Improving Eating Behaviors in Dementia Using Behavioral Strategies

Abstract

The purpose of this experimental pilot study was to determine the short- and long-term efficacy of directed verbal prompts and positive reinforcement on the level of eating independence (LEI) of elderly nursing home patients with dementia. Twenty-four subjects from a dementia unit were randomly selected and randomly assigned to three experimental groups and three control groups. The LEI scale was used to measure eating frequency and task performance at six consecutive meals during pretest and posttests, T2 and T3. During the treatment phase, which consisted of nine consecutive meals, prompts were administered to each experimental group and positive reinforcement was given when a subject completed eating tasks. Short-term effects were assessed on 2 consecutive days following treatment (T2) and long-term effects on 2 consecutive days, 7 days following treatment. Significant differences were found in eating performance but not in frequency. Experimental groups retained treatment at both posttests. The dementia diagnosis should not preclude the possibility that eating skills may be reacquired.

ESPEN guidelines on nutrition in dementia

“…Positive effects were reported when patients with severe dementia were fed by the same carer compared to various carers [124]. Specific behavioral and communication strategies have been shown to positively affect eating behavior and increase food intake in three case reports [125] and in a small controlled, non-randomized study [126].…”

Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy

“…Positive results compared to a usual-care control group were reported in all the identified studies. The interventions included: scheduling and prompting used to reduce urinary incontinence [80] ; graded assistance to improve individual autonomy [81] ; prompting and reinforcement during meals to improve eating independence [82] , and a specific way-finding intervention to assist residents in locating a dining room [83] . Group sessions of cognitive stimulation, reminiscence and relaxation (multicomponent interventions for PWD, enriched group cognitive stimulation) improved orientation after 3 months whereas persons receiving usual care deteriorated [110] .…”

A Review of Behavioural Gerontology and Dementia Related Interventions

“…provision of a cue to set the occasion for self-feeding behaviour). 43 Eating performance was improved in the intervention group and supported Baltes & Zerbe's outlook that a dementia diagnosis is not the determining factor whether or not skills such as self-feeding can be re-established. 44 However, in general CRF is suggested to only be utilised to strengthen behaviour in the initial stages of an intervention and then to be thinned so the behaviour eventually becomes naturally maintained.…”