Dyadic interactions and physical and social environment in dementia mealtime care: a systematic review of instruments

Using valid instruments to measure dyadic interactions and physical and social environment during mealtime care of persons with dementia is critical to evaluate the process, fidelity, and impact of mealtime interventions. However, the characteristics and quality of existing instruments remain unexplored. This systematic review described the characteristics and synthesized the psychometric quality of instruments originally developed or later modified to measure mealtime dyadic interactions and physical and/or social dining environment for people with dementia, on the basis of published reports between January 1, 1980 and December 31, 2020. We identified 26 instruments: 17 assessed dyadic interactions, one assessed physical environment, and eight assessed physical and social environment. All instruments were used in research and none in clinical practice. All instruments were observational tools and scored as having low psychometric quality, except for the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video-coding scheme rated as having moderate quality. Reasons for low quality are the use of small samples compared with the number of items, limited psychometric testing, and inadequate estimates. All existing tools warrant further testing in larger diverse samples in varied settings and validation for use in clinical practice. The refined CUED is a potential tool for use and requires testing in direct on-site observations.

Staff Perceptions of a Mealtime Management Educational Video for Training in Long-Term Care Homes

The purpose of this study was to determine if staff perceive a mealtime management video to be a beneficial and useful training tool in long-term care (LTC) homes. An email invitation was sent to the Dietitians of Canada Gerontology Network inviting dietitians working in LTC homes to participate. A previously used and reliable 25-item questionnaire was used to assess sustained attention/mental effort, learner satisfaction, clinical experience/relevance, and information processing of the video. Dietitians were asked to show the video to LTC staff and distribute the questionnaire to staff after viewing the video. A total of 769 surveys were completed at 28 LTC homes across Canada. Eighty-seven percent (n = 637/736) of participants felt more knowledgeable after viewing the video and 91% (n = 669/738) found the video format easy for learning. Managers had a higher Likert scores (mean = 6.2 out of 7) than continuing care assistant (mean = 5.7, P = 0.02) and food service workers (mean = 5.5, P = 0.001) for the clinical relevance scales. No differences were found for age (χ² = 5.52, P = 0.60), gender (χ² = 2.65, P = 0.10), and size of home (χ² = 3.34, P = 0.34). Staff perceived the video to be useful for their work with residents living in LTC homes and it raised awareness of the importance of their roles at mealtimes.

"Tailoring homely meals": Family members' motivations underlying nursing home visits during residents' meals

AIM

Elderly nursing home residents are often malnourished or at risk of malnutrition. Family members often visit residents during mealtimes, which might be an ideal opportunity for interventions targeted at improving the nutritional status of older residents. Therefore, this study aimed to explore motivations behind family member visits with nursing home residents during mealtime in Taiwan.

METHODS

This phenomenological study was conducted with family members of residents from four nursing homes in Taiwan. Participants were purposively sampled. Data were collected with individual face-to-face interviews from 18 family members. Data from transcribed audio-recorded interviews were analyzed using the approach of van Manen.

RESULTS

Analysis of the interview data identified the essence of motivations underlying family members' visits to nursing home residents during mealtimes, which we termed "tailoring homely meals." This referred to providing food tailored to residents' needs, providing a comforting family atmosphere, assisting residents during mealtime, and monitoring food consumption.

CONCLUSIONS

The motivations of family members to visit during mealtime could guide healthcare professionals working with East Asian populations in developing interventions to reduce the possibility of malnutrition, while also improving their quality of life. We recommend providing the following for nursing home residents: a nutritious and balanced diet, supporting their independence and ability to feed themselves, and encouraging involvement of family members during mealtimes.

The "Plan" phase of a Deming cycle: Measurement of quality and outcome of root canal treatments in a university hospital

INTRODUCTION

In many countries, dental students are taught in private or university hospitals where they treat patients under the supervision of teachers. Assessing the quality of root canal treatments (RCT) would provide information about the quality of care patients receive when treated by students.

METHODS

This study describes the six-step "Plan" phase of a Plan-Do-Check-Act (PDCA) cycle that identifies and analyses clinical practices in endodontics in a university dental hospital service.

RESULTS

Step 3 reported that the proportion of RCTs of adequate quality reached 57.1% and this proportion was significantly decreased when specific indicators for treatment difficulties were present. The proportion of successful RCTs after 1 year was 65.6%, and its variation was influenced by the preoperative periapical status rather than the quality of RCTs. The consensual meeting in Step 6 proposed to introduce three new procedures for the further Do, Check and Act phases of the PDCA cycle.

CONCLUSION

This study encourages systematic evaluation of RCTs and provides the first step of the methodology that can be reproduced in private and hospital practices where students are asked to treat patients.

Managing Person-Centered Dementia Care in an Assisted Living Facility: Staffing and Time Considerations

Background and Objectives

To describe (a) the unlicensed staff time necessary to provide quality activities of daily living (ADL) care to residents receiving dementia care within an assisted living facility and (b) a staff management approach to maintain quality ADL care.

Research Design and Methods

Supervisory staff used a standardized observational method to measure ADL care quality and the staff time to provide care during the morning and evening across 12 consecutive months. Staff were given individual feedback about the quality of their care provision following each observation.

Results

The average staff time to provide ADL care averaged 35 (± 11) minutes per resident per care episode with bathing and 18 (± 6) minutes/resident/care episode without bathing. Morning ADL care required significantly more staff time than evening care. There was not a significant relationship between residents' levels of cognitive impairment or ADL dependency and the staff time to provide ADL care. Quality ADL care was maintained for 12 months.

Discussion and Implications

This study provides novel data related to the amount of staff time necessary to provide quality ADL care for persons with dementia in an assisted living care setting. This study also describes a standardized approach to staff management that was effective in maintaining quality ADL care provision. Assisted living facilities should consider these data when determining the necessary unlicensed staffing level to provide person-centered ADL care and how to effectively manage direct care providers.

Mealtime Interactions and Life Satisfaction Among Older Adults in Shanghai

Objective: We examined the association between older adults’ mealtime interactions at senior centers in Shanghai and their life satisfaction. Competing hypotheses, derived from socioemotional selectivity theory and activity theory, were tested. Method: Data were obtained from the 2011 Shanghai senior center service utilization survey ( N = 320). Relationships between respondents’ mealtime interactions and life satisfaction were tested using multilevel regression modeling. Results: After adjusting for demographics, interactions with tablemates (companionship, self-disclosure, and instrumental support) were positively associated with respondents’ life satisfaction. These associations varied by senior centers. However, the number of tablemates was not significantly associated with respondents’ life satisfaction. Discussion: Findings support the activity-theory-based hypothesis that mealtime interactions are related to older adults’ life satisfaction independent of the number of tablemates. This study illuminates the value of social interactions in the context of community dining programs for the rapidly increasing older population in urban China.

The Impact of Family Visitation on Feeding Assistance Quality in Nursing Homes

The purpose of this study was to determine: (a) the frequency of family visitation during mealtime and (b) whether the presence of family during meals had an impact on the quality of feeding assistance care and resident intake. Participants included 74 nursing home residents from two Veterans Affairs (VA) and four community facilities in one geographic region. Mealtime periods in which family was present were compared with mealtime periods when family was not present for the same resident. Results showed that family visitation was infrequent during mealtime; however, feeding assistance time was significantly higher when visitors were present. Despite the increase in assistance time, there was not a significant difference in intake. Strategies that encourage the involvement of family in mealtime assistance may have additional benefits not directly associated with meal consumption, including providing family members with meaningful activity during a visit and enhancing residents’ quality of life and well-being.

Transitions to long-term care: how do families living with dementia experience mealtimes after relocating?

Food and mealtimes play a central role in our lives and often hold great meaning. This study is a secondary analysis of a subset of data collected from a 6-year longitudinal qualitative study called Eating Together (ET), which sought to better understand the experiences around food and mealtimes for community dwelling persons with dementia (PWD) and their primary care partners (CP). Several PWD and, in some cases, their spousal CP, relocated to long-term care (LTC) during the conduct of the ET study. To understand how this relocation influenced the meaning of meals, a subset of those who experienced this transition were selected and analysis specific to this issue was undertaken. Seven families were included in this thematic inductive analysis. Findings revealed five themes related to the different mealtime experience in the LTC home, including systemizing the meal, adjusting to dining with others, holding on to home, evolving mealtime roles, and becoming "at home." Understanding how families adapt to commensal dining in LTC may be relevant to successful relocation. This work furthers this understanding and provides a basis for person-centered mealtime practices that promote adaptation.

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Efforts to translate efficacious interventions into long-term care practice have had limited success due to the lack of consideration of key translational intervention components. A multi-faceted intervention was implemented in two veteran affairs facilities to improve feeding assistance care. There were three study phases: baseline, intervention, and follow-up. During each phase, trained research staff conducted standardized observations of 12 meals/participant to assess feeding assistance care quality. The staff received three initial training sessions followed by six consecutive weeks of feedback sessions wherein the observation-based care process measures were shared with the staff. There were significant, but modest, improvements in mealtime feeding assistance care processes, and most of the improvements were maintained during follow-up. A multi-faceted intervention resulted in significant, but modest, improvements in mealtime feeding assistance care quality. Organizational (staff schedules, communication) and environmental (dining location) barriers were identified that interfered with improvement efforts.