Evaluating a brief intervention for mealtime difficulty on older adults with dementia

Abstract

Aims and objective: To test a spaced retrieval intervention using spaced retrieval to alleviate mealtime difficulties in older people with dementia.Design: A single-case study design.Setting: Nursing Homes in North Central England, United Kingdom.Participants: Older people with Alzheimer's disease.Methods: A single-case study using an ABA design was used. Data were collected using the Edinburgh Feeding Evaluation in Dementia scale, Mini Nutritional Assessment, and Body Mass Index before intervention, postintervention and following 3 months of postintervention. Realist evaluation was used to identify for which participants the intervention was effective, and an economic evaluation was also carried out.Finding: Of 15 participants who entered the study, eight completed all phases of the study. A mean 104.4 h were needed to deliver the intervention. The number of sessions required ranged from 90-222. The length of time each participant retained information (for all sessions) ranged from 13-28 min. Participants had most difficulty with: "putting food into mouth and chewing it"; "realizing it was mealtime"; and "eating a whole meal continuously." A reduction in the difficulty with mealtimes occurred between phase A1-A2 for most participants. Six participants maintained this in phase A3. Similar patterns were evident for nutritional scores. For most participants, the effect size of the intervention was moderate or large.Conclusions: Spaced retrieval is useful in reducing mealtime difficulties in older participants with dementia. While the results of this study are promising, further large and multicentre trials are needed to explore the effectiveness of the intervention in diverse populations.

Interventions to address mealtime support needs in dementia: A scoping review

“…Lastly, a spaced retrieval intervention was tested, through sections with activities created to help residents re-learn a fixed series of actions related to recognizing mealtime, feeding themselves, eating and swallowing, while controlling environment settings (lighting, noise) [ 68 ].…”

“…The multicomponent interventions were equally divided regarding the inclusion of residents and staff as participants. Three studies that included only residents had similar objectives, which included improving oral intake and eating abilities [ 53 , 60 ], relieving the mealtime support needs [ 68 ]. The impact of the interventions was positive, as there was an increase in oral intake, body weight, and a reduction in inappropriate mealtime behaviors, with a consequent improvement in the ability to eat.…”

“…Despite presenting only residents’ outcomes, one study [ 46 ] considered the context as feeding support needs and two others as mealtime support needs [ 57 , 59 ]. One study [ 68 ] included an economic evaluation of intervention costs related to daily calorie and protein intake.…”

“…Based on the definitions presented in the introduction of this article, the studies analyzed in this review predominantly used the concept of eating (n = 22). For the remaining articles six used the concept of mealtimes [57,59,62,[66][67][68]; and 5 studies used the concept of feeding [17,46,51,55,64]. It was expected to find a relationship between the studies that used the concepts of feeding or mealtime support needs and outcomes for both residents and staff, but it was not possible to establish such association.…”