Playing music, switching to a “family style” service, and other food reforms seem to help people living with dementia, but experts say they don’t know how to find the best course (or why it works).
British researchers say they’ve looked at thousands of studies on different approaches to making people with dementia more comfortable while they eat, but, like Churchill’s infamous pudding, the research lacks a theme.
“Most of the studies were small and the reports were of poor quality,” writes Rebecca Whear, a researcher at the University of Exeter, to her colleagues in the March issue of Journal of the American Medical Directors Association. “We identified only 11 studies involving 265 people who met the inclusion criteria for this review.”
More than half of long-term care residents suffer from malnutrition, which results in other problems, from infections to falls, experts say. Keeping residents with dementia calm during mealtimes is, therefore, crucial for providers and residents.
Studies show, in general, that rethinking meal service has “some positive influence” in reducing stress for people with dementia, Whear says. “The evidence in our review suggests that simple and inexpensive interventions can help alleviate agitated behaviors,” he says.
The problem, Whear and others say, is that it is difficult to test results because the profession has not yet accepted the terms. “Well-designed … controlled studies are needed to test the generalizability of these results and to build evidence for best practice in this area,” says Whear. “Effective, simple, and non-pharmacological interventions have the potential to improve the low-cost residential care environment, reