Experiences of Carers and People with Dementia from Ethnic Minority Groups Managing Eating and Drinking at Home in the United Kingdom

Food for Soul-Older Immigrants' Food Habits and Meal Preferences After Immigration: A Systematic Literature Review

There are few primary studies that focused on the older immigrants' food habits and meal preferences after immigration and settlement in a new country. A comprehensive database search for literature was conducted in May 2021 and upgraded in September 2021. Ten databases (Medline (Ovid), EMBASE (Ovid), PsycInfo (Ovid), Cinahl (EBSCOhost), Food Science Source (EBSCOhost), SocIndex (EBSCOhost), Social Care Online, Applied Social Sciences Index & Abstracts (ASSIA), Web of Science and Google Scholar), were scanned for original, peer-reviewed papers published in English. The review was conducted and reported in accordance with the PRISMA 2020 guidelines and SWiM items. Out of 3069 records, 10 papers were included for thematic synthesis. A data synthesis across all studies resulted in three main findings: (i) the significance of food in maintaining cultural identity, (ii) the continuity of traditional food culture and (iii) adapting to the host country's food culture. Although different forms of dietary acculturation occur throughout life, older immigrants often want to maintain their traditional food habits and meal preferences. For them, traditional eating habits offer comfort and security by serving as a means of identifying who they are and reminding them where they have come from. Public health and social services play an important role in providing cultural nutritional care to older immigrants; therefore, this issue should be carefully addressed by professionals and future research.Registration: The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 27 September 2022 with registration number CRD42022358235.

Eating experiences in people living with dementia: A concept analysis using Rodgers's methodology

AIMS

To analyse the concept of eating experiences in people living with dementia.

DESIGN

Rodgers' evolutionary method of concept analysis was used as a framework for the paper.

DATA SOURCES

The literature was searched using electronic databases PubMed, Google Scholar, CINHAL, PsycInfo, Web of Science, Embase and Elsevier databases. These databases cover a variety of disciplines, including but not limited to nursing, medicine and occupational therapy. The relevant literature published from 1989 to April 2023 was thoroughly examined. Any quantitative or qualitative studies published in English focused on eating or dining experiences in people with dementia were included.

REVIEW METHODS

Rodgers' evolutionary method for concept analysis was used. The attributes, antecedents, consequences and case examples of the concept were identified.

RESULTS

Twenty-two articles met the inclusion criteria, identifying key attributes of self-connection, the special journey of life and self-interpretation. Antecedents, as framed by the socio-ecological model, were categorized to represent intrapersonal (personal preferences, individual culture, mealtime routines), interpersonal (social interaction) and environmental (dining room environment, policies) factors. Consequences were divided into external (nutritional health, physical health and quality of life) and internal (personhood, autonomy and independence, dignity and feeling valued and mental well-being) domains.

CONCLUSION

A theoretical definition and conceptual model of eating experiences in people living with dementia was developed. The identified attributes, antecedents and consequences can be utilized in nursing education, research and intervention approaches.

IMPACT

This article allows nurses and other healthcare professionals to better understand people living with dementia through the relationship between eating and interpersonal, intrapersonal and environmental aspects to develop personalized interventions and care strategies to achieve an optimal quality of life.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Co-design development of a decision guide on eating and drinking for people with severe dementia during acute hospital admissions

INTRODUCTION

Using co-design processes, we aimed to develop an evidence-based decision guide for family carers and hospital professionals to support decision-making about eating and drinking for hospital patients with severe dementia.

METHODS

Following a systematic review, we interviewed people with mild dementia, family carers and hospital professionals in England. We then held co-design workshops with family carers and hospital professionals. In parallel with the workshops, we used a matrix to synthesize data from all studies and to develop a decision guide prototype. The prototype was iteratively refined through further co-design workshops and discussions among researchers and Patient and Public Involvement (PPI) representatives. We conducted user testing for final feedback and to finalize the decision guide.

RESULTS

Most participants acknowledged the limited benefits of tube feeding and would not use or want it for someone with severe dementia. However, they found decision-making processes and communication about nutrition and hydration were emotionally demanding and poorly supported in acute hospitals. The co-design groups developed the aims of the decision guide to support conversations and shared decision-making processes in acute hospitals, and help people reach evidence-based decisions. It was designed to clarify decision-making stages, provide information and elicit the values/preferences of everyone involved. It encouraged person-centred care, best-interests decision-making and multidisciplinary team working. From user testing, family carers and hospital professionals thought the decision guide could help initiate conversations and inform decisions. The final decision guide was disseminated and is being used in clinical practice in England.

CONCLUSION

We used rigorous and transparent processes to co-design the decision guide with everyone involved. The decision guide may facilitate conversations about nutrition and hydration and help people reach shared decisions that meet the needs and preferences of people with severe dementia. Future evaluation is required to test its real-world impacts.

PATIENT OR PUBLIC CONTRIBUTION

People with mild dementia, family carers and hospital professionals contributed to the design of the decision guide through the interviews and co-design workshops. PPI members helped design study procedures and materials and prepare this manuscript.

A shared decision-making model about care for people with severe dementia: A qualitative study based on nutrition and hydration decisions in acute hospitals

OBJECTIVES

To understand the decision-making processes regarding eating and drinking for hospital patients with severe dementia and use this data to modify a decision-making model about care for people with severe dementia.

METHODS

From January to May 2021, qualitative semi-structured interviews were conducted with 29 family carers and hospital staff in England who cared for people with severe dementia during hospital admissions. Interviews were transcribed verbatim and analysed using codebook thematic analysis.

RESULTS

We demonstrated a modified decision-making model consisting of six stages of the decision-making process: (i) identify a decision to be made; (ii) exchange information and recognise emotions; (iii) clarify values and preferences of all involved; (iv) consider feasibility of each choice; (v) share preferred choice and make a final decision; and (vi) deliver the decision, monitor outcomes and renegotiation. From this study, decision-making needed to be shared among all people involved and address holistic needs and personal values of people with dementia and family carers. However, hospital staff often made assumptions about the persons' ability to eat and drink without adequate consultation with family carers. The process was impacted by ward culture, professional practice, and legal framework, which might overlook cultural and personal beliefs of the persons and families. Treatment escalation plans could help inform stepwise treatments, create realistic expectations, and guide future decisions.

CONCLUSIONS

Our decision-making model provides clear stages of decision-making processes and can be used to guide clinical practice and policy around care decisions for eating and drinking, which is often poorly supported.