Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study

Abstract

BackgroundDespite 32 years of research and 13 reviews published in the field, no intervention can be considered a gold standard for maintaining eating performance among residents with dementia. The study aim was to highlight the interventions derived from tacit knowledge and offered daily in assisting eating by healthcare professionals (HCPs) in nursing homes (NHs).MethodA multicentre descriptive qualitative study was performed in 2017. Thirteen NHs admitting residents with moderate/severe functional dependence in eating mainly due to dementia, were approached. A purposeful sample of 54 HCPs involved on a daily basis in assisting residents during mealtime were interviewed in 13 focus groups. Data analysis was conducted via qualitative content analysis.ResultsThe promotion and maintenance of eating performance for as long as possible is ensured by a set of interventions targeting three levels: (a) environmental, by ‘Ritualising the mealtime experience by creating a controlled stimulated environment’; (b) social, by ‘Structuring effective mealtime social interactions’; and (c) individual, by ‘Individualising eating care’ for each resident.ConclusionsIn NHs, the eating decline is juxtaposed with complex interventions regulated on a daily basis and targeting the environment, the social interactions, and the residents’ needs. Several interventions that emerged as effective, according to the experience of participants, have never been documented before; while others are in contrast to the evidence documented. This suggests the need for further studies in the field; as no conclusions regarding the best interventions have been established to date.

Overview of systematic reviews: Effectiveness of non‐pharmacological interventions for eating difficulties in people with dementia

“…This may be related to the individual differences of PWD and the severity and type of dementia. Besides, the location where PWD were seated reflects strong social element, especially in nursing homes (Palese et al., 2018). Staff need to know about the relationships between PWD in advance, then arrange their seats in dining room.…”

“…There had been currently no clear evidence to support the effectiveness of feeding assistance, mixed interventions, vocal or tactile positive feedback, and exercise. The effect of feeding assistance was related to a social element around eating (Simmons & Schnelle, 2004), as well as daily preferences and eating ability of PWD (Palese et al., 2018). Therefore, there are large individual differences.…”

Negative prompts aimed at maintaining eating independence

“…This was a secondary analysis of negative cases 18 that emerged in a large descriptive qualitative study 19 based on focus group methodology 20 performed in 2017. The COnsolidated criteria for REporting Qualitative research (COREQ) 21 were considered here to report those methodological aspects related to the study design as summarised in Table 1.…”

Informal dementia caregivers’ experiences and perceptions about mealtime care: A qualitative evidence synthesis

“…As the disease progresses, people with dementia experience a series of eating problems at different disease stages (Bakker et al., 2013; Kai et al., 2015; Spillman, Wolff, Freedman, & Kasper, 2017). Eating, particularly at mealtimes, is vital to providing energy, nutrients, and adequate intake; moreover, it affects physiological, psychological, and social well‐being and quality of life (Palese et al., 2018).…”

“…Recently, systematic reviews (Abdelhamid et al., 2016; Bunn et al., 2016) have assessed the effectiveness of direct and indirect interventions aimed at facilitating food or drink intake but unfortunately failed to find definitive evidence of the effectiveness of specific interventions due to their small size and short duration. In a field of research where evidence is still lacking, consulting relevant personnel to discover the tacit knowledge they have developed from practice or experience is very valuable for researchers designing interventions (Palese et al., 2018).…”