Informal dementia caregivers' experiences and perceptions about mealtime care: A qualitative evidence synthesis

Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review

BACKGROUND

Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia.

METHODS

Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews.

RESULTS

A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context.

CONCLUSIONS

Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

An Exploratory Study of Nutrition Knowledge and Challenges Faced by Informal Carers of Community-Dwelling People with Dementia: Online Survey and Thematic Analysis

Nutrition knowledge is a primary factor influencing food choices and the ability to identify nutritional risk for carers of people with dementia. Acquiring nutrition knowledge helps carers monitor changes in food intake and micronutrient intake, and whether a healthy and balanced diet is being consumed. This study aimed to assess the nutrition knowledge of carers in the Australian community and their experiences with nutrition education. Using a mixed-methods approach, the nutrition knowledge of informal carers was assessed using the revised General Nutrition Knowledge Questionnaire (AUS-R-NKQ), and interviews of informal carers were used to explore the perspectives in a sub-sample. A total of 57 carers (44 females; mean age of 63.0 ± 13.1) completed the survey, and 11 carers participated in follow-up interviews. The total sample scored 22.9 (±4.57) out of 38 on the AUS-R-NKQ, suggesting basic nutrition knowledge. The interviewed carers acknowledged the importance of healthy nutrition but viewed the provision of a healthy diet for a person with dementia as challenging. In both the survey and interviews, carers reported limited use and availability of dementia-specific nutrition resources. Carers were unsatisfied with the advice and number of referrals provided to improve the nutrition of the person with dementia and desired less confusing nutrition education materials adapted to their level of knowledge. The present study highlights the need for informal carers to be supported to acquire adequate nutrition knowledge.

Temporal Relationships Between Nursing Home Staff Care Approaches and Behaviors of Residents With Dementia During Mealtimes: A Sequential Analysis

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.

Difficulties experienced by caregivers of patients with Alzheimer's Disease in relation to dietary care: integrative review

Objective: To analyze the problems experienced by caregivers of patients with Alzheimer's Disease (AD) in dietary care. Methods: An integrative review was carried out, whose guiding question was "What are the experiences and difficulties reported by caregivers of people with Alzheimer's disease concerning dietary care?". The search occurred in April/2021 in the following databases: MEDLINE, Science Direct, SCOPUS, Web of Science, SciELO, and Lilacs. Publications fromthe last 10 years in English, Portuguese or Spanish were included. Results: Of the 2,418 articles initially found, the titles of 39 seemed to fit the research objectives. Of these, 11 articles were selected for full reading, and 8 were evaluated to answer the research question. A gap in the approach to the problems experienced by caregivers of patients with AD concerning dietary care was observed. Difficulties dealing with reduced appetite, dysphagia, inability to remember eating, mealtime refusal, and food repulsion were reported. Allied to this, caregiver stress was reported. Conclusion: The main problems experienced by caregivers of patients with AD involve reduced appetite, dysphagia, difficulty remembering what they have already eaten, refusal at mealtimes, and food repulsion. Thus, the theme deserves the attention and involvement of health professionals to focus on the most frequent difficulties and teach caregivers to overcome them.

A systematic review of the application of a diary for people with dementia: how to maximise the effect of diary use?

Diaries have been widely used among people with dementia as a data collection tool and memory aid. An understanding of their usage is conducive to the subsequent development of intervention measures, but comprehensive evidence is still lacking. This review synthesises the existing literature to obtain an in-depth understanding of the positive and negative effects of diary usage among people with dementia and the influencing factors. The data were collected from eight databases from the inception of each database to November 2020. A thematic synthesis method was used to sort and summarise the included studies. Ten studies were chosen for the review. The following three analytical themes were identified: (i) positive changes; (ii) factors affecting the record; and (iii) negative feelings. Diaries can cause positive changes in people with dementia, but the specific patterns of stimulation and changes over time remain to be explored. Furthermore, researchers should encourage patients and their families to have a correct understanding of the diary, improve their motivation and social support, fully use the positive effects of the diary, and reduce the occurrence of negative effects. Medical staff should help caregivers improve their awareness of the usefulness and ease of the diary and encourage them to provide support and companionship to people with dementia while exhibiting a positive attitude.

Optimizing mealtime care for people with dementia from the perspective of formal caregivers: A systematic review of qualitative research

BACKGROUND

As dementia progresses, people with dementia experience many problems during mealtimes that seriously affect their physical, psychological, and social health and quality of life. Formal caregivers play an important role in optimizing mealtime care.

OBJECTIVE

To systematically review and synthesise relevant qualitative studies exploring the experience and perceptions of formal caregivers regarding optimizing mealtime care for people with dementia.

DESIGN

A systematic review of qualitative research.

DATA SOURCES

The PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, WanFang and Vip databases were systematically searched.

REVIEW METHODS

Two reviewers independently screened the titles and abstracts, extracted the data and performed critical appraisals of each included study. The data synthesis was conducted using thematic analysis.

FINDINGS

A total of 10 studies were included. The formal caregivers included nursing assistants, nurses, speech and language therapists, nursing students, dietitians, a social worker, a professional educator, physiotherapists, health care aides, kitchen staff, diversional therapy assistants and other unidentified care staff. The findings were synthesised into the following 3 analytical themes: (1) tailored rather than standardized; (2) emotional nurturance; and (3) beyond the individual level.

CONCLUSIONS

Mealtimes involve complex physiological and psychological processes. Formal caregivers should develop tailored care practices based on individual patients' preferences and needs. Emotional connection plays a key role and has a positive impact on the mealtime experience. Further research is needed to explore the specific effects of emotional connections on optimizing mealtime care.