The association of eating challenges with energy intake is moderated by the mealtime environment in residential care homes

Abstract

Objectives: Given the increased risk of malnutrition in residential care homes, we studied how specific aspects of the mealtime environment are associated with residents’ eating challenges and energy intake in general and dementia care units of these homes. Design: Cross-sectional study. Participants: 624 residents and 82 dining rooms. Setting: 32 residential care homes across Canada. Measurements: Eating challenges were measured using the Edinburgh Feeding Evaluation in Dementia Questionnaire (Ed-FED-q). Energy intake was estimated over nine meals. Physical, social, person-centered, functional, and homelike aspects of the mealtime environment were scored using standardized, valid measures. Effects of interactions between dining environment scores and eating challenges on daily energy intake were assessed using linear regression. Results: More eating challenges were associated with decreased energy intake on the general (β = −36.5, 95% confidence interval [CI] = −47.8, −25.2) and dementia care units (β = −19.9, 95% CI = −34.6, −5.2). Among residents living on general care units, the functional (β = 48.5, 95% CI = 1.8, 95.2) and physical (β = 56.9, 95% CI = 7.2, 106.7) environment scores were positively and directly associated with energy intake; the social and person-centered aspects of the mealtime environment moderated the relationship between eating challenges and energy intake. Conclusions: Resident eating challenges were significantly associated with energy intake on both dementia care and general care units; however on general care units, when adjusting for eating challenges, the functional and physical aspects of the environment also had a direct effect on energy intake. Furthermore, the social and person-centered aspects of the dining environment on general care units moderated the relationship between eating challenges and energy intake. Dementia care unit environments had no measurable effect on the association between resident eating challenges and energy intake.

Effect of communal dining and dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in acute and sub‐acute hospital, rehabilitation and aged‐care settings: A systematic review

“…30 Due to the higher level of evidence provided in this RCT, certainty of evidence for the above outcomes was rated as moderate. Dining room enhancement studies including these outcomes in lower quality studies (and therefore excluded from GRADEpro analysis) reported inconsistent effects on energy and/or protein intake (increased in two studies, 32,42 non-significant change in six studies, 24,[43][44][45][46][47] decreased in two studies 44,45 ) and weight (increased in two studies, 26,32 non-significant or no change in four studies 24,25,35,46 ). One study reported improved quality of life.…”

Social connection and physical health outcomes among long-term care home residents: a scoping review

“…The results of the current review, taken in context with a recent review on social connection and mental health outcomes in this population [ 24 ], suggest mechanisms consistent with previously proposed models [ 4 , 77 ], but which highlight specific psychological factors (e.g., stress, depression) and lifestyle (e.g., nutrition, sleep) which warrant further research in this population. For example, with respect to the latter, addressing social connection as a means to improving nutritional status – either through individual-delivered interventions [ 78 ] or addressing aspects of the LTC home mealtime environment [ 79 ] – has been investigated. Third, few studies stratified results to compare populations within LTC homes (e.g., by sex or gender [ 47 – 49 , 59 ], cognition […”

How do we provide good mealtime care for people with dementia living in care homes? A systematic review of carer–resident interactions

“…Similarly, the idea of tailoring care to the individual resident is prevalent both in broader mealtime care literature ( Reimer & Keller, 2009 ; Slaughter et al, 2020 ; Wu et al, 2018 ) and in dementia care literature ( Fazio et al, 2018 ; Manthorpe and Samsi, 2016b ). This concept also features prominently in guidance and regulation in this area ( Care Quality Commission, 2014 ; Social Care Institute for Excellence, 2020 ).…”