A model for the assessment of eating problems in patients with Parkinson's disease

How assisted eating becomes a caring practice in institutional settings: Embodied gestures and stages of assisted eating

Assisted eating is a basic caring practice and the means through which many individuals receive adequate nutrition. Research in this area has noted the challenges of helping others to eat while upholding their independence, though has yet to explicate how this caring practice is achieved in detail and across the lifespan. This paper provides an empirical analysis of assisted eating episodes in two different institutions, detailing the processes through which eating is collaboratively achieved between two persons. Data are video-recorded episodes of infants during preschool lunches and care home meals for adults with dementia, both located in Sweden. Using EMCA's multimodal interaction analysis, three core stages of assisted eating and their underpinning embodied practices were identified: (1) establishing joint attention, (2) offering the food, and (3) transferring food into the mouth. The first stage is particularly crucial in establishing the activity as a collaborative process. The analysis details the interactional practices through which assisted eating becomes a joint accomplishment using a range of multimodal features such as eye gaze, hand gestures, and vocalisations. The paper thus demonstrates how assisted eating becomes a caring practice through the active participation of both caregiver and cared-for person, according to their needs. The analysis has implications not only for professional caring work in institutional settings but also for the detailed analysis of eating as an embodied activity.

Eating Problems and Weight Loss for Patients With Head and Neck Cancer

This descriptive study aimed to examine the occurrence and treatment of eating problems, and their causes and consequences during the trajectory of care for patients with head and neck cancer treated with radiotherapy. The method used was a review of patient records, conducted by means of an audit instrument developed for the study. The instrument audits demographic data and documented eating problems, their causes and consequences, and undertaken interventions in medical and nursing records from diagnosis until 1 year after completion of treatment. Data were collected prior to treatment, each week during radiotherapy and at the follow-up visits to the physician 1, 6, and 12 months after completion of treatment. The results show that eating problems were common before treatment started, and at the end of radiotherapy every patient suffered from eating problems. One year after treatment the majority still had eating problems. Weight loss occurred early during radiotherapy and became aggravated after treatment, but was not treated to an adequate extent. Implications of this study are that nutritional interventions must be initiated before the treatment starts and they need to be ongoing after completion of treatment.

Identifying important issues for people with Parkinson's disease

This article identifies issues that are important for people with Parkinson's disease (PD). A review of the literature showed that information about PD commonly relates to anatomy and physiology, medication and activities of daily living. These categories were used to formulate statements on a questionnaire, which was distributed to members of the Parkinson's Disease Society within the East Midlands. The results demonstrated that those with PD wanted advice on maintaining their independence, the amount of movement they were capable of and how to respond if their symptoms changed. They wanted to know when to seek medical advice, information about their medication and the treatments available for PD. Knowing what could be tried next if the present treatment failed was thought more important than knowing about all treatments.

Case studies of food shopping, cooking and eating habits in older women with Parkinson's disease

AIMS

The principal aim of this study was to investigate how married and single-living older women diagnosed with Parkinson's disease managed to shop for food, cook and carry out their meals; and to observe whether their nutritional needs were satisfied. A secondary aim was to identify women with severe motor problems and describe their food-related situation.

BACKGROUND

Parkinson's disease is associated with motor and eating problems, which, combined with age-related declines in physical functioning, may affect activities of daily living and dietary intake.

METHODS

Qualitative interviews and food survey were carried out in the homes of 10 women aged 67-80 years. The sample was recruited from outpatient registers.

RESULTS

Decreased sense of smell, appetite and taste in combination with problems transporting food to the mouth and swallowing were risks for nutritional well-being. Food shopping was most difficult to manage, but six cooked even if their cooking style was changed. Married women with healthy husbands received support from their spouses. Single-living women suffering from motor problems had to call for help, which represented a threat to their well-being. Independence was given high priority.

CONCLUSIONS

The whole situation - including psychosocial and stress factors - must be taken into account when discussing shopping, cooking and eating among old women with Parkinson's disease. A home-helper should not take over but facilitate procedures so that the woman can manage as long as possible. This gave them self-esteem.

Social dancing: a way to support intellectual, emotional and motor functions in persons with dementia

Dementia causes serious impairments and the inability to perform those activities which give meaning to a person's life. Therefore, these persons are in need of professional nursing care interventions as well as a special supporting environment. In this study, social dancing has been regarded as a nursing intervention that supports persons with dementia in nursing home settings. The aim was to find out how persons with dementia functioned in social dance sessions, in order to understand the reasons behind the use of social dancing as a nursing intervention in a nursing home setting. Six persons with dementia were videotaped during four dance sessions in one nursing home. The qualitative content analyses were carried out deductively, using a guide developed from the variables in the Gottfries, Bråne and Steen rating scale (GBS scale). The findings show that, for persons with dementia, retained abilities were prominent in dancing. It was obvious that social dancing was supportive and seemed to have meaning to both patients and their carers. Social dancing seems to be a nursing intervention that supports patients' positive feelings, communication and behaviour. The carers' preunderstanding of the patients' levels of dementia and the wholeness of the situation was of importance.

Cultural perspectives of meals expressed by patients in geriatric care

The aim of this study was to investigate cultural values and ideas concerning table manners and food habits expressed by patients in geriatric care. The research approach was ethnographic. The findings exposed conflicts related to three themes. The first, "Mind your manners", demonstrated problems in managing food and objects, keeping clean, and conduct at table. The second, "Appetite for food", was connected to tradition and taste, healthy food and the need not to waste food. The third, "Be contented and do not complain", illustrated the elderly patients' socialized manners in talking about meals and food.

