Temporal Associations between Caregiving Approach, Behavioral Symptoms and Observable Indicators of Aspiration in Nursing Home Residents with Dementia

Abstract

These findings provide compelling preliminary evidence that caregiver approach may influence the occurrence of aspiration. Provided the urgent need for more approaches to mitigate the complications associated with dysphagia in people with dementia, even a moderate reduction in aspiration events may be clinically meaningful. Further, well-designed observational studies with individuals with well-characterized dysphagia are needed to better understand and characterize these relationships, their temporal structures and their impacts on other relevant outcomes such as eating performance and malnutrition.

Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review

“…Three were classified as pseudo randomized controlled trials and another three were quasi-experimental studies [ 25 , 31 , 34 , 37 , 39 , 40 ]. Observational design was used in one study [ 27 ]. Of the six reviews, four were literature reviews and the other were systematic reviews [ 13 , 32 , 33 , 35 , 36 , 38 ].…”

“…As Table 1 shows, of the nineteen studies [13,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], six were conducted in the USA, three were conducted in Japan, two were conducted in Australia, and one was conducted in the UK, France, Sweden, Brazil, South Korea, Mainland China, Hongkong and Taiwan, respectively. Most were conducted in developed countries or regions (89.5%).…”

Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations

“…While staff negative behaviours may be few, the impact on residents should not be ignored. Residents may resist food or care, disengage from eating, and show other behavioural symptoms such as agitation, resulting in low intake and risk of aspiration (Gilmore‐Bykovskyi et al., 2015; Gilmore‐Bykovskyi & Rogus‐Pulia, 2018). Future research needs to identify, prevent, and decrease negative dyadic interactions during dementia mealtime care.…”

“…While evidence is emerging on the importance of positive staff–resident (dyadic) interactions during mealtime care, little work has characterized dynamic and complex mealtime interactions, limiting the development of effective interventions to manage mealtime difficulties and insufficient intake. Prior studies have examined temporal associations of staff behaviours with resident agitation (Gilmore‐Bykovskyi et al., 2015) and aspiration (Gilmore‐Bykovskyi & Rogus‐Pulia, 2018) during mealtime and temporal associations of staff behaviours with resident agitation (Roth et al., 2002) and resistiveness to care (Belzil & Vézina, 2015) during hygienic care routines. Another study shows that both positive and negative/neutral interactions during care‐related activities (not mealtime specific) are associated with interaction location and resident participation level and suggests more research on the role of resident and staff characteristics on quality of dyadic interactions in dementia care (Paudel et al., 2019).…”

Perceived oral care needs of terminally ill adults – a qualitative investigation

“…Thus, dysphagia can increase social anxiety and may lead to social withdrawal and reduce the quality of life of the affected individuals (275). Severe forms of dysphagia can impair liquid and nutritional intake, and thereby increase the risk of developing malnutrition and dehydration, and also aspiration pneumonia (276)(277)(278). In elderly patients, oropharyngeal dysphagia is a significant risk factor for hospital readmission (276,279).…”