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Volkert D, Beck AM, Faxén-Irving G, Frühwald T, Hooper L, Keller H, Porter J, Rothenberg E, Suominen M, Wirth R, Chourdakis M. ESPEN guideline on nutrition and hydration in dementia - Update 2024. Clin Nutr 2024; 43:1599-1626. [PMID: 38772068 DOI: 10.1016/j.clnu.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND & AIMS Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. METHODS The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. RESULTS 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. CONCLUSION Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Gerd Faxén-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Hietzing Municipal Hospital, Vienna, Austria
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Heather Keller
- Department of Kinesiology & Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Judi Porter
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Passos L, Tavares J, Batchelor M, Figueiredo D. Interventions to address mealtime support needs in dementia: A scoping review. PLoS One 2024; 19:e0300987. [PMID: 38527044 PMCID: PMC10962800 DOI: 10.1371/journal.pone.0300987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
The decrease in cognitive and physical ability among people with dementia can significantly affect eating performance, resulting in mealtime support needs that could lead to inadequate oral intake, weight loss, malnutrition, and reduced functionality in activities of daily living. This scoping review aimed to identify and summarize available research literature on mealtime interventions for people with dementia, and their impact on older people with dementia living in a residential care setting, care staff, and care context/environment. A scoping review of available research published in English, French, Portuguese, or Spanish, was conducted according to the methodology established by The Joanna Briggs Institute. The search was conducted between November 2022 and February 2023 in the following databases: MEDLINE, Web of Science, Scopus, CINAHL Complete, and SciELO. A total of 275 articles were retrieved, of which 33 studies were selected according to inclusion criteria. The interventions were classified into four general categories: environmental, mealtime assistance, staff training, and multicomponent. Most studies demonstrated effectiveness in increasing oral intake and improving behaviors such as agitation and aggression in people with dementia. The impact of interventions on care staff was linked to greater knowledge and attitudes towards mealtime support needs. There is a lack of reporting on the impact of interventions on the care context/environment. Most interventions examined the effects exclusively on residents, focusing on their oral intake and behavioral patterns, particularly agitation among individuals with dementia. However, it is crucial to conduct studies that evaluate the impact on administrators, to comprehend the viewpoints of various hierarchical levels within an organization regarding challenges associated with mealtime. The findings of this scoping review can support the development of new supportive programs, or strategies to improve mealtime experience with positive impact according to the reality and needs of each person or institution.
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Affiliation(s)
- Lígia Passos
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - João Tavares
- Center for Health Technology and Services Research (CINTESIS@RISE), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Melissa Batchelor
- School of Nursing, George Washington University, Washington, DC, United States of America
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS@RISE), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Middleton LE, Freeman S, Pelletier C, Regan K, Donnelly R, Skinner K, Wei C, Rossnagel E, Nasir HJ, Albisser T, Ajwani F, Aziz S, Heibein W, Holmes A, Johannesson C, Romano I, Sanchez L, Butler A, Doggett A, Buchan MC, Keller H. Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:87. [PMID: 37775790 PMCID: PMC10542247 DOI: 10.1186/s40900-023-00497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.
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Affiliation(s)
- Laura E Middleton
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada.
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada.
| | - Shannon Freeman
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Chelsea Pelletier
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Kayla Regan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Rachael Donnelly
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Kelly Skinner
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Cindy Wei
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Emma Rossnagel
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Huda Jamal Nasir
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Tracie Albisser
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Fatim Ajwani
- University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Sana Aziz
- Alzheimer Society of B.C., 828 W 8Th Ave Suite 300, Vancouver, BC, V5Z 1E2, Canada
| | - William Heibein
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Ann Holmes
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Carole Johannesson
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Isabella Romano
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Louisa Sanchez
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Alexandra Butler
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Amanda Doggett
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - M Claire Buchan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Heather Keller
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
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Liu W, Chen Y. Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations. J Clin Nurs 2023; 32:3482-3495. [PMID: 35706419 PMCID: PMC9972876 DOI: 10.1111/jocn.16411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study examined the sequential relationships of food intake and the moderating role of the characteristics of intake and resident conditions. BACKGROUND Nursing home residents commonly experience insufficient food intake. While multilevel factors influence intake, evidence on sequential relationships is lacking. DESIGN The study was an observational study using secondary, behavioural analyses following the STROBE Statement. METHODS Videotaped observations (N = 160) collected from a dementia communication trial during 2011-2014 were coded using the refined Cue Utilisation and Engagement in Dementia Mealtime Video-coding Scheme during 2018-2019. The 160 videos involved 27 residents living with dementia and 36 staff in 9 nursing homes. Independent variables were the state (solid intake, liquid intake, no intake) of an intake episode occurring during mealtime (current episode), eating technique (resident-initiated, staff-facilitated) used in the next episode occurring after the current episode (subsequent episode), interval between adjacent episodes, and resident comorbidities and dementia stage. The dependent variable was the state of subsequent episode. RESULTS Successful liquid and solid intake increased odds of subsequent liquid and solid intake. Comorbidities were associated with decreased odds of subsequent liquid and solid intake for staff-facilitated episodes. When liquid intake occurred, staff-facilitation decreased odds of subsequent liquid intake; longer intervals between adjacent episodes increased odds of subsequent solid intake. CONCLUSION Food intake was strongly and sequentially associated, and such temporal relationships were dependent on characteristics of the intake process and resident conditions. RELEVANCE TO CLINICAL PRACTICE The study findings supported that initiating successful intake facilitates continuity of successful intake during mealtime. Behavioural interventions tailored by comorbidities that modify characteristics of the food intake process may improve food intake.
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Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing, Iowa City, Iowa, USA
| | - Yong Chen
- Department of Industrial and Systems Engineering, The University of Iowa College of Engineering, Iowa City, Iowa, USA
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Yoshida S, Shiraishi R, Nakayama Y, Taira Y. Can Nutrition Contribute to a Reduction in Sarcopenia, Frailty, and Comorbidities in a Super-Aged Society? Nutrients 2023; 15:2991. [PMID: 37447315 DOI: 10.3390/nu15132991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Many countries are facing the advent of super-aging societies, where sarcopenia and frailty will become pertinent problems. The prevalence of comorbidities is a major problem in countries with aged populations as elderly people suffer from various diseases, such as diabetes, heart failure, chronic kidney disease and dementia. All of these diseases are associated with sarcopenia and frailty, and they frequently cause falls, fractures, and a decline in activities of daily living. Fractures in the elderly people are associated with bone fragility, which is influenced by diabetes and chronic kidney disease. Nutritional support for chronic disease patients and sarcopenic individuals with adequate energy and protein intake, vitamin D supplementation, blood glucose level management for individuals with diabetes, obesity prevention, nutritional education for healthy individuals, and the enlightenment of society could be crucial to solve the health-related problems in super-aging societies.
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Affiliation(s)
- Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
- Department of Health and Nutrition, Okinawa University, 555 Kokuba, Naha 902-8521, Okinawa, Japan
- Faculty of Health Sciences, Kinjo University, 1200 Kasama-machi, Hakusan 924-8511, Ishikawa, Japan
| | - Ryo Shiraishi
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yuki Nakayama
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yasuko Taira
- Faculty of Nutrition, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
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Liu W, Perkhounkova Y, Hein M, Bakeman R. Temporal Relationships Between Nursing Home Staff Care Approaches and Behaviors of Residents With Dementia During Mealtimes: A Sequential Analysis. Innov Aging 2023; 7:igad061. [PMID: 37538917 PMCID: PMC10396369 DOI: 10.1093/geroni/igad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 08/05/2023] Open
Abstract
Background and Objectives Optimal dyadic interactions are critical to quality mealtime care and outcomes. Prior work supports associative relationships between staff approaches and individual mealtime behaviors, yet evidence on temporal relationships is limited. This study examined temporal associations between staff approaches and resident behaviors during mealtimes. Research Design and Methods Videotaped mealtime observations (N = 160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analyses using 5-, 10-, and 15-second time windows were conducted for resident positive, neutral, and challenging behaviors as antecedents as well as consequences of staff person-centered and task-centered approaches. Results Residents exhibited positive verbal (35.0%) and positive/neutral nonverbal (12.6%) behaviors, as well as challenging behaviors including functional impairments (27.7%) and resistive behaviors (24.7%). Staff primarily used person-centered approaches (54.1% verbal, 40.3% nonverbal); task-centered approaches were less frequent (5.6%). Immediately (within 5 seconds) after staff person-centered approaches, resident positive/neutral and resistive behaviors were more likely, and functional impairments less likely. After staff task-centered approaches, resident positive verbal and resistive behaviors were less likely. After resident positive/neutral behaviors, staff person-centered approaches were more likely. After resident functional impairments, staff person-centered verbal approaches were less likely, and task-centered approaches more likely. After resident resistive behaviors, all staff approaches were more likely. The strength of temporal relationships diminished in 10-second and 15-second time windows. Discussion and Implications Staff-resident positive interactions were associated with more subsequent positive interactions. Person-centered care was associated with fewer subsequent resident functional impairments and more subsequent resistive behaviors. Resident resistive behaviors were associated with more subsequent person-centered and task-centered care. Findings confirm the importance of facilitating positive staff-resident interactions and managing functional impairments using person-centered care. Resistive behaviors require additional awareness and attention beyond commonly used person-centered care approaches. Further investigation of temporal relationships is needed using larger diverse samples.
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Affiliation(s)
- Wen Liu
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | | | - Maria Hein
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Roger Bakeman
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
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van Buuren CP, van der Steen JT, Olthof-Nefkens M, Bakker C, Koopmans RTCM, Perry M, Kalf JG. The Complexity of Nutritional Problems in Persons with Dementia: Expanding a Theoretical Model. J Alzheimers Dis 2023; 96:183-192. [PMID: 37742638 PMCID: PMC10657712 DOI: 10.3233/jad-230135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Persons with dementia are at risk of developing nutritional problems. Theoretical models on nutritional problems have been developed, but have not been evaluated with healthcare professionals. OBJECTIVE This study aimed to explore the comprehensiveness and applicability of a theoretical model of nutritional problems in persons with dementia for daily nursing home practice. METHODS A qualitative design employing a combined deductive and inductive approach was used. Healthcare professionals were eligible to participate if they 1) had expert knowledge of and experience with nutritional problems related to dementia, and 2) worked in a nursing home affiliated with an academic network covering the east and south of the Netherlands. Three focus group interviews with 20 healthcare professionals from seven professions were held. We conducted thematic analysis and we compared themes with existing theoretical models from the literature. RESULTS We identified six themes, four of which corresponded with the existing models (observing and analysing nutritional problems; consequences of nutritional problems; functioning of the person with dementia; environmental factors). Interprofessional collaboration and ethical factors were identified as new themes. The analyses indicated interactions within each theme, between themes, and a bidirectional connection between themes. CONCLUSIONS This study demonstrated the relevance of interprofessional collaboration and ethical considerations in nutritional problems related to dementia. It uncovered complex bidirectional relations within and between factors regarding nutritional problems. All aspects should be taken into account to minimize the consequences of nutritional problems for persons with dementia.
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Affiliation(s)
- Cornelia Pieternella van Buuren
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- ‘Joachim en Anna’, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Jenny Theodora van der Steen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Olthof-Nefkens
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Zorggroep Maas & Waal, Beneden-Leeuwen, The Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Groenhuysen, Center for Geriatric Care, Roosendaal, The Netherlands
| | - Raymond Theodorus Catherina Maria Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- ‘Joachim en Anna’, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- General Medical Practice, Velp, The Netherlands
| | - Johanna Gezina Kalf
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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Chen HL, Li C, Wang J, Fei Y, Min M, Zhao Y, Shan EF, Yin YH, Liu CY, Li XW. Non-Pharmacological Interventions for Feeding and Eating Disorders in Persons with Dementia: Systematic Review and Evidence Summary. J Alzheimers Dis 2023; 94:67-88. [PMID: 37212096 DOI: 10.3233/jad-221032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Feeding and eating disorders related to cognitive and psycho-behavioral symptoms are strongly associated with health status in persons with dementia (PWD). Non-pharmacological interventions have been the priority selection to address this significant issue. However, the direct targets of non-pharmacological interventions are unclear and there is no consistent evidence of recommendations on the intervention of different dementia stages and the settings of intervention practice. OBJECTIVE To provide caregivers with a set of self-help non-pharmacological interventions for feeding and eating disorders in PWD. METHODS Based on the process of evidence summary, a systematic literature search was performed on dementia websites and seven databases. Two researchers screened the studies independently and appraise the quality. The evidence was graded by Joanna Briggs Institute Grades of Recommendation. RESULTS Twenty-eight articles were included. Twenty-three non-pharmacological intervention recommendations were categorized into six themes containing oral nutritional supplementation, assistance with eating and drinking, person-centered mealtime care, environmental modification, education or training, and multi-component intervention. These interventions corresponded to three direct targets including improving engagement, making up for loss ability, and increasing food intake directly. They were applied to different stages of dementia and most interventions were targeted at PWD in long-term care institutions. CONCLUSION This article summarized the direct targets and the specific implementation of recommendations at different stages of dementia to provide caregivers with self-help non-pharmacological interventions. The practice of recommendations was more applicable to institutionalized PWD. When applied to PWD at home, caregivers need to identify the specific feeding and eating conditions at different stages and adopted the interventions in conjunction with the wishes of the PWD and professional advice.
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Affiliation(s)
- Hong-Li Chen
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Jing Wang
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Yang Fei
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Min Min
- Landsea Long-term Care Facility, Nanjing, PR China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Yue-Heng Yin
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Chong-Yuan Liu
- Center of Clinical Reproductive Medicine, The NMU First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, PR China
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Burdick R, Lin TF, Shune SE. Visual Modeling: A Socialization-Based Intervention to Improve Nutritional Intake Among Nursing Home Residents. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2202-2213. [PMID: 34463561 DOI: 10.1044/2021_ajslp-21-00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Malnutrition is a widespread, dangerous, and costly condition among institutionalized older adults and can be both a contributor to and consequence of dysphagia for individuals with cognitive impairment. However, interventions to maximize intake in individuals with dementia are limited and frequently problematic, with negative implications for independence and quality of life. The goal of this study was to examine a novel, socialization-grounded intervention based on visual modeling, utilizing the theoretical underpinnings of motor resonance and mimicry. Method To examine the impact of environment on intake, data were collected from four nursing home residents (M age = 83.5 years, SD = 4.2; three women) with dementia. Weight of food and liquid intake was measured across 15 meals and three different mealtime conditions: the "baseline condition" in which the individual ate alone, the "watch condition" in which the individual ate in the company of a "mealtime buddy," and the "eat" condition in which the individual consumed a meal while the "mealtime buddy" did the same. Results Data visualization supported a weak functional relation between eating environment and amount of intake consumed across participants. Log response ratio estimates suggested a trend for increased weight of food consumed during the eat condition as compared to baseline and the eat condition as compared to the watch condition for some participants. Conclusions These results preliminarily support the benefit of a visual model for increased consumption in some individuals with dementia. The presence and magnitude of the effect across conditions varied based on individual-level factors, such as cognitive status, which has implications for implementation. Overall, this study provides initial proof of concept regarding the use of visual modeling as an intervention approach, laying the foundation for larger scale future studies.
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Affiliation(s)
- Ryan Burdick
- Genesis Rehab Services, Kennett Square, PA
- Swallowing and Salivary Bioscience Lab, Department of Medicine, University of Wisconsin-Madison
| | - Ting-fen Lin
- Communication Disorders and Sciences, University of Oregon,Eugene
- Department of Communicative Sciences and Deaf Studies, California State University, Fresno
| | - Samantha E Shune
- Communication Disorders and Sciences, University of Oregon,Eugene
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