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The association of eating challenges with energy intake is moderated by the mealtime environment in residential care homes

Published online by Cambridge University Press:  09 January 2020

Susan E. Slaughter ,
Jill M. Morrison-Koechl ,
Habib Chaudhury ,
Christina O. Lengyel ,
Natalie Carrier  and
Heather H. Keller
Susan E. Slaughter*
Affiliation:
Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
Jill M. Morrison-Koechl
Affiliation:
Research Institute on Aging, University of Waterloo, Waterloo, Canada
Habib Chaudhury
Affiliation:
Simon Fraser University, Vancouver, Canada
Christina O. Lengyel
Affiliation:
University of Manitoba, Winnipeg, Canada
Natalie Carrier
Affiliation:
University of Moncton, Moncton, Canada
Heather H. Keller
Affiliation:
Research Institute on Aging, University of Waterloo, Waterloo, Canada
*
Correspondence should be addressed to: Susan E. Slaughter, Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, CanadaT6G 1C9. Phone: 1 780 492 7321; Fax: 1 780 492 2551. E-mail: [email protected].
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Abstract

Objectives:

Given the increased risk of malnutrition in residential care homes, we studied how specific aspects of the mealtime environment are associated with residents’ eating challenges and energy intake in general and dementia care units of these homes.

Design:

Cross-sectional study.

Participants:

624 residents and 82 dining rooms.

Setting:

32 residential care homes across Canada.

Measurements:

Eating challenges were measured using the Edinburgh Feeding Evaluation in Dementia Questionnaire (Ed-FED-q). Energy intake was estimated over nine meals. Physical, social, person-centered, functional, and homelike aspects of the mealtime environment were scored using standardized, valid measures. Effects of interactions between dining environment scores and eating challenges on daily energy intake were assessed using linear regression.

Results:

More eating challenges were associated with decreased energy intake on the general (β = −36.5, 95% confidence interval [CI] = −47.8, −25.2) and dementia care units (β = −19.9, 95% CI = −34.6, −5.2). Among residents living on general care units, the functional (β = 48.5, 95% CI = 1.8, 95.2) and physical (β = 56.9, 95% CI = 7.2, 106.7) environment scores were positively and directly associated with energy intake; the social and person-centered aspects of the mealtime environment moderated the relationship between eating challenges and energy intake.

Conclusions:

Resident eating challenges were significantly associated with energy intake on both dementia care and general care units; however on general care units, when adjusting for eating challenges, the functional and physical aspects of the environment also had a direct effect on energy intake. Furthermore, the social and person-centered aspects of the dining environment on general care units moderated the relationship between eating challenges and energy intake. Dementia care unit environments had no measurable effect on the association between resident eating challenges and energy intake.

Keywords

environmentmealtimefood intakeenergy intakeeating challengesdementiaresidential care homeslong-term care
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 7: Issue Theme: Sleep and Sleep Disorders in Older Adults , July 2020 , pp. 863 - 873
Copyright
© International Psychogeriatric Association 2020