Eating despite severe difficulties: assessment of poststroke eating

A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals. The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions. General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions. The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual.

The experiential meaning of eating, handicap, adaptedness, and confirmation in living with esophageal dysphagia

This article is mainly based on interview studies of pensioners' (n = 62), patients' (n = 19), and students' (n = 87) experiences of living with longstanding esophageal dysphagia. The aim is to describe the experiential meaning of dysphagic patients' lives by interpreting their experiences, problems, and emotions and by specifying these into scales according to the model of goal-directed action by Pörn [43-49]. The experiential meaning will be articulated in terms of attainment or nonattainment of goals in relation to eating, handicap, adaptedness, and confirmation. In the experiential meaning of eating, the emphasis is on the attainment of nourishing goals or goals attained by means of food with desired hedonistic qualities and linked with feelings of hope or no hope of a shared life. The experiential meaning of handicap is interpreted as the dysphagic individual's experiences of an actual nonattainment of eating goals due to swallowing disabilities and with experiences of nonattainment of other important goals and related emotions; for example, shame for human incompetence. The experiential meaning of adaptedness is understood as the dysphagic individual's experiences of actual capacity for goal attainments interpreted as a sense of control in the daily living with dysphagia and linked with security, or in the negative case, reduced self-esteem and feelings of panic or fear. The experiential meaning of confirmation is interpreted as the dysphagic individual's experiences of actual or potential repertoire for goal attainment, i.e., self-assessment strengthened by evidence obtained in relationships linked with emotions of hope of self-realization. In conclusion, a specific model for understanding the dysphagic patient's concealment of dysphagia in the medical encounter has been developed.

Adaptedness and coping in dysphagic students

Using a definition based on Bowlby and Pörn, an effort is made to interpret adaptedness and coping in 87 dysphagic students (corresponding to a prevalence of dysphagia in 9% of the boys and 12% of the girls) found in a screening study utilizing a questionnaire. Coping patterns and methods of adaptation were explored in a telephone interview with dysphagic students. Those who stated that their dysphagia influenced their daily living were classified as subjectively maladapted (S-maladapted; n = 9). Compared with the S-adapted students, the S-maladapted students reported more defects in ability to eat, more inappropriate beliefs about the causes and management of dysphagia, and greater desires regarding eating than S-adapted students (p < 0.05). The environmental conditions more often impaired the eating ability in S-maladapted students (p < 0.05). Anxiety at mealtime was reported more frequently than in S-adapted students (p < 0.05). Every second S-maladapted student had reduced self-esteem because of dysphagia (p < 0.05). The S-maladapted students had talked about their dysphagia with parents and/or friends and visited a school physician because of dysphagia more often than S-adapted students (p < 0.05). Two of 9 students felt confirmed by the physician and experienced help. There was concordance between the students' own beliefs regarding the causes of dysphagia and corresponding coping strategy.

Dysphagia, an unrecognized handicap

The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20-44). The DGH score correlated significantly with the patients' own evaluation of the severity of their dysphagia (p = 0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p = 0.001). Denial of dysphagia (N = 18), concealment of dysphagia (N = 18), and lack of confirmation by the patient's physician (N = 15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia affects all aspects of life as expressed by reduction in self-esteem (N = 13), security (N = 16), work capacity (N = 8), exercise (N = 7), and leisure time (N = 6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code described in this study.

Aberrant eating behavior in elderly parkinsonian patients with and without dementia: analysis of video-recorded meals

Aberrant eating behavior among 14 elderly, non-demented and 10 demented patients with Parkinson's disease was studied by means of video-recordings. The findings revealed problems in handling food on the plate, transporting food into the mouth, manipulating food in the mouth, and swallowing. Interpretations were performed based on impairments of autonomic processes, perception, cognition, emotion, and motor performance that occur in the disease.

Verbal communication and behaviour during meals in five institutionalized patients with Alzheimer-type dementia

Five institutionalized patients with Alzheimer-type dementia were observed (video-recorded) during meals. The aim was to assess their meal behaviour and social interaction. The results showed that when the patients ate without the participation of staff, the two least demented patients became 'caregivers' in the group and helped the three most demented patients to eat. When two mental nurses joined the group, the patients dropped their roles as helpers. The conversation in the group could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all comprehensible utterances concerned food and eating and almost all conversation concerned the present.

Food refusal amongst nursing home patients as conceptualized by nurses' aids and enrolled nurses: an interview study

One hundred and forty-three nurses' aids and 48 enrolled nurses at nursing homes in Sweden were interviewed about food refusal among patients. It became evident that their concepts of 'food refusal' and 'forced feeding' were very vague. This could partly be explained by the lack of knowledge among staff of how to interpret the frequent ambiguous eating behaviours among demented patients. It has been suggested that concept clarification and ethical analysis might reduce anxiety among staff caring for patients with severe eating problems.

The interaction between the parkinsonian patient and his caregiver during feeding: a theoretical model

A theoretical model for the assessment of the interaction between the patient with Parkinson's disease and his caregiver during assisted feeding is suggested. It is based on literature about impairments in Parkinson's disease and about interaction. The main concepts of the model are clarity of cues, sensitivity, interpretation, responsiveness and synchrony. It is suggested that the patient should be allowed to focus on the socio-emotional content versus the task content of communication during different phases of interaction during the meal.