Mealtime Difficulties in a Home for the Aged: Not Just Dysphagia (original) (raw)
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An Assessment of the Feeding Behaviors of the Institutionalized Elderly
American Journal of Occupational Therapy, 1982
Data obtazned from observing the residents of three long-term care facilities showed that the majority req uired some assistance in feedmg. The facilitzes differed in the percentage of residents needzng help and in the physical and attitudinal support given for selffeeding. Regardless of level of independence in feeding, most residents received adequate food intake. Physical problems, which posed a greater handicap to selffeedzng than mental problems, were of four types: improper positioning, dysphagia, upper extremity dysfunctzons, and blindness.
Mealtime difficulty in older people with dementia
WikiJournal of Medicine, 2019
Aim: To evaluate the evidence published in systematic reviews on the effectiveness of interventions aimed at alleviating mealtime difficulties in older people with dementia. Background: Older people with dementia gradually lose their self-care abilities as the condition of dementia progresses and this includes the ability to eat independently. There is a large body of research into this phenomenon, including into the effectiveness of interventions to alleviate the problems which arise. Recently there have also been several systematic reviews with different conclusions about the effectiveness of these interventions. Design: A systematic review of systematic reviews. Methods: Databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Excerpta Medica Database (EMBASE), the Cochrane Library and the Joanna Briggs Library) were searched between January 2005-December 2018 using the search strategy: (feeding OR mealtimes OR eating OR intake OR food and drink OR nutrition OR difficulty) AND dementia AND intervention AND systematic review. The Critical Appraisal Skills Programme (CASP) checklist for Systematic Reviews was used to evaluate the reviews. Results: Eight eligible studies were retrieved; three scored 10 and five scored 8 according to the CASP checklist. Conclusion: The quality of the reviews included in the review were high. There is no strong evidence to support the use of any particular intervention for the alleviation of mealtime difficulties in older people with dementia. Methodological problems related to sample size and bias were apparent in the studies included in all the reviews and there was a lack of standardisation around interventions and outcomes across studies. Behavioural intervention, specifically Montessori education and spaced retrieval methods were considered promising and worthy of further research.
Background Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition in subjects with severe dysphagia. The objective assesses the prevalence of dysphagia in European and Israeli NHRs, its association with mortality, and the relationship of different nutritional interventions, i.e. texture modified diets and artificial nutrition (AN) - with weight loss and mortality. Methods A prospective observational study three thousand fifty one European and Israeli NHRs older than 65 years, participating in the SHELTER study from 2009 to 2011, at baseline and after 12 months. All residents underwent a standardized comprehensive evaluation using the interRAI Long Term Care Facility (LTCF). Cognitive status was assessed using the Cognitive Performance Scale (CPS), functional status using Activities of D...
Prevalence and factors associated with food intake difficulties among residents with dementia
PloS one, 2017
Few studies have examined the prevalence of food intake difficulties and their associated factors among residents with dementia in long-term care facilities in Taiwan. The purpose of the study was to identify the best cutoff point for the Chinese Feeding Difficulty Index (Ch-FDI), which evaluates the prevalence of food intake difficulties and recognizes factors associated with eating behaviors in residents with dementia. A cross-sectional design was adopted. In total, 213 residents with dementia in long-term care facilities in Taiwan were recruited and participated in this study. The prevalence rate of food intake difficulties as measured by the Chinese Feeding Difficulty Index (Ch-FDI) was 44.6%. Factors associated with food intake difficulties during lunch were the duration of institutionalization (beta = 0.176), the level of activities of daily living-feeding (ADL-Q1) (beta = -0.235), and the length of the eating time (beta = 0.416). Associated factors during dinner were the illu...
