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

Abstract

Introduction Mealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person‐centred and task‐centred care and positive/neutral and challenging mealtime behaviours in persons with dementia. Methods This study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff‐resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video‐coding scheme was used to code videos during 2019–2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person‐centred and task‐centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression. Results Staff person‐centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09–1.76), functional impairments (OR = 0.81, 95% CI = 0.66–1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18–2.31). Staff person‐centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02–1.74). Staff task‐centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours. Conclusion This study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person‐centred approaches and resident positive and challenging behaviours. Person‐centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.

Physical function decline predictors in nursing home residents using new national quality indicators

“…As oral dysfunction leads to PF decline and deterioration of quality of life, 34 careful monitoring of choking, included in the LIFE data, is useful for identifying those with a high risk of PF decline. Given the limited human resources in nursing homes, mealtimes are a good time to efficiently observe the status of each resident, 35 as most residents eat together. Thus, they should be carefully observed during daily meals, and those at high risk of PF decline should be identified.…”

Temporal Relationships Between Nursing Home Staff Care Approaches and Behaviors of Residents With Dementia During Mealtimes: A Sequential Analysis

“…Mealtime dyadic interactions are dynamic, complex, and fluid, involving a mixture of person-centered and task-centered care approaches by staff in responding to resident positive, neutral, and challenging behaviors, which further influences subsequent staff care approaches. Both staff person-centered and task-centered care approaches and resident positive, neutral, and challenging behaviors were frequently observed during mealtime care ( 11 , 17 , 18 ). Person-centered care (eg, orientation/giving instructions, giving choices; Supplementary Table 1 ) is defined as the individually tailored and directly delivered verbal and nonverbal assistance provided by staff that aims to engage and motivate residents in mealtime activities and address resident needs and preferences by accommodating resident remaining abilities, dyadic interactions, and the physical and social dining environments ( 19–21 ).…”

“…Although evidence is emerging on the importance of quality dyadic interactions during mealtime care, prior work has primarily focused on the associative (vs temporal) relationships between staff person- and task-centered care approaches and resident positive, neutral, and challenging behaviors and food intake, generating limited evidence to guide the development of effective interventions to improve mealtime care quality and resident outcomes. For example, recent mealtime research supported associative relationships of (a) staff person-centered approaches with resident positive and challenging behaviors ( 11 , 17 , 18 ), and (b) staff person-centered approaches and resident positive and challenging behaviors with resident food intake ( 12 , 22 ). Another study supported associative relationships between positive and negative/neutral interactions during care-related activities (not mealtime-specific) and interaction location and resident participation level, and suggests more research is needed on the role of resident and staff characteristics on quality of dyadic interactions in care of people with dementia ( 23 ).…”

Mealtime interactions between nursing home staff and residents with dementia: a behavioral analysis of Language characteristics

“…Person-centered communication helps to facilitate relationship building and positive engagement as well as assess and respond to residents’ needs and preferences. Person-centered communication is especially critical during mealtime – a basic daily activity that not only ensures fundamental health needs including function, hydration, nutritional intake but also fulfills the social needs by providing interpersonal interactions for residents with dementia [ 5 , 7 , 8 ].…”

“…Additionally, the neurodegenerative decline in people with dementia particularly affects their linguistic and communicative abilities, such as word finding, conversation initiation and responses, and language comprehension, and may ultimately result in loss of language in the late stage of dementia [ 10 – 12 ]. Staff-level factors include social demographics (e.g., age, sex, race), professional education and experiences (e.g., hours worked per week, qualifications, knowledge of dementia), individual experiences and perceptions (e.g., mood/feelings, perceived workload), verbal and non-verbal communication skills and approaches (e.g., English language skills, encouragement, physical touch), and values (e.g., respecting privacy, preserving identity) [ 2 , 7 , 9 ]. Contextual factors include location (e.g., long-term care facility and unit, dining area), time and duration of care encounters (e.g., beginning/end and duration of mealtime interactions), and environmental stimuli (e.g., background noise/music, temperature) [ 9 ].…”