Effectiveness of interventions on feeding difficulties among people with dementia: A systematic review and meta‐analysis

Abstract

Objectives This systematic review and meta‐analysis aimed to examine non‐pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status. Methods The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non‐RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta‐analysis. Results The systematic review and meta‐analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta‐analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of −1.36 (95% confidence interval: −1.84 to −0.89, p < 0.001) and on self‐feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta‐analysis, these interventions had no effect on improving the nutritional status of people with dementia. Conclusions None of the included RCTs met the Cochrane risk‐of‐bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions.

Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study

“…Eating, considered the late-loss BADL, correlated with two additional geriatric syndromes-dysphagia and unintentional weight loss-alongside previously discussed issues like fecal incontinence and cognitive impairment. The current scientific literature consistently identifies dementia, unintentional weight loss, and dysphagia as key factors associated with limitations to eating [49,50]. A cross-sectional study found similar associated factors and provided two interpretations that point in distinct directions: one suggesting that those with self-feeding limitations experience inadequate nutritional care leading to malnutrition, and the other proposing that self-feeding limitations in residents may indicate a precursor of approaching the end of life [51].…”

“…A cross-sectional study on self-feeding did not identify NH-level explanatory variables, but suggested latent variables within the NH cluster might influence outcomes [51]. Nevertheless, NHs with kitchens have the potential to address individual factors influencing residents' eating behaviors and food choices, including innate and learned food preferences, motivations, attitudes, hunger, personality traits, and values, among other considerations [50,53].…”

“…Therefore, it is imperative that the prescription of exercise becomes a mandatory component in the training of all healthcare professionals and is consistently promoted in long-term care facilities [62,63]. Finally, access to a kitchen in NHs may significantly address malnutrition among residents who are dependent when eating, enabling meal adaptation based on factors like innate preferences, motivations, attitudes, hunger, personality traits, and values [50,53].…”