Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia

Abstract

BACKGROUND Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake. OBJECTIVES To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand (DH), Over Hand (OH), and Under Hand (UH). DESIGN A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences. SETTING AND PARTICIPANTS 30 residents living with advanced dementia in 11 U.S. NHs. MEASUREMENTS Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. INTERVENTION Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N=540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every two days. RESULTS Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67±15.2%) and UH (65±15.0%) with both significantly greater than OH (60±15.1%). Feeding behaviors were more frequent with OH (8.3±1.8%), relative to DH (8.0±1.8) and UH (7.7±1.8). CONCLUSION All three techniques are time neutral. UH & DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding.

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

“…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). Findings of this study provide evidence to support the positive impact of using visual assistance and full physical assistance to improve residents' pace of food intake and thus potentially improve the amount of food and fluid consumption.…”

Ease of use, feasibility and inter‐rater reliability of the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video‐coding scheme

“…Another example, current mealtime care interventions primarily focus on the use of direct feeding skills rather than positive dyadic interactions, have low to insufficient evidence to decrease resident mealtime difficulties and increase intake and fail to address staff's needs for knowledge and skills to provide person‐centred mealtime care (Batchelor‐Murphy et al, 2017; Chang & Lin, 2005; Chen et al., 2016; Liu, Miao, et al, 2015; Liu, Cheon, Cheon, & Thomas, 2014; Liu, Galik, Boltz, Nahm, & Resnick, 2015). Future research on the temporal relationship between staff verbal and nonverbal behaviours and resident mealtime difficulties and intake will help identify specific staff behaviours that may reduce (precede) resident mealtime difficulties and/or improve (decrease) intake.…”

<p>Feasibility of a Mobile Meal Assistance Program for Direct Care Workers in Long-Term Care Facilities in South Korea</p>

“…The APP was developed based on previous literature on meal assistance. 14 , 17 – 19 , 29 A draft of the APP was reviewed by six experts, including long-term care directors and staff nurses, and professors of gerontological nursing. The final version of the APP included four sections: premeal assistance, midmeal assistance, postmeal assistance, and feeding-related issues.…”

“…Training or education programs for direct care workers (CAs) seek to optimize eating skills of RWDs and improve CA feeding skills 17 – 19 because without training, CA feeding behavior may rely on personal habits rather than on evidence-based approaches or scientific guidelines. 20 Frequent staff shortages at long-term care facilities, however, can make it difficult for CAs to participate in traditional training programs.…”