Eating performance in relation to intake of solid and liquid food in nursing home residents with dementia: A secondary behavioral analysis of mealtime videos

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Abstract

Background

Persons with dementia commonly experience low food intake leading to negative nutritional and functional outcomes. While multilevel personal and environmental factors that influence intake are implicated, evidence is lacking on the role of characteristics of dynamic eating performance cycles. An eating performance cycle is defined as the process of getting food from the plate or container, transporting it into the mouth, and chewing and swallowing it.

Objective

This study aimed to examine the association between intake and characteristics of eating performance cycles among nursing home residents with dementia.

Methods

A secondary analysis of 111 mealtime video clips from a nursing home communication training study was conducted. The 111 videos involved 25 residents and 29 staff (N = 42 unique staff-resident dyads) in 9 nursing homes. The Cue Utilization and Engagement in Dementia Mealtime video-coding scheme was used to code the characteristics of eating performance cycles, including eating technique (resident-completed, staff-facilitated), type of food (solid, liquid), duration of each eating performance cycle, and intake outcome (intake, no intake). The Generalized Linear Mixed Model was used to examine the interaction effects of eating technique by type of food, eating technique by duration, and type of food by duration on intake outcome.

Results

Totally 1122 eating performance cycles were coded from 111 video clips. The majority of the cycles (85.7%) resulted in intake. There were significant interactions for eating technique by duration, and type of food by duration. As the duration of the eating performance cycle increased, staff-facilitated cycles resulted in greater odds of intake than resident-completed cycles (OR = 17.80 vs. 2.73); and cycles involving liquid food resulted in greater odds of intake than cycles involving solid food (OR = 15.42 vs. 3.15). Though the interaction between eating technique and type of food was not significant, the odds of intake were greater for resident-completed cycles than for staff-facilitated cycles regardless of the type of food being involved in the cycle (OR = 3.60 for liquid food, OR = 10.69 for solid food).

Conclusions

The findings pointed out the importance of supporting resident independence in eating performance, providing liquid food when residents struggle with solid food, and provision of longer and continuous facilitation at mealtimes to improve intake. The findings inform the development and implementation of innovative mealtime assistance and staff training to promote eating performance and intake.

Section snippets

What is already known about the topic?

  • Persons with dementia commonly experience low food and liquid intake, leading to negative nutritional and functional outcomes.

  • While multilevel personal and environmental factors may influence intake, current research primarily focus on the amount of intake per meal, with little attention given to the impact of the complex, interactive, and dynamic eating process that consists of one or more eating performance cycles.

  • An eating performance cycle is defined as the process of getting solid or

What this paper adds

  • As the duration of the eating performance cycle increased, staff-facilitated cycles resulted in greater odds of intake than resident-completed cycles (OR = 17.80 vs. 2.73).

  • As the duration of the eating performance cycle increased, cycles involving liquid food resulted in greater odds of intake than cycles involving solid food (OR = 15.42 vs. 3.15).

  • The odds of intake were greater for resident-completed cycles than for staff-facilitated cycles regardless of the type of food being involved in the

Design

This study was a secondary analysis of a subset of archived mealtime video recordings that were collected under usual care conditions from a randomized controlled trial of a staff communication intervention between 2011 and 2014 (Williams et al., 2016). The purpose of the parent study was to evaluate the efficacy of a training program to improve nursing staff communication and decrease resistiveness to care among NH residents with dementia. The parent study and this secondary analysis study

Participant characteristics

Characteristics for resident and staff participants are shown in Table 2. Residents were on average 84.6 years old (ranging from 64 to 96), and were in the severe stage of dementia (FAST scores ranging from 6.6 to 7.4). Residents had moderate levels of comorbidities (scores ranging from 19 to 36) and functional decline (ADL scores ranging from 12 to 39). The majority of residents were female (60%) and non-Hispanic (92%). All residents were white. Staff were on average 34.9 years old (ranging

Discussion

This study is one of the first that used an innovative and feasible computer-assisted video coding scheme with high inter-rater reliability to evaluate the role of characteristics of eating performance cycles (food type, eating technique and duration) on intake among NH residents with dementia during usual mealtime care. Overall, there were significant interactions between eating technique and duration, and between type of food and duration, indicating the important role of these

Conclusion

This study provides fundamental information to support the role of eating performance characteristics on food and liquid intake for older adults with dementia who need help with eating. The study findings point out the importance of supporting resident eating performance, providing liquid when residents struggle with eating solid food, and providing continuous staff facilitation at mealtimes to improve intake for residents with dementia. Residents with dementia often demonstrate compromised

Contributions

WL, KW and MBM contributed to the study conceptualization. MBM developed the coding scheme. WL led video screening and video coding. MBM and KW contributed to technical support for the Noldus Observer XT software. WL and MH contributed to data cleaning and management. WL and EP contributed to data analysis and interpretation of findings. KW is the Principal Investigator (PI) of the parent study. All authors meet the criteria for authorship, and have approved the final article. All those

Author statement

The work described has not been published previously, that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.

Funding statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflicts of interest

None.

Acknowledgements

The authors acknowledge that the parent study was supported by NIH grant NR011455-04, Changing Talk to Reduce Resistiveness in Dementia Care (CHAT), K. Williams, PI. ClinicalTrials.gov Identifier: NCT01324219. The sponsor was not involved in study design, data collection and analysis, interpretation of findings, and manuscript preparation. Development of the coding scheme by MBM was supported by the National Hartford Centers for Gerontological Nursing Excellence Claire M. Fagin Fellow and

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