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Chee SY. "Savoring the Past, Nourishing the Present": Uncovering the Essence of Multicultural Mealtime Experiences in Senior Living Facilities. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:322-348. [PMID: 37786389 DOI: 10.1080/01634372.2023.2264894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Mealtimes are crucial markers of daily schedules and hold significant meaning for older adults in senior living facilities worldwide, extending beyond the food served. Utilizing Moustakas' transcendental phenomenological approach, this study explores the lived experiences and multifaceted meanings of mealtimes for older adults from multicultural backgrounds in senior living facilities in Malaysia. In six urban senior living facilities, 28 older adults from Malaysia's three major ethnic groups, namely Bumiputera Malays, Chinese, and Indians were interviewed through semi-structured one-on-one interviews. Five discernible themes beyond tangible aspects emerged: mealtimes as cultural bridges, memories and palate, emotional bonds through food, quality control and consumption, and comfort through personalized dining experience. This study raises awareness among senior-living facilitators, family caregivers, academics, and policymakers to acknowledge the evident complexities of mealtimes for older adults living away from the comfort of familiarity. Future research should consider the active involvement of all stakeholders in co-creating and implementing interventions that enhance older adults' mealtime experiences in senior-friendly establishments.
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Affiliation(s)
- Shi Yin Chee
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- Active Ageing Impact Lab, Taylor's University, Subang Jaya, Malaysia
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Mellow ML, Luscombe-Marsh N, Taylor PJ, Kenny P, Lushington K. Food, nutrition and the dining experience in aged care settings: Findings of a nationwide survey. Australas J Ageing 2024; 43:100-111. [PMID: 38160440 DOI: 10.1111/ajag.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Previous research on food, nutrition and dining practices in Australian residential aged care (RAC) homes has been based on a limited sample of single-home or multiple-home providers, but a nationwide study has not been conducted. The aim of this study was to provide a preliminary overview of current food, nutrition and dining practices across Australian RAC facilities using a nationwide survey. METHODS A survey was distributed to Australian RAC homes in August-September 2020, as part of the National Congress on Food, Nutrition and the Dining Experience in Aged Care (February 2021). The survey, administered via an online portal, consisted of 38 semistructured questions including yes/no or multiple-choice responses, free text, frequency scales and number entry. Six key topics were explored, including 'food service system and environment', 'catering style', 'menu planning and evaluation', 'nutrition planning and requirements', 'nutrition-related screening and assessment' and 'training and additional information', which were informed by the Australian Government Department of Health and reflected the interests of the Congress. RESULTS The final sample included 292 respondents (204 individual homes and 88 multiple-home proprietors) representing 1152 homes and 125,393 residents, encompassing approximately 43% of RAC homes (of a possible 2671) and 57% of residents (of a possible 219,965) in Australia. Survey respondents representing RAC homes included service managers, catering managers, Chief Executive Officers, cooks, chefs, dietitians or staff from other roles within homes. A number of potential areas of need were identified, included increasing the autonomy of residents to select the foods they desire, increasing the variety and choice (including timing) of meals, enhancing the dining environments in homes to stimulate food intake and increasing staff training and the number of trained chefs in homes, so that meals are prepared which address diverse nutritional needs of residents. CONCLUSIONS This study provides insight into the food service and mealtime practices of over a third of Australian RAC homes. The findings of this survey may help to identify key targets for intervention to improve the food, nutrition and quality of life of aged care residents.
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Affiliation(s)
- Maddison L Mellow
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | | | - Pennie J Taylor
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, Adelaide, South Australia, Australia
| | - Peter Kenny
- Maggie Beer Foundation, Adelaide, South Australia, Australia
| | - Kurt Lushington
- Behaviour Brain Body Research Centre, Justice and Society, University of South Australia, Adelaide, South Australia, Australia
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Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. Instrumental swallowing assessment in adults in residential aged care homes: Practice patterns and opportunities. Australas J Ageing 2023; 42:108-117. [PMID: 35938310 PMCID: PMC10947304 DOI: 10.1111/ajag.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe practice patterns in the use of instrumental swallowing assessment (ISA) for older adults in residential aged care homes (RACHs). METHODS A retrospective audit of medical records of residents living in RACHs in Melbourne, Australia to extract data on speech-language pathologist (SLP) involvement, indications for ISA and ISA practice patterns. RESULTS Medical files of 323 residents across four Melbourne facilities were reviewed. 36% (n = 115) of residents were referred to SLP for swallowing assessment. Referral to SLP was related to length of stay (U = 7393.00, p < 0.001), dementia status (χ2 [1] = 7.06, p = 0.008), texture modification (χ2 [1] = 93.34, p < 0.001) and an existing dysphagia diagnosis (χ2 [1] = 112.89, p < 0.001). There were no referrals for ISA and no instances of ISA being used. Among 115 residents who were referred to SLP for swallowing assessment, there were 33 instances where ISA might be clinically relevant according to ISA indicators. CONCLUSIONS Instrumental swallowing assessment is not being used for the management of swallowing in RACHs in Australia despite a clinical need for ISA and a potential role for ISA to improve swallowing care quality. Lack of timely ISA may fail to meet the complex health-care needs of older adults living with dysphagia in RACHs, increasing their vulnerability to complications of dysphagia and its management.
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Affiliation(s)
- Olga Birchall
- Centre for Neurosciences of SpeechThe University of MelbourneMelbourneVictoriaAustralia
- Department of Audiology and Speech PathologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Michelle Bennett
- School of Allied HealthAustralian Catholic UniversityNorth SydneyNew South WalesAustralia
| | - Nadine Lawson
- Speech Pathology DepartmentCabrini HospitalMalvernVictoriaAustralia
| | - Susan M. Cotton
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleVictoriaAustralia
- Centre for Youth Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Adam P. Vogel
- Centre for Neurosciences of SpeechThe University of MelbourneMelbourneVictoriaAustralia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain ResearchUniversity of TübingenTubingenGermany
- RedenlabMelbourneVictoriaAustralia
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Koh RTG, Thirumanickam A, Attrill S. How are the mealtime experiences of people in residential aged care facilities informed by policy and best practice guidelines? A scoping review. BMC Geriatr 2022; 22:737. [PMID: 36085034 PMCID: PMC9463738 DOI: 10.1186/s12877-022-03340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Mealtimes are embedded routines of residents living in residential aged care facilities (RACFs) that directly impact their health and quality of life. Little is known about how mealtime experiences are informed and affected by structures such as government and organisational policies and processes. This scoping review used Giddens’ (The constitution of society: outline of the theory of structuration, 1984) Structuration Theory to investigate how governance structures related to mealtime practices inform residents’ mealtime experiences. Methods Using Arksey and O’Malley’s (Int J Soc Res Methodol 8:19–32, 2005) scoping review framework, a systematic database, grey literature and policy search was completed in May 2020 and updated in July 2021. From 2725 identified articles, 137 articles were included in data charting and deductive analysis, and 76 additional Australian government policy papers were used interpretatively. Results Data charting identified that the included studies were prominently situated in Western countries, with a progressive increase in publication rate over the past two decades. Qualitative findings captured structures that guide RACF mealtimes, how these relate to person-centred mealtime practices, and how these facilitate residents to enact choice and control. Conclusions Current policies lack specificity to inform the specific structures and practices of RACF mealtimes. Staff, residents, organisational and governance representatives possess different signification, legitimation and domination structures, and lack a shared understanding of policy, and how this influences processes and practices that comprise mealtimes. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03340-9.
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Social interactions and quality of life of residents in aged care facilities: A multi-methods study. PLoS One 2022; 17:e0273412. [PMID: 36037181 PMCID: PMC9423621 DOI: 10.1371/journal.pone.0273412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background The relationship between social contact and quality of life is well-established within the general population. However, limited data exist about the extent of social interactions in residential aged care facilities (RACFs) providing long-term accommodation and care. We aimed to record the frequency and duration of interpersonal interactions among residents in RACFs and identify the association between residents’ interpersonal interactions and quality of life (QoL). Materials and methods A multi-methods study, including time and motion observations and a QoL survey, was conducted between September 2019 to January 2020. Thirty-nine residents from six Australian RACFs were observed between 09:30–17:30 on weekdays. Observations included residents’ actions, location of the action, and who the resident was with during the action. At the end of the observation period, residents completed a QoL survey. The proportion of time residents spent on different actions, in which location, and with whom were calculated, and correlations between these factors and QoL were analysed. Results A total of 312 hours of observations were conducted. Residents spent the greatest proportion of time in their own room (45.2%, 95%CI 40.7–49.8), alone (47.9%, 95%CI 43.0–52.7) and being inactive (25.6%, 95%CI 22.5–28.7). Residents were also largely engaged in interpersonal communication (20.2%, 95%CI 17.9–22.5) and self-initiated or scheduled events (20.5%, 95%CI 18.0–23.0). Residents’ interpersonal communication was most likely to occur in the common area (29.3%, 95%CI 22.9–35.7), residents’ own room (26.7%, 95%CI 21.0–32.4) or the dining room (24.6%, 95%CI 18.9–30.2), and was most likely with another resident (54.8%, 95%CI 45.7–64.2). Quality of life scores were low (median = 0.68, IQR = 0.54–0.76). Amount of time spent with other residents was positively correlated with QoL (r = 0.39, p = 0.02), whilst amount of time spent with facility staff was negatively correlated with QoL (r = -0.45, p = 0.008). Discussion and conclusions Our findings confirm an established association between social interactions and improved QoL. Opportunities and activities which encourage residents to engage throughout the day in common facility areas can support resident wellbeing.
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Heikkilä K, Andersson S, Lagerbielke E, Persson C, Sandgren A, Harstäde CW. Mealtime interventions and their outcomes in care homes for older people considering the five aspects meal model: An integrative review. Geriatr Nurs 2022; 47:171-182. [PMID: 35926339 DOI: 10.1016/j.gerinurse.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
Mealtimes are important events in care homes for physical and social well-being. However, residents usually have little input concerning meal timings, what food is offered, and how it is served. This integrative review explored mealtime interventions and their outcomes in care homes related to the Five Aspects Meal Model (FAMM). Research articles published 2010-2021 were searched for in ASSIA, CINAHL, PsycINFO, PubMed, and SveMed+ and resulted in 13 articles focusing on interventions. The analysis was based on the aspects of FAMM: room, meeting, product, management control system, and atmosphere. The result shows that even though interventions specifically focused on one aspect, they often evaluated outcomes related to several aspects. Different aspects can work together to foster effective mealtimes. FAMM eased to visualise the usefulness of mealtime interventions from a broad perspective and can be a useful tool for assessing and improving mealtime situations in clinical practice.
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Affiliation(s)
- Kristiina Heikkilä
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus university, Kalmar/Växjö, Sweden; Department of Health and Caring sciences, Linnaeus university, Kalmar/Växjö, Sweden
| | - Stefan Andersson
- Department of Health and Caring sciences, Linnaeus university, Kalmar/Växjö, Sweden
| | | | - Carina Persson
- Department of Health and Caring sciences, Linnaeus university, Kalmar/Växjö, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus university, Kalmar/Växjö, Sweden; Department of Health and Caring sciences, Linnaeus university, Kalmar/Växjö, Sweden
| | - Carina Werkander Harstäde
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus university, Kalmar/Växjö, Sweden; Department of Health and Caring sciences, Linnaeus university, Kalmar/Växjö, Sweden.
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Villar F, Chacur K, Serrat R, Celdrán M. Resistance to Eating in People with Dementia Living in Long-term Care Facilities: Gaps between Common and Good Practices. Clin Gerontol 2022; 45:859-869. [PMID: 34100339 DOI: 10.1080/07317115.2021.1933292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The present study aims to explore the perception of common and best practices for dealing with resistance to eating of persons with dementia living in long-term care facilities. METHODS Forty-two staff members working in long-term care facilities were interviewed. They worked in four Spanish long-term care facilities; 21 were nursing assistants and 21 technical staff. Participants heard a vignette in which person with dementia showed resistance to eating. Participants were asked how a situation like that is commonly managed by their workmates, and how the situation should be managed. Responses were content-analyzed. RESULTS Strategies mentioned by participants were quite diverse and did not converge on common ground that harmonizes their responses. Less than half of the participants considered person-centered strategies as a best practice. Those strategies were lower on assistant carers, compared to technical staff. CONCLUSIONS Resistance to eating is a common situation faced by professionals. Nonetheless, there is not a common procedure to deal with this situation. Resistance to eating was seen more as a problem to be eradicated than a behavior to be understood. CLINICAL IMPLICATIONS Staff development initiatives are necessary in relation to mealtime situations. They should consider work position and competencies needed by assistant carers.
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Affiliation(s)
- Feliciano Villar
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Karima Chacur
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Rodrigo Serrat
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Montserrat Celdrán
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
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Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study. Geriatrics (Basel) 2022; 7:geriatrics7030067. [PMID: 35735772 PMCID: PMC9222299 DOI: 10.3390/geriatrics7030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.
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Cartwright J, Roberts K, Oliver E, Bennett M, Whitworth A. Montessori mealtimes for dementia: A pathway to person-centred care. DEMENTIA 2022; 21:1098-1119. [PMID: 35259303 DOI: 10.1177/14713012211057414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project. METHOD An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19-32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service. RESULTS A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes. IMPLICATIONS The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.
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Affiliation(s)
- Jade Cartwright
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia;1649 Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Karen Roberts
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Elizabeth Oliver
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Michelle Bennett
- School of Allied Health, 580091Australian Catholic University, North Sydney, Australia
| | - Anne Whitworth
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia; Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
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Hill C, Clapham RP, Buccheri A, Field M, Wong Shee A, Alston L. Assessing adherence and exploring barriers to provision of prescribed texture modifications for dysphagia in a residential aged care facility in rural Australia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:67-76. [PMID: 34420459 DOI: 10.1080/17549507.2021.1953144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Purpose: Between 55-65% of residents living in residential aged care facilities (RACFs) experience dysphagia and are prescribed texture-modified diets by a speech-language pathologist (SLP). The aim of this study was to assess current adherence to prescribed texture modification for people with dysphagia; and explore barriers to implementation in a rural aged care setting. METHOD Method: Meal texture audits (N = 42) were completed with residents with dysphagia in a rural RACF who were prescribed texture-modified diets or fluids by a SLP. Semi-structured focus groups were conducted with nursing and food preparation staff (N = 11) to identify barriers to implementation. RESULT Result: Mealtime texture audits identified that 54.8% (n = 23) of residents' food modification requirements were incorrectly documented in the manual entry database (kitchen form) and 64.3% (n = 27) of meal trays contained foods that did not meet residents' dysphagia management plans. Focus group data revealed seven main themes impacting on the ability of staff to implement prescribed texture-modified diets. Complicated processes and communication between nursing, food services and SLP staff were identified as major barriers. These were complicated further by time pressures experienced by staff as well as staffing issues, resourcing of the kitchen, accommodating individual dietary preferences and the variety/presentation of dietary options at the aged care facility.Conclusion: There was low adherence to SLP prescribed texture-modified diets and fluids in the participating rural RACF. This study identified major barriers to implementing SLP prescribed texture-modified diets including complicated processes, communication breakdowns, time pressures and limited staffing. Implementation of an online menu management system and regular dysphagia-specific training may address barriers to communication and complicated paper-based menu systems and should be a priority for health services to ensure adequate dysphagia management.
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Affiliation(s)
- C Hill
- Speech Pathology, Colac Area Health, Colac, Australia
| | - R P Clapham
- Primary and Community Care, Ballarat Health Services, Ballarat, Australia
- Deakin Rural Health, Deakin University, Geelong, Australia
| | - A Buccheri
- Speech Pathology, Colac Area Health, Colac, Australia
| | - M Field
- Research Unit, Colac Area Health, Colac, Australia
| | - A Wong Shee
- Primary and Community Care, Ballarat Health Services, Ballarat, Australia
- Deakin Rural Health, Deakin University, Geelong, Australia
| | - L Alston
- Deakin Rural Health, Deakin University, Geelong, Australia
- The Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
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Aloisio LD, Varin MD, Hoben M, Baumbusch J, Estabrooks CA, Cummings GG, Squires JE. To whom health care aides report: Effect on nursing home resident outcomes. Int J Older People Nurs 2021; 16:e12406. [PMID: 34247437 DOI: 10.1111/opn.12406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Health care aides (personal support workers and nursing assistants) provide ~80%-90% of direct care to residents in nursing homes; it is therefore important to understand whether supervision of health care aides affects quality of care. We sought to determine whether health care aide reporting practices are associated with resident outcomes in nursing homes. DESIGN AND METHODS We conducted a cross-sectional secondary analysis of survey data of 3991 health care aides from 322 units in 89 nursing homes in Western Canada. We then linked resident data from the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 database to care aide surveys at the unit level. We used hierarchical mixed models to determine if the proportion of health care aides reporting to a respective nursing leader role was associated with 13 practice sensitive quality indicators of resident care. RESULTS Most health care aides reported to a registered nurse (RN, 44.5%) or licenced practical nurse (LPN, 53.3%). Only 2.2% of health care aides reported to a care manager and were excluded from the analysis. Resident outcomes for only declining behavioural symptoms were more favourable when a higher proportion of health care aides (on a unit) reported to RNs, β = -0.004 (95% CI -0.006, -0.001, p = .004). The remaining indicators were not affected by care aide reporting practices. DISCUSSION AND IMPLICATIONS Resident outcomes as evaluated by the indicators appear largely unaffected by care aide reporting practices. LPNs' increasing scope of practice and changing work roles and responsibilities in nursing homes across Western Canada may explain the findings.
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Affiliation(s)
| | | | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Carole A Estabrooks
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | | | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Keage M, Baum S, Pointon L, Lau J, Berndt J, Hopkins J, Maule R, Vogel AP. Imaging and Clinical Data on Swallowing Function of Individuals with Huntington's Disease and Dysphagia. J Huntingtons Dis 2021; 9:163-171. [PMID: 32417787 DOI: 10.3233/jhd-190390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dysphagia is common in Huntington's disease (HD) affecting all phases of swallowing. Correlations exist between non-instrumental measures of dysphagia and clinical features of HD, including age, disease duration and degree of motor impairment. Lack of instrumental data limits our ability to wholly characterize HD-related dysphagia and prognosticate swallowing changes over time. OBJECTIVE To retrospectively describe a relatively large database of videofluoroscopic studies (VFSSs) and determine the relationships between dysphagia and HD clinical parameters, including disease duration and burden of pathology score. METHODS Medical and swallowing data of 49 individuals with HD and dysphagia were examined. VFSS data were interpreted using the Bethlehem Assessment Scale and Penetration-Aspiration Scale. Data from clinical bedside examination and social information were collated to describe the impact of dysphagia in HD. Repeated VFSS data were available for seven individuals. RESULTS Swallowing was characterized by lingual dysfunction, reduced soft palate elevation, delayed pharyngeal swallow initiation, and inability to clear matter from the pharynx. Two-thirds of cases presented with compromised airway protection with both liquid and solid consistencies. Tachyphagia and difficulty self-feeding were common. Dysphagia correlated with disease severity and duration. Longitudinal analysis revealed a mixed pattern of progression with some individuals presenting with worsening dysphagia whilst others appeared to remain stable or improved in function. CONCLUSIONS Dysphagia in HD is exacerbated by difficulties with self-feeding and monitoring feeding rate. Burden of pathology relates to pharyngeal swallow initiation and penetration and aspiration of fluid. Dysphagia did not appear to worsen in a systematic way in a subset of participants.
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Affiliation(s)
- Megan Keage
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, Victoria, Australia
| | - Shira Baum
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa Pointon
- Calvary Health Care Bethlehem, Victoria, Australia
| | - Jane Lau
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, Victoria, Australia
| | - Jacinta Berndt
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, Victoria, Australia
| | - Josephine Hopkins
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Redenlab, Australia
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13
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Understanding the dining experience of individuals with dysphagia living in care facilities: A grounded theory analysis. Int J Nurs Stud 2019; 92:144-153. [DOI: 10.1016/j.ijnurstu.2019.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 12/16/2022]
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney FJ. Best intentions or best practice? A case study of the nutritional needs and outcomes of a person with dementia living in a residential aged care home. Int J Nurs Pract 2018; 25:e12692. [PMID: 30094901 DOI: 10.1111/ijn.12692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 03/29/2018] [Accepted: 07/09/2018] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the nutritional status and needs of a person with dementia living in an aged care home, including identification of barriers to, and effective strategies for, the provision of person-centred care. BACKGROUND Nutrition and hydration care are integral to quality of life for adults with dementia, but there is little research on whether staff knowledge around effective care strategies for residents is translated into optimal care. DESIGN Focused ethnographic single-case design. METHODS The perspectives of the resident, her prime family member, and six care staff were triangulated through interviews, observation, document audit, and medical file review to investigate the resident's nutrition and hydration status and needs (October 2014-April 2015). RESULTS During 3 years in care, this resident had lost weight steadily. Staff appeared attentive but did not maintain a systematic record of body mass index. At meals, staff encouraged eating but used ineffective strategies. Food was not served in ways that facilitated active participation. Eating and drinking were structured as tasks to be completed rather than activities to be enjoyed. CONCLUSION This instrumental case study identified a task-oriented, rather than person-centred, approach to nutrition and hydration care, adversely affecting the resident's nutritional health and capability to participate actively.
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Affiliation(s)
- Emma J Lea
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Andrea D Price
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Fran J McInerney
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Australia
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15
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney F. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study. J Clin Nurs 2017; 26:5169-5178. [DOI: 10.1111/jocn.14066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Emma J Lea
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Andrea D Price
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
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16
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Watkins R, Goodwin VA, Abbott RA, Hall A, Tarrant M. Exploring residents' experiences of mealtimes in care homes: A qualitative interview study. BMC Geriatr 2017; 17:141. [PMID: 28697747 PMCID: PMC5506571 DOI: 10.1186/s12877-017-0540-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents’ health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents’ experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents’ enjoyment of meals, and resulting health and wellbeing. Methods Semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. Interviews were supplemented by researcher observations of mealtimes. Results The dining experience was a focal point for participants’ broader experiences of residing in a care home. Three themes pertaining to residents’ experiences were identified: (1) Emotional and psychological connections with other residents; (2) managing competing interests with limited resources; and (3) familiarity and routine. Conclusion Mealtimes are a mainstay of life in a care home through which residents’ experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. It may also help to ease the transition from independent-living to life in care, which can be particularly stressful for some residents, and improve health and wellbeing over the long-term.
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Affiliation(s)
- Ross Watkins
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. .,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK.
| | - Victoria A Goodwin
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
| | - Rebecca A Abbott
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
| | - Abi Hall
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
| | - Mark Tarrant
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South West Peninsula, UK
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17
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Attitudes, perceptions and experiences of mealtimes among residents and staff in care homes for older adults: A systematic review of the qualitative literature. Geriatr Nurs 2017; 38:325-333. [DOI: 10.1016/j.gerinurse.2016.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/02/2016] [Accepted: 12/04/2016] [Indexed: 11/21/2022]
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