Feeding difficulty in older adults with dementia
Journal of Clinical Nursing, 2008
Aims and objectives. To use concept analysis to identify characteristics of feeding difficulty and its antecedents and consequences that provide direction for assessment and management. Background. Feeding difficulty is often recognised as a common problem for older adults and is associated with weight loss, poor nutrition and risk for aspiration pneumonia. The cognitive impairment found in persons with dementia impairs the ability of these adults to complete motor and perceptual tasks required for eating and often prevent the older adult from accepting help with feeding from caregivers. Design. Systematic review. Methods. In 2006, literature searches using keywords (feeding, eating, nutrition, malnutrition, feeding assessment, dementia, ageing and concept analysis, dementia and feeding and excluding enteral feeding, tube feedings, PEG and enteral nutrition) were done in Medline, CINHAL, AGELINE and Social Science Full Text. Seventy relevant articles in English were found. After a review of the relevant articles, concept analysis was used to develop a definition of feeding difficulty, its defining characteristics and to delineate feeding difficulty from its antecedents and consequences. Results. Feeding difficulties arise at the interface between the caregiver strategies to assist the older adult with getting food into the mouth and chewing and swallowing food. A model of feeding difficulty delineates the antecedents and consequences of feeding difficulties. Conclusions. The conceptual model of feeding difficulties provides a strong and clear organising structure for research that can be used to developed evidence based guidelines for practice. Relevance to clinical practice. The conceptual model provides directions for assessment of feeding difficulties and their antecedents. The model can be used to identify interventions that address antecedents of feeding difficulty (risk factors) and different types of feeding difficulties.
Dysphagia in Nursing Home Residents: Management and Outcomes
Journal of the American Medical Directors Association, 2018
Objectives: To define the prevalence of dysphagia and its associated factors and to investigate the influence of dysphagia and nutritional therapies performed in dysphagic subjects on clinical outcomes, including nutritional status, pressure ulcers, hospitalization, and mortality. Design: A prospective observational study. Setting and participants: Thirty-one Italian nursing homes participating in the ULISSE project and 1490 long-stay nursing home residents, older than 65 years, assessed at baseline and reassessed after 6 and 12 months. Measures: All participants underwent a standardized comprehensive assessment using the Italian version of the nursing home Minimum Data Set. The activities of daily living Long-Form scale was used to evaluate functional status. Health care professionals assessed dysphagia by means of clinical evaluation. Nutritional status was assessed using the information on weight loss. Results: The prevalence of dysphagia was 12.8%, and 16% of the subjects were treated with artificial nutrition. The mortality rate in subjects with dysphagia was significantly higher compared with that of nondysphagic subjects (27.7% vs 16.8%; P ¼ .0001). The prevalence of weight loss and pressure ulcers was also higher in dysphagic subjects. At variance, dysphagia was not associated with a higher hospitalization risk. Conclusion/Implications: Dysphagia is common in nursing home residents, and it is associated with higher mortality. Therefore, early diagnosis and optimal management of dysphagia should become a priority issue in nursing homes.
Original Study Dysphagia in Nursing Home Residents: Management and Outcomes
2019
Objectives: To define the prevalence of dysphagia and its associated factors and to investigate the influence of dysphagia and nutritional therapies performed in dysphagic subjects on clinical outcomes, including nutritional status, pressure ulcers, hospitalization, and mortality. Design: A prospective observational study. Setting and participants: Thirty-one Italian nursing homes participating in the ULISSE project and 1490 long-stay nursing home residents, older than 65 years, assessed at baseline and reassessed after 6 and 12 months. Measures: All participants underwent a standardized comprehensive assessment using the Italian version of the nursing home Minimum Data Set. The activities of daily living Long-Form scale was used to evaluate functional status. Health care professionals assessed dysphagia by means of clinical evaluation. Nutritional status was assessed using the information on weight loss. Results: The prevalence of dysphagia was 12.8%, and 16% of the subjects were treated with artificial nutrition. The mortality rate in subjects with dysphagia was significantly higher compared with that of nondysphagic subjects (27.7% vs 16.8%; P ¼ .0001). The prevalence of weight loss and pressure ulcers was also higher in dysphagic subjects. At variance, dysphagia was not associated with a higher hospitalization risk.
International Journal of Nursing Studies
Background: Dementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person's ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person's ability to engage in a meal. Objectives: The objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability. Design: Systematic review using the Joanna Briggs Institute review methods. Data sources: Seven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000-2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator. Review methods: Studies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format. Results: 136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation; meal styles; environment adaptations; skills training; music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index. Conclusion: There is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.