The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: A secondary analysis

Abstract

Background Nursing home residents with dementia experience increased risk for compromised eating performance due to intrapersonal, interpersonal, and environmental factors. Environmental stimulation is physical, social, and/or sensory stimulation present in the environment that can potentially trigger individuals’ emotion or motivate physical reactions. Beyond the personal factors, there is a lack of evidence on how environmental stimulation influences individuals’ eating performance at mealtimes. Objectives This study examined the association between environmental stimulation and eating performance among nursing home residents with dementia. Design This study was a secondary analysis using baseline videos selected from a communication intervention study, where videos were recorded to capture staff-resident interactions during care activities for nursing home residents with dementia. Videos were included in this study only if residents demonstrated eating activities at mealtimes. Sample and Setting A total of 36 videos were selected (mean length = 4 minutes). The sample included 15 residents with dementia (mean age = 86), and 19 certified nursing assistants (mean age = 36) in 8 nursing homes. Methods The dependent variable was eating performance as measured by the Level of Eating Independence scale (range: 15–36, with higher scores indicating better eating performance). The independent variables were characteristics of environmental stimulation measured by the Person-Environment Apathy Rating-Environment subscale (stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback). Each characteristic was rated on a 1–4 scale with higher scores indicating more desirable environmental stimulation. Multilevel models were used to examine the association between eating performance and environmental stimulation, adjusting for resident characteristics (i.e., age, gender, dementia stage, function, comorbidity, psychoactive medication use) and nesting effects of residents and staff. Results Resident participants demonstrated moderate levels of eating performance (M=27.08, SD = 5.16). Eating performance was significantly lower among older residents, those with more advanced dementia, and higher comorbidity. After controlling for resident characteristics, eating performance was significantly associated with stimulation specificity (how the stimulation is delivered and tailored to the resident), and was not associated with other environmental stimulation characteristics. For each 1 point increase in stimulation specificity, eating performance increased by 8.78 points (95% CI=.59, 16.97). Conclusions Environmental stimulation that is personally tailored to a resident’ needs and preferences and directly offered to a resident contributed to better eating performance among residents with dementia. The findings will direct future development and implementation of person-directed mealtime care programs and dining environment arrangements fo...

Factors influencing the pace of food intake for nursing home residents with dementia: Resident characteristics, staff mealtime assistance and environmental stimulation

“…The association of food intake pace with environmental specificity and environmental feedback was not supported in this study. Prior research shows that environmental specificity is significantly associated with residents' eating performance (i.e., stimulations from the caregiver and dining environment that are directly tailored and individually delivered to individuals based on their needs and preferences are associated with better eating performance; Liu et al, ). With the findings that eating performance is associated with both stimulation specificity and the pace of food intake, future work may need to further examine the relationship between food intake pace and stimulation specificity, as well as the role of eating performance in this relationship in a more heterogeneous sample.…”

“…Videos were excluded if they only captured residents' taking medications no matter whether food was served or not, being transferred to or from the dining location, waiting for the meal to be served, sitting in front of the dining table with food being served but not eating or drinking. A detailed description of sample selection following exclusion and inclusion criteria was reported in another study using this video sample (Liu et al, ). The 36 eligible videos involved 15 residents with dementia and 19 nursing staff in 8 NHs.…”

<p>Feasibility of a Mobile Meal Assistance Program for Direct Care Workers in Long-Term Care Facilities in South Korea</p>

“…The APP was developed based on previous literature on meal assistance. 14 , 17 – 19 , 29 A draft of the APP was reviewed by six experts, including long-term care directors and staff nurses, and professors of gerontological nursing. The final version of the APP included four sections: premeal assistance, midmeal assistance, postmeal assistance, and feeding-related issues.…”

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

“…Nursing home (NH) residents with dementia commonly experience functional, cognitive and behavioural symptoms that inference with mealtime activities, leading to functional and nutritional consequences that decrease quality of life and increase morbidity and mortality (Bell, Lee, & Tamura, 2015; Chang & Roberts, 2011; Hanson, Ersek, Lin, & Carey, 2013). Among the personal and environmental factors that influence resident eating performance and intake (Liu et al., 2016; Liu, Jao, Jao, & Williams, 2019; Liu, Tripp‐Reimer, Williams, & Shaw, 2018), quality of mealtime engagement and interactions between NH direct care staff (staff) and residents with dementia (residents) are important intervenable factors (Liu, Jao, & Williams, 2017; Liu, Williams, Williams, Batchelor‐Murphy, Perkhounkova, & Hein, 2019).…”