Abstract
BackgroundAddressing eating difficulties among older individuals with dementia living in nursing homes requires evidence-based interventions. However, to date, there is limited evidence of effective interventions designed to maintain and/or increase independent eating. In a field in which evidence is still lacking, a critical analysis of the state of research describing its main features can help identify methodological gaps that future studies should address. Hence, the aim of this study was to map the state of the research designed to maintain and/or promote independent eating in older individuals with dementia living in nursing homes.MethodsA scoping review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Reviews and conceptual analyses performed with different methodological approaches, published in indexed journals, and written in English were included. Keywords Were searched for in the MEDLINE, the Cumulative Index of Nursing and Allied Health, and in the Scopus databases to identify papers published up to 31 May 2018.Results17 reviews were included, assessing interventions’ effectiveness (n = 15) and providing conceptual frameworks for eating/mealtime difficulties (n = 2). Conceptual frameworks supporting interventions’ effectiveness have rarely been described in available studies. Moreover, interventions tested have been categorized according to non-homogeneous frameworks. Their effectiveness has been measured against (1) eating performance, (2) clinical outcomes, and (3) adverse event occurrence.ConclusionAn increased use of conceptual frameworks in studies, as well as greater clarity in intervention categorization and outcomes, is necessary to enhance the reviews’ value in providing useful cumulative knowledge in this field. Interventions delivered should embody different components that integrate individual, social, cultural, and environmental factors, while when evaluating an intervention’s effectiveness, eating performance, clinical outcomes and adverse events should be considered. Together with more robust studies, involving clinicians could prove to be useful, as their knowledge of practice developed from direct experience can help develop innovative research questions.
Highlights
Addressing eating difficulties among older individuals with dementia living in nursing homes requires evidence-based interventions
Relevant studies and rationale Based on the research question, the following inclusion criteria were established: 1) Secondary studies that summarized the state of art of research in this field and its gaps, and provide future study directions, were included; 2) Concept analyses used to summarize knowledge based on the review of the literature: these were included to ensure a comprehensive map of the conceptual frameworks available in this research field, and 3) Papers written in English and published in journals indexed in the Medline, Cumulative Index of Nursing and Allied Health (CINAHL), and Scopus databases, up to 31st May, 2018
In 1998, Amella published clinical guidelines based on a review of the diagnosis and management of eating difficulties among older individuals, not those diagnosed with dementia [23]
Summary
Addressing eating difficulties among older individuals with dementia living in nursing homes requires evidence-based interventions. To date, there is limited evidence of effective interventions designed to maintain and/or increase independent eating. The aim of this study was to map the state of the research designed to maintain and/or promote independent eating in older individuals with dementia living in nursing homes. Despite the daily efforts of healthcare professionals (HCPs) and family caregivers to promote independence in eating and in providing adequate support, in the long run unintentional weight loss, malnutrition, dehydration, pneumonia, decreased quality of life, and in some cases death [1] have been documented among older individuals with dementia living in a NH. Eating dependence has been shown to raise important ethical issues (e.g., when the resident refuses to eat) and to affect the residents’, HCPs’ (e.g., nurses, nurses’ assistants), and/or family caregivers’ quality of life [4]
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