Mealtime nonverbal communications among nursing home staff and residents with dementia: A secondary analysis of videotaped observations

Abstract

AbstractBackgroundMealtime difficulties are common among nursing home (NH) residents with dementia. Quality communications between staff and residents are critical to engage residents in eating. This study characterized dyadic nonverbal communications between nursing home staff and residents and evaluated relationships of nonverbal communications with individual characteristics.MethodsThis secondary analysis of 110 videotaped mealtime observations involved 25 residents and 29 staff (42 unique dyads) in 9 NHs. Nonverbal communication behaviors were coded using the refined Cue Utilization and Engagement in Dementia mealtime video‐coding scheme. Codes for staff nonverbal behaviors include 8 negative and 26 positive behaviors (modification for resident ability n=12, care approaches n=7, and dining environment n=7). Codes for resident nonverbal behaviors include 5 positive/neutral behaviors and 22 negative behaviors (chewing/swallowing difficulties n=4, functional impairment n=6, and resistive behaviors n=12).ResultsStaff modifications for resident ability (41.9%) were more prevalent than modifications of care approaches (35.1%) and dining environment (13.6%). Staff negative behaviors (9.3%) (33.5%) were more frequent compared to functional impairment (9.9%). Residents demonstrated positive/neutral behaviors (20.9%). Resident chewing/swallowing difficulties were correlated with resident eating function (p=.002). Resident functional impairment was correlated with staff education (p=.026) and resident age (p=.013), gender (p=.013), and dementia stage (p=.003). Resistive behaviors were correlated with resident comorbidity (p=.003), dementia stage (p=.049), and eating function (p=.001). Resident positive behaviors were correlated with staff race (p=.005) and resident age (p=.002), dementia stage (p=.049), and eating function (p=.002). Modifications for resident functional/cognitive ability were correlated with resident eating function (p<.001), while modifications of care approaches were correlated with staff race (p<.001) and years in current NH (p<.001), as well as with resident gender (p=.003) and eating function (p<.049). Modifications of dining environment were correlated with staff gender (p=.017) and years in current NH (p=.046), as well as with resident dementia stage (p=.008) and eating function (p<.001). Staff negative behaviors were correlated with resident comorbidity (p=.008).ConclusionsDyadic mealtime nonverbal communications were dynamic, interactive, and complex. Multiple individual characteristics were related to dyadic nonverbal communications. Findings may inform development of individualized, person‐centered mealtime care interventions.