Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review

Abstract

BackgroundRisks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia).MethodsWe comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). The review was conducted with service user input in accordance with Cochrane Collaboration’s guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively.ResultsWe included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions.ConclusionsWe found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try.Trial registrationThe systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0256-8) contains supplementary material, which is available to authorized users.

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

“…In contrast, a recent study found that the perceptions of the quality of the dining environment and the quality of the meal have very limited influence on intake (Buckinx, Morelle, & Bruyère, ). The finding is consistent with systematic reviews reporting that modification of dining environments or routines including tableware and table setting visual contrast (Brush, Meehan, & Calkins, ), noise reduction (McDaniel, Hunt, Hackes, & Pope, ), lighting enhancement (Brush et al, ; McDaniel et al, ), bulk food delivery service (Desai, Winter, Young, & Greenwood, ), family‐style meals (Altus, Engelman, & Mathews, ), smoothing or re‐creative music (Mc Hugh, ) have low level of evidence in improving meal intake (Abbott et al, ; Bunn et al, ; Liu, Watson et al, ). With the mixed results, the role of environmental factors on intake in dementia deserves further investigation.…”

“…As gender and dementia stage are less modifiable, improving eating performance, the most fundamental ADL among residents (Liu, Unick, Galik, & Resnick, 2015), has been a focus of recent intervention research. Montessori-based activities and spaced retrieval trainings targeting older adults with dementia (Wu, Lin, Wu, Lin, & Liu, 2014) and staff mealtime assistance with a strong social interaction component (standardized verbal prompts, positive reinforcement, appropriate encouragement; Coyne & Hoskins, 1997;Van Ort & Phillips, 1995) have showed some evidence in decreasing feeding difficulty and improving eating performance Bunn et al, 2016;Liu, Galik, Boltz, Nahm, & Resnick, 2015a, 2015bLiu, Watson et al, 2014). Future work needs to test the impact of these strategies on the pace and amount food intake in dementia.…”

“…More recent studies have reported that full feeding assistance resulted in more oral intake and lack of feeding assistance was associated with low food intake in residents with severe dementia (Keller et al, 2017;Lin et al, 2010). Conversely, systematic reviews have reported that staff training programme on feeding skills (Chang & Lin, 2005), educational programmes (Suominen, Kivisto, & Pitkala, 2007) and feeding assistance interventions (Simmons et al, 2008) had insufficient evidence in supporting food intake in dementia (Abbott et al, 2013;Bunn et al, 2016;Liu, Watson et al, 2014). Moreover, different hand feeding techniques have shown inconsistent effects on food intake in dementia-direct hand feeding and under-hand feeding techniques reduced eating difficulties and improved food intake compared with over hand feeding (Batchelor-Murphy et al., 2017).…”

Impact of the Consistency of Food Substances on Health and Related Factors of Residents in Welfare Facilities for Seniors in Japan

“…Programs to improve the meals of residents and aid in their health recovery have been reported; these programs are generally focused on the transition from gastric tube feeding to oral feeding or nutritional supplementation [10,11]. Further efforts are needed to enable senior residents to eat foods with consistencies close to those of regular foods.…”

The nutritional care of people living with dementia at home: A scoping review

“…The management of symptoms relating to dementia will vary dependent on the care setting. Previous systematic reviews in this area have focused on randomised controlled trials (RCTs) carried out across all care settings (residential care facility, hospital ward environments and own homes), but to date have included minimal analysis of studies specific to “own home” (Abdelhamid et al., ; Bunn et al., ). Carer surveys have indicated that there is a need for increased primary care support relating to the nutritional needs and consequences associated with dementia in those living at home (Alzheimer's Society, ).…”