Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations

Abstract

Aims To characterize dyadic mealtime verbal interactions and examine the associations with staff and resident characteristics. Design A secondary analysis of 110 videotaped mealtime observations collected from a dementia communication trial during 2011–2014. Methods Videos involved 25 residents with dementia and 29 staff in nine nursing homes. Verbal behaviours (utterances) were coded during 2018–2019 using the Cue Utilization and Engagement in Dementia mealtime video‐coding scheme, addressing eight positive behaviours and four negative behaviours. Bivariate analyses and multivariate regression models were used. Results Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%); 85.1% of residents' utterances were positive and 14.9% negative. Staff positive utterances were correlated with their negative utterances and resident positive and negative utterances. Staff negative utterances were correlated with resident negative utterances. Resident positive and negative utterances were correlated. Resident positive utterances were significantly associated with staff care‐giving length in the current nursing home (OR = 1.430, 95% CI = 1.008, 2.027). Resident negative utterances were significantly associated with resident gender (female versus male, OR = 11.892, 95% CI = 1.237, 114.289) and staff years worked as a caregiver (OR = 0.838, 95% CI = 0.710, 0.989). Staff positive and negative utterances were not associated significantly with any participant characteristics. Conclusions Staff engage residents using primarily positive verbal strategies. Staff–resident mealtime verbal interactions were dynamic, interactive, and complex and related to multiple individual characteristics. Impact Positive dyadic mealtime interactions are critical to engage residents in eating. Little work has characterized dyadic mealtime interactions, limiting the development of effective interventions. Findings showed staff–resident mealtime verbal interactions were primarily positive, inter‐related, and associated with multiple individual characteristics. Findings inform directions to improve mealtime care practice and develop person‐centred mealtime interventions targeting modifiable factors, including staff care‐giving experiences.

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

“…Among the 16 instruments that were used in the dementia population, 13 were originally developed in persons with dementia and their caregivers or partners, and three were not developed for but later used in persons with dementia and their caregivers (modified Nursing Child Assessment Scale (NCAS), 32,33 Feeding Assistance Observational Protocol (FAOP), 34–38 and Marital Interaction Coding System‐IV (MICS‐IV) 39,40 ). Among the 13 instruments that were originally developed in the dementia population and their caregivers or partners, eight were originally developed for mealtime care activities (Feeding Traceline Technique (FTT), 41–43 Trouble Source Repair (TSR), 44–46 Priefer and Robbins’ observation tool, 47 Altus et al .’s observation checklist, 48 Feeding Cycle Recording (FCR), 49 Levy‐Storms et al .’s observation tool, 50 the refined CUED mealtime video‐coding scheme, 11–13,16,17,51 and Gilmore‐Bykovskyi's coding scheme 52,53 ). Four of the 13 instruments were originally developed in ADLs, including but not limited to mealtime (Armstrong‐Esther and Browne's observation tool, 54–56 Hallberg et al .’s audio analysis, 57–60 Dementia Care Mapping (DCM), 61–63 and Small et al .’s observation tool 64 ).…”

“…Support of mealtime and other ADLs following person‐centered care has been identified as one of the nine goals of quality dementia care in the Alzheimer's Association Dementia Care Practice Recommendations 9 . Particularly, person‐centered mealtime care practice should attend to “individualized abilities, likes, and dislikes” as well as “dignity, respect and choice; the dining process; the dining environment; health and biological considerations; adaptations and functioning; and food, beverage and appetite.” Following the recommendations, person‐centered dementia mealtime care that features individualized, multifaceted, and person‐oriented care can be achieved through the RECIPE principles: (1) showing R espect; (2) creating E nvironment; (3) offering C hoices; (4) supporting I ndependence; (5) acknowledging P references; and (6) maintaining E ngagement 7,10–12 . These principles are important foundations for the development and evaluation of innovative person‐centered mealtime care interventions.…”

“…In this review, dyadic (staff–resident) interactions are defined as the features and quality of verbal and nonverbal communications between people with dementia and their formal/informal caregivers 12,13 . Physical and social environment are defined as the features and quality of the surroundings, atmosphere, stimuli, as well as food and meal‐related items in the dining locations where people with dementia eat and/or receive mealtime care 10,14 .…”

“…For example, caregivers communicate with people with dementia in a respectful way to check preferences, offer choices, and engage them in eating and social conversations. Recent work shows that positive dyadic interactions and high‐quality social/physical environment stimuli are associated with reduced mealtime challenging behaviors and increased food intake in people with dementia 10–13,15–17 . Both dyadic interactions and physical and social environment are important, modifiable factors that influence resident mealtime behaviors and food intake and, therefore, have been promising targets of person‐centered mealtime care interventions 18,19 …”

“…While the long‐term goal of a person‐centered mealtime care intervention is commonly optimization of clinically relevant outcomes at the resident, caregiver, facility, and/or societal levels, dyadic interactions and physical and social environment as the target of the intervention are important process outcomes to evaluate the fidelity of interventions. However, dyadic interactions and physical and social environment during mealtime care involve multiple factors at the individual, caregiver, and environmental levels and can be complex, dynamic, interactive, and evolving nonlinearly or sequentially 7,12,13 . The use of psychometrically sound instruments to measure dyadic interactions and physical and social environment is critical to evaluate the process, fidelity, and the impacts of mealtime interventions targeting dyadic and environmental factors.…”