Mealtime Caregiving Approaches and Behavioral Symptoms in Persons Living With Dementia: A Longitudinal, Observational Study

Abstract

Background: Behavioral symptoms during mealtime can prohibit persons living with dementia from obtaining sufficient nutrition. However, little research has examined the relationship between behavioral symptoms and caregiving approaches. This study examines this relationship and further explores which specific caregiver behaviors were related to behavioral symptoms among persons living with dementia. Methods: A secondary data analysis was performed using 86 mealtime videos from a longitudinal, observational study. The videos were repeatedly taken at months 0, 3, and 6 with 30 persons living with dementia in one of four long-term care facilities. Video coding was performed using coding schemes modified from the Cohen-Mansfield Agitation Inventory for behavioral symptoms and the Person-/Task-Centered Behavior Inventory for caregiving approaches. Coding schemes for behavioral symptoms consisted of four categories: total duration, aggressive behavior, physically nonaggressive behavior, and verbally agitated behavior. Caregiving approaches consisted of ten-verbal/seven-nonverbal person-centered behavior codes, four-verbal/four-nonverbal task-centered behavior codes, and no-verbal/no-nonverbal interaction codes. A mixed-effect model was conducted using variables such as demographics, medical information, cognitive status, depression, function, and caregiving approaches as fixed effects, participant as a random effect, and four categories of behavioral symptoms as dependent variables. Results: The total duration of the Cohen-Mansfield Agitation Inventory was associated with no verbal response (β = 9.09) and task-centered verbal behavior (β = 8.43), specifically verbal controlling (β = 7.87). Physically nonaggressive behavior was associated with no verbal response (β = 9.36). Verbally agitated behavior was associated with task-centered nonverbal behavior (β = 51.29), and specifically inappropriate touch (β = 59.05). Conclusions: Mealtime is indispensable to dementia care, but best practices for mealtime have not been suggested when behavioral symptoms are present. Our findings revealed caregivers’ task-centered behaviors and no interaction were related to behavioral symptoms of persons living with dementia. When caregivers encounter behavioral symptoms during mealtime, it is recommended to avoid no response and task-centered behaviors, especially verbal controlling and inappropriate touch, and to promote person-centered behaviors.

Person‐centred and task‐centred care: Impact on mealtime behaviours in nursing home residents with dementia

“…Staff task-centred approaches were not correlated with resident behaviours, inconsistent with previous reports that supported temporal or associative relationships with resident agitation (Gilmore-Bykovskyi et al, 2015;Lee et al, 2021) and aspiration (Gilmore-Bykovskyi & Rogus-Pulia, 2018) during mealtimes, and with resident resistiveness to care during hygienic care (Belzil & Vézina, 2015). The non-significant findings could be related to the dichotomisation of staff task-centred approaches and/ or multivariable analyses that examined associative (vs. temporal) relationships in this study.…”

“…Comparatively, task‐centred care prioritises activities without adequate consideration of individual needs and preferences and focuses on completion of activities for (rather than with) the individual. Task‐centred care approaches, including providing full assistance for residents with some eating independence, verbal controlling and inappropriate touch, are correlated with disengagement, behavioural challenges and decreased intake (Lee et al, 2021; Morrison‐Koechl et al, 2021).…”

Impact of COVID-19 on Relationship-Centred Residential Dining Practices

“…For example, regulations stipulate that meals must begin and end within a certain time frame (e.g., dinner between 5:00 p.m. and 6:00 p.m.), that staff may support up to two residents at a time with eating assistance for safety reasons, and that residents should have sufficient time to eat at their own pace (e.g., Ministry of Health and Long-term Care, 2007). While such regulations are reasonable, the reality is that eating assistance requires additional time and dedicated support (Lee, Lee, & McConnell, 2021;Simmons & Schnelle, 2006) that are not always possible given such factors as the increasing complex care needs of residents and limited staffing (Chamberlain et al, 2017;Hsu, Berta, Coyte, & Laporte, 2016;McGregor et al, 2006). Consequently, staff assist more than two residents at a time, stopping and starting assistance while attending to other residents and mealtime tasks (Lowndes et al, 2018).…”