What nursing home environment can maximise eating independence among residents with cognitive impairment? Findings from a secondary analysis

Abstract

To explore the influence of the Nursing Home (NH) environment on eating independence while taking into account individual and nursing care factors, was the aim of the study. A secondary analysis was performed based on data collected in a multicentre prospective observational study involving 13 NHs. Residents aged >65 were included (n=1,027). Dependence in eating was measured using the Edinburgh Feeding Evaluation in Dementia scale (EdFED, range 0-20). In addition to individual and nursing care variables, the NHs environments were assessed with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH, range 0-149). The mean EdFED score was 2.48 (95% Confidence Interval [CI]=2.22-2.73) and the TESS-NH score was 122.19 (95% CI=115.89−128.49). A linear regression analysis explained 30.8% of the total variance in eating dependence. Alongside individual and nursing care factors, in poor NH unit environments, residents with severe cognitive impairment showed increased eating dependence; in contrast, in better environments, similar residents showed maximal eating performance.

What Kind of Interventions Were Perceived as Effective Against Coronavirus-19 in Nursing Homes in Italy? A Descriptive Qualitative Study

“…In short, the entire NH environment has been revised by sacrificing some common areas devoted to residents with specific needs (eg, dementia) and by an in-depth altering of the home-like environment that has been considered as a key role in improving the quality of life of residents. 32 , 39…”

Eating Difficulties among Older Adults with Dementia in Long-Term Care Facilities: A Scoping Review

“…The factors observed in this review were primarily categorized at the intrapersonal and environmental level. Intrapersonal factors associated with reduced eating performance of residents included declined cognitive [ 7 , 8 , 36 , 37 , 38 , 39 , 42 ] and physical functions [ 35 , 37 , 40 ], long periods of residence in LTC [ 7 , 40 ], female sex [ 35 , 44 ], old age [ 35 ], presence of comorbidities [ 36 ], longer illness duration [ 59 ], increased usage of medications [ 19 ], and presence of dysphasia [ 38 ]. It remains unclear whether age and sex significantly affect eating ability, as they were not identified as significant factors in some studies.…”

“…Environmental factors significantly associated with the eating difficulties of residents with dementia include the absence of supervisory staff [ 7 , 35 ], non-public eating places [ 7 , 34 ], physical settings (louder sounds and low light level) [ 41 ], diet type (soft and liquid food) [ 7 ], longer mealtimes [ 41 ], and eating without other residents [ 44 ]. A dining area is a place for social interaction, and physical environmental factors are important for residents with dementia, who are often easily distracted by perceptual surroundings [ 79 ].…”

“…Significant interpersonal factors, on the other hand, include close relationships with family [ 35 , 44 ] as well as caregivers’ visual and physical assistance during mealtime [ 63 ]. While direct caregivers are in a strategically essential position to assist institutionalized older adults with dementia and high dependence to carry out activities of daily living, and interpersonal factors are relatively modifiable compared to the individual characteristics [ 41 , 80 ], there is a paucity of studies reporting the influences of a caregiver’s characteristics.…”

“…These were, therefore, identified as factors that can significantly affect eating behavior. Eating place 2 [7,34] Presence of staff 3 [7,34,35] Length of the eating time 1 [41] Eating with other residents 1 [44] Physical (tablecloth, illuminance level, sound volume level, etc.) 4 [34,41,43,44]…”