were retrieved and assessed for inclusion. Two independent investigators conducted data extraction and quality assessment using Critical Appraisal Skills Programme checklists. Thematic analysis was used to summarise the findings. Results Six studies met the inclusion criteria. Four themes were identified: Finger food menu implementation; Importance of a team approach; Effect on nutrition; and Influence on wellbeing. Study designs were poorly reported, with small sample sizes. Conclusions There is some evidence that the provision of finger foods may positively affect patient outcomes in long‐term care settings. There is a paucity of research evaluating the use of a finger food menu in acute care settings, including economic evaluation. Future high quality trials are required.

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Section: Introductionmentioning

confidence: 99%

The use of finger foods in care settings: an integrative review

Heelan

Prieto

Roberts

et al. 2019

J Human Nutrition Diet

View full text Add to dashboard Cite

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“…Despite recognition of the presence of mealtime difficulties in dementia, the evidence base for their management is limited, as highlighted by a recent Cochrane review (Herke et al . 2018). Their analysis of nine studies of environmental and behavioural strategies to increase food and drink intake among people with dementia could not provide a consensus on the best approach.…”

Section: Introductionmentioning

confidence: 99%

“…Though Herke et al . (2018) identified some issues with the study's methodological rigour, it suggests at least the potential for new direct approaches to compensation and rehabilitation of dementia‐related dysphagia and mealtime difficulties.…”

Section: Introductionmentioning

confidence: 99%

Dysphagia and mealtime difficulties in dementia: Speech and language therapists’ practices and perspectives

Egan

Andrews

Lowit

2020

Intl J Lang & Comm Disor

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Background There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well‐being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia‐related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. Aims To establish the current practices of SLTs managing dementia‐related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. Methods & Procedures An anonymous, cross‐sectional web‐based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open‐ended questions were analysed using conventional content analysis. Outcomes & Results A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self‐rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. Conclusions & Implications The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents’ views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well‐being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential.

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“…The PWDs attending RCCs must have an accountable caregiver, and all centers are required to offer both a morning snack and lunch meal. Thus, the respite care staff and volunteers become familiar with the wants and needs of their 'clients' (PWDs) and are able to adjust both social events and mealtimes to accommodate their client's individual needs [11]. It is this accommodation that fits within the C3P Model (Change the Person, People and Place) developed by Amella (1999) that has been pilot tested [1] and is currently being tested in this larger study.…”

Section: Introductionmentioning

confidence: 99%

A cluster randomized controlled trial to assess the efficacy of a telehealth-based train-the-trainer mealtime intervention delivered by respite care center volunteers to caregivers of persons with dementia to improve nutritional outcomes and quality of life

et al. 2020

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Background: Persons with dementia with mild to moderate cognitive impairment are at risk for developing impairments with activities of daily living such as the ability to feed oneself, that negatively influence health. Lack of caregiver skills related to mealtime planning for persons with dementia and the ability to cope with dysfunctional behaviors are well-documented factors that influence nutritional status outcomes, lead to weight loss, poor quality of life, and impact their ability to remain at home. Methods: A cluster randomized controlled trial with a parallel mixed methods evaluation processes will be conducted to examine the efficacy of a train-the-trainer program using non-paid volunteers in respite care centers to deliver a telehealth mealtime intervention guided by the theory-based C3P Model-Change the Person, Change the People, Change the Place (C3P). In this six-month study, dyads of caregivers and persons with mild to moderate dementia receiving respite care services will be randomized to receive either the telehealth intervention or enhanced usual care. Within the intervention group, dyads will be partnered with a C3P trained volunteer who will work with caregivers via videoconference to devise and implement mealtime plans. Under usual care, dyads will receive standardized educational materials modified from The Savvy Caregiver Program for Alzheimer's disease. The primary outcomes include weight maintenance or gain of the person with dementia and quality of life of the caregiver. A multi-level evaluation process utilizing respite center administrators and directors, volunteers, and caregivers will explore intervention fidelity, acceptability and sustainability. Using both the CONSORT and

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Environmental and behavioural modifications for improving food and fluid intake in people with dementia

Cited by 19 publications

References 66 publications

The use of finger foods in care settings: an integrative review

The use of finger foods in care settings: an integrative review

Dysphagia and mealtime difficulties in dementia: Speech and language therapists’ practices and perspectives

A cluster randomized controlled trial to assess the efficacy of a telehealth-based train-the-trainer mealtime intervention delivered by respite care center volunteers to caregivers of persons with dementia to improve nutritional outcomes and quality of life

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