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References

Abdelhamid, A.et al. (2016). Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis. BMC Geriatrics, 16, 26. doi: 10.1186/s12877-016-0196-3.CrossRefGoogle ScholarPubMed
Barkema, W. S., Heckman, G. A., Slaughter, S. E., Carrier, N., Lengyel, C. O. and Keller, H. H. (2019). Medical diagnosis does not influence food intake in frail long-term care residents. Journal of Nursing Home Research, 5, 49–55. doi: 10.14283/jnhrs.2019.9.Google Scholar
Bell, C. L., Tamura, B. K., Masaki, K. H. and Amella, E. J. (2013). Prevalence and measures of nutritional compromise among nursing home patients: weight loss, low body mass index, malnutrition, and feeding dependency: a systematic review of the literature. Journal of the American Medical Directors Association, 14, 94–100. doi: 10.1016/j.jamda.2012.10.012.CrossRefGoogle ScholarPubMed
Brush, J. A., Meehan, R. A. and Calkins, M. P. (2002). Using the environment to improve intake for people with dementia. Alzheimer’s Care Today, 3, 330–338.Google Scholar
Bunn, D. K.et al. (2016). Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA). BMC Geriatrics, 16, 89. doi: 10.1186/s12877-016-0256-8.CrossRefGoogle Scholar
Carrier, N., West, G. E. and Ouellet, D. (2006). Cognitively impaired residents’ risk of malnutrition is influenced by foodservice factors in long-term care. Journal of Nutrition for the Elderly, 25, 73–87. doi: 10.1300/J052v25n03_06.CrossRefGoogle ScholarPubMed
Chaudhury, H., Cooke, H. A., Cowie, H. and Razaghi, L. (2018). The influence of the physical environment on residents with dementia in long-term care settings: a review of the empirical literature. The Gerontologist, 58, e325–e337. doi: 10.1093/geront/gnw259.CrossRefGoogle ScholarPubMed
Chaudhury, H., Hung, L. and Badger, M. (2013). The role of physical environment in supporting person-centered dining in long-term care: a review of the literature. American Journal of Alzheimer’s Disease and Other Dementias, 28, 491–500. doi: 10.1177/1533317513488923.CrossRefGoogle ScholarPubMed
Chaudhury, H., Hung, L., Rust, T. and Wu, S. (2017a). Do physical environmental changes make a difference? supporting person-centered care at mealtimes in nursing homes. Dementia, 16, 878–896. doi: 10.1177/1471301215622839.CrossRefGoogle ScholarPubMed
Chaudhury, H., Keller, H., Pfisterer, K. and Hung, L. (2017b). Development of a physical environmental observational tool for dining environments in long-term care settings. The Gerontologist, 57, e59–e101. doi: 10.1093/geront/gnw261.CrossRefGoogle ScholarPubMed
Cichero, J. A.et al. (2017). Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia, 32, 293–314. doi: 10.1007/s00455-016-9758-y.CrossRefGoogle ScholarPubMed
Cipriani, G., Lucetti, C., Nuti, A. and Danti, S. (2014). Wandering and dementia. Psychogeriatrics, 14, 135–142. doi: 10.1111/psyg.12044.CrossRefGoogle ScholarPubMed
Douglas, J. W. and Lawrence, J. C. (2015). Environmental considerations for improving nutritional status in older adults with dementia: a narrative review. Journal of the Academy of Nutrition and Dietetics, 115, 1815–1831. doi: 10.1016/j.jand.2015.06.376.CrossRefGoogle ScholarPubMed
Edvardsson, D., Winblad, B. and Sandman, P. O. (2008). Person-centred care of people with severe Alzheimer’s disease: current status and ways forward. Lancet Neurology, 7, 362–367. doi: 10.1016/S1474-4422(08)70063-2.CrossRefGoogle ScholarPubMed
Fleming, R. and Purandare, N. (2010). Long-term care for people with dementia: environmental design guidelines. International Psychogeriatrics, 22, 1084–1096. doi: 10.1017/S1041610210000438.CrossRefGoogle ScholarPubMed
Hartmaier, S. L., Sloane, P. D., Guess, H. A., Koch, G. G., Mitchell, C. M. and Phillips, C. D. (1995). Validation of the minimum data set cognitive performance scale: agreement with the mini-mental state examination. Journals of Gerontology: Series A, 50A, M128–M133.CrossRefGoogle Scholar
Hirdes, J. P.et al. (2008). Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Services Research, 8, 277. doi: 10.1186/1472-6963-8-277.CrossRefGoogle ScholarPubMed
Hung, L. and Chaudhury, H. (2011). Exploring personhood in dining experiences of residents with dementia in long-term care facilities. Journal of Aging Studies, 25, 1–12. doi: 10.1016/j.jaging.2010.08.007.CrossRefGoogle Scholar
Iuglio, S.et al. (2018a). Construct validity of the dining environment audit protocol: a secondary data analysis of the Making the Most of Mealtimes (M3) study. BMC Geriatrics, 18, 20. doi: 10.1186/s12877-018-0708-4.CrossRefGoogle ScholarPubMed
Iuglio, S.et al. (2018b). Construct validity of the mealtime scan: a secondary data analysis of the Making the Most of Mealtimes (M3) study. Journal of Nutrition in Gerontology and Geriatrics, 37, 82–104. doi: 10.1080/21551197.2018.1461166.CrossRefGoogle ScholarPubMed
Keller, H., Carrier, N., Duizer, L., Lengyel, C., Slaughter, S. and Steele, C. (2014). Making the Most of Mealtimes (M3): grounding mealtime interventions with a conceptual model. Journal of the American Medical Directors Association, 15, 158–161. doi: 10.1016/j.jamda.2013.12.001.CrossRefGoogle ScholarPubMed
Keller, H. H.et al. (2017a). Prevalence and determinants of poor food intake of residents living in long-term care. Journal of the American Medical Directors Association, 18, 941–947. doi: 10.1016/j.jamda.2017.05.003.CrossRefGoogle ScholarPubMed
Keller, H. H.et al. (2017b). Making the most of mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes. BMC Geriatrics, 17, 15. doi: 10.1186/s12877-016-0401-4.CrossRefGoogle ScholarPubMed
Keller, H. H., Chaudhury, H., Pfisterer, K. J. and Slaughter, S. E. (2018). Development and inter-rater reliability of the mealtime scan for long-term care. The Gerontologist, 58, e160–e167. doi: 10.1093/geront/gnw264.CrossRefGoogle ScholarPubMed
Kok, J. S., Berg, I. J. and Scherder, E.J.A. (2013). Special care units and traditional care in dementia: relationship with behavior, cognition, functional status and quality of life – a review. Dementia and Geriatric Cognitive Disorders, 3, 360–375. doi: 10.1159/000353441.CrossRefGoogle ScholarPubMed
Liu, W., Galik, E., Boltz, M., Nahm, E.-S. and Resnick, B. (2015). Optimizing eating performance for older adults with dementia living in long-term care: a systematic review. Worldviews on Evidence-Based Nursing, 12, 228–235. doi: 10.1111/wvn.12100.CrossRefGoogle ScholarPubMed
Liu, W., Jao, Y.-W. and Williams, K. (2017). The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: a secondary analysis. International Journal of Nursing Studies, 71, 70–79. doi: 10.1016/j.ijnurstu.2017.03.004.CrossRefGoogle ScholarPubMed
Morris, J. N., Fries, B. E. and Morris, S. A. (1999). Scaling ADLs within the MDS. Journal of Gerontology: Medical Sciences, 54A, M546–M553.Google Scholar
Nijs, K.A.N.D.et al. (2006). Effect of family-style meals on energy intake and risk of malnutrition in Dutch nursing home residents: a randomized controlled trial. Journals of Gerontology: Series A, 61, 935–942. doi: 10.1093/gerona/61.9.935.CrossRefGoogle ScholarPubMed
Perlman, C. M. and Hirdes, J. P. (2008). The aggressive behavior scale: a new scale to measure aggression based on the minimum data set. Journal of the American Geriatrics Society, 56, 2298–2303. doi: 10.1111/j.1532-5415.2008.02048.x.CrossRefGoogle ScholarPubMed
Shephard, T. J., Kovach, A. M., Hale, K. and Miller, A. (2007). STAND (Screening Tool for Acute Neurological Dysphagia) study results. Paper Presented at the American Association of Neuroscience Nurses Annual Meeting, San Diego, CA, April 2007.Google Scholar
Slaughter, S. E., Eliasziw, M., Morgan, D. and Drummond, N. (2011). Incidence and predicators of eating disability among nursing home residents with middle-stage dementia. Clinical Nutrition, 30, 172–177. doi: 10.1016/j.clnu.2010.09.001.CrossRefGoogle Scholar
Slaughter, S. E. and Morgan, D. G. (2012). Functional outcomes of nursing home residents in relation to features of the environment: validity of the Professional Environmental Assessment Protocol. Journal of the American Medical Directors Association, 13, 487e1–487e7. doi: 10.1016/j.jamda.2012.01.003.CrossRefGoogle ScholarPubMed
Smith, K. L. and Greenwood, C. E. (2008). Weight loss and nutritional considerations in Alzheimer disease. Journal of Nutrition for the Elderly, 27, 381–403. doi: 10.1080/01639360802265939.CrossRefGoogle ScholarPubMed
Stockdell, R. and Amella, E. J. (2008). The Edinburgh Feeding Evaluation in Dementia scale: determining how much help people with dementia need at mealtime. American Journal of Nursing, 108, 46–54. doi: 10.1097/01.naj.0000327831.51782.8e.CrossRefGoogle ScholarPubMed
Watson, R. and Deary, I. J. (1997). Feeding difficulty in elderly patients with dementia: confirmatory factor analysis. International Journal of Nursing Studies, 34, 405–414. doi: 10.1016/s0020-7489(97)00033-3.CrossRefGoogle ScholarPubMed
Weisman, G. D., Chaudhury, H. and Moore, K. D. (2000). Theory and practice of place: toward an integrative model. In: Rubinstein, R., Moss, M. and Kleban, M. (Eds.), The Many Dimensions of Aging: Essays in Honor of M. Powell Lawton (pp. 3–21). New York: Springer.Google Scholar
Weyerer, S., Schaufele, M. and Hendlmeier, I. (2010). Evaluation of special and traditional dementia care in nursing homes: results from a cross-sectional study in Germany. International Journal of Geriatric Psychiatry, 25, 159–167. doi: 10.1002/gps.2455.CrossRefGoogle ScholarPubMed
Woodbridge, R.et al. (2018). Use of the physical environment to support everyday activities for people with dementia: a systematic review. Dementia, 17, 533–572. doi: 10.1177/1471301216648670.CrossRefGoogle ScholarPubMed