Facilitating ADLs by caregivers of persons with dementia: the C3P model.

The purpose of this paper is to explicate a change model for caregivers of persons with dementia to assist them in facilitating meals in the home, at community-based programs and in institutional settings. Building on a Social Ecological Model, the C3P Model-Change the Person, Change the People, Change the Place offers a clear method to adapt care strategies to foster independence while providing appropriate support as the person with dementia cognitively and functionally declines. Meals are highly embedded within a culture and are ritualized events within a family requiring an individualized approach when modifications are needed.

State of the science: alleviating mealtime difficulties in nursing home residents with dementia.

Three million people will reside in nursing homes (NH) in the United States, and over 50% will experience some level of dementia by 2030. People with dementia become increasingly dependent on others to manage mealtime difficulties and oral intake as the disease progresses. The purpose of this review is to explore the state of the science related to assisted hand-feeding of people with dementia in the NH, identify gaps, and inform future policy. The review was conducted in 2010 and identified sources from journal articles, websites, and other related publications. Results are presented around key themes of characteristics, measurements, related factors, and interventions for alleviating mealtime difficulties in people with dementia. Though in the early stages, international and interdisciplinary research interest exists to understand mealtime difficulties and effective intervention strategies. Health care providers must be able to identify problems and intervene appropriately to alleviate mealtime difficulties.

An evolutionary analysis of mealtime difficulties in older adults with dementia.

AIMS AND OBJECTIVES: To use the evolutionary method of concept analysis to identify attributes, antecedents and consequences of mealtime difficulties providing direction for assessment and management in older adults with dementia. BACKGROUND: Mealtimes encompass more than the physical act of feeding a person with dementia. Social and contextual considerations are vital considerations to improving nutritional intake. While feeding difficulties in dementia have been analysed in the literature, this paper proposes a broader scope of mealtime considerations to alleviate nutritional deficiencies often associated with dementia. DESIGN: Evolutionary method of concept analysis. METHODS: In 2008, literature searches using keywords (meal, history, sociology, mealtime, culture, habit, dementia, dementia) were done in CINAHL, Academic Search Premiere, MasterFILE, Americal Life and History, Communication and Mass Media Complete, EJS, Health Source Plus-Academic, PsychARTICLES and PsychINFO, ScienceDirect, Sociological Abstracts and Google. Year limits were from 1988-2008. A total of 659 abstracts were reviewed, Google, books and textbooks with relevant content. RESULTS: Fourty-eight sources were used in the final analysis of mealtime difficulties in older adults with dementia. A model of mealtime difficulties delineates attributes, antecedents and consequences. CONCLUSIONS: Mealtime difficulties in dementia emerged as a concept with supporting evidence-based practice guidelines in 2003. Most research has been conducted in institutional settings, but community research is growing as the shifting demographics of ageing demand attention for this setting. Interventions vary in effectiveness for alleviating sequelae of mealtime difficulties in older adults with dementia. RELEVANCE TO CLINICAL PRACTICE: The conceptual model of mealtime difficulties provides a broader scope of mealtime difficulties in dementia that considers environmental, social, cultural and contextual implications with nutritional intake. The model can be used to guide future research to alleviate mealtime difficulties in older adults with dementia.

Measuring mealtime difficulties: eating, feeding and meal behaviours in older adults with dementia.

AIMS AND OBJECTIVES: The purpose of this integrative review is to examine the instruments currently available for clinical use specifically to assess mealtime difficulties, a concept subsuming the domains of eating, feeding and meal behaviours in older adults with dementia; and to determine the quality and practicality of those instruments for use in clinical practice. BACKGROUND: Dementia is a leading cause of death globally and the 5th leading cause of death in the USA for adults over 65. Nutritional status is vital to well-being, therefore, instruments to measure eating, feeding and meal behaviours are important. Instruments measuring these behaviours can be used to plan effective interventions to alleviate the behaviours and improve oral intake. DESIGN: Integrative review. METHOD: Database searches of EBSCOHost, PubMed, CINAHL, ScienceDirect, AgeLine and HaPI using various keyword combinations related to meal, eating and feeding behaviours in dementia as well as keywords related to instruments, scales or measurement. Abstracts and articles were analysed to identify instruments used in research and clinically to measure eating, feeding and meal behaviours in dementia. RESULTS: Twelve observational instruments were identified and organised into categories of eating, feeding and meal behaviours for older adults with dementia. Instruments were described by concepts measured. CONCLUSIONS: The majority of instruments identified do not report adequate psychometric testing in the literature. One instrument is identified reporting extensive testing for reliability and validity and has been recommended for clinical practice--The Edinburgh Feeding Evaluation in Dementia (EdFED) scale. RELEVANCE TO CLINICAL PRACTICE: The EdFED has been identified as a valid and reliable instrument for measuring feeding difficulties and is available for use in clinical practice. In using the EdFED, interventions can be planned to monitor feeding difficulties and promote nutritional status of older adults with dementia.