Equipping Nurses and Care Staff to Manage Mealtime Difficulties in People With Dementia: A Systematic Scoping Review of Training Needs and Interventions

Abstract

Purpose Mealtime difficulties are prevalent in dementia, posing major challenges to people with dementia (PWD), carers, and clinical services. Speech-language pathologists have a recognized role in providing training to carers of PWD who have mealtime difficulties. The aims of this study are (a) to identify the training needs of nurses and care staff with regard to managing mealtime difficulties in PWD, (b) to describe existing training interventions on this topic, and (c) to investigate the extent to which these interventions are relevant to the needs of nurses and care staff. Method A systematic search was carried out to identify studies relevant to the aims of the review. Data were extracted and then synthesized using thematic analysis and a synthesis matrix. Study quality was appraised using a validated appraisal tool. Results Various themes were identified in relation to the training needs of nurses and other care staff who manage mealtime difficulties in PWD. These were as follows: person-centered care; dealing with uncertainty; strategies, skills, and knowledge; and creating the right environment. Existing training interventions were described and compared against the training needs. The review found some correspondence between interventions and staff needs, but also some gaps. Conclusions Training interventions on this topic should be more systematically developed and better reported to facilitate effective implementation. Evidence to date indicates that training should do more to help staff deal with uncertainty. Further research assessing the benefits of speech-language pathologists' involvement in the development of training interventions is recommended because of this profession's specialist skills and knowledge with regard to both dysphagia and communication.

Mealtime difficulties in adults with mental health conditions: an integrative review

“…Patient perspectives in the decisions around further assessment, treatment, risk management and outcome measures for dysphagia or choking had scant attention. This is at odds with national aspirations for co-produced recovery and inclusivity in mental healthcare approaches and contrasts the growing attention to person centred care in other dysphagia patient populations (Faraday et al, 2019, Hansjee, 2018, McHorney et al, 2000, Vieira and Antunes, 2017. Shared decision making acknowledges the patient perspective, and ensures approaches are relevant, feasible and sustainable.…”

Exploring perceptions of eating with dementia: Findings from a massive open online course

“…A person-centred approach to encouraging eating in dementia has been widely advocated in the literature (Keller et al, 2015;Mole et al, 2019). In contrast to other research into awareness of eating difficulties in dementia (Faraday et al, 2019), participants in the UD-MOOC were able to identify a range of person-centred eating practices, including social encouragement and feeding assistance, honouring preference and offering the chance to make informed medical nutrition decisions. This finding may be attributable to the large number of participants and various demographic backgrounds in the UD-MOOC study that provide an unbalanced comparison to many other qualitative studies in this area (Seaton et al, 2014).…”

“…Despite a wealth of evidence to suggest the considerable impact of decreased eating on health outcomes in dementia and the benefits of specific approaches, uptake of practices to encourage eating does not always occur in both residential aged care and home environments (Beattie et al, 2014;Lea et al, 2019;Mole et al, 2018). Although there are many factors at play, this is partially a result of poor knowledge of nutrition, contrasting perspectives about best care and limited caregiver reserve to face situational barriers in paid and unpaid settings (Faraday et al, 2019;Keller et al, 2015). Previous research into knowledge of improving eating in paid settings suggests that identification of malnutrition is low (Mole et al, 2019).…”

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

“…29 A growing body of evidence examined the effectiveness of mealtime interventions either from single or multifaceted aspects. 25,[30][31][32][33][34][35] Recent studies also further examined the effects of oral nutritional supplements on improving the nutritional status of people with dementia with mealtime difficulties. 36 Although these reviews mainly focused on the level of food and fluid consumption and/or nutritional status as primary outcome measurements, the effects on eating, feeding or mealtime difficulties were not discussed.…”

“…A growing body of evidence examined the effectiveness of mealtime interventions either from single or multifaceted aspects 25,30–35 . Recent studies also further examined the effects of oral nutritional supplements on improving the nutritional status of people with dementia with mealtime difficulties 36 .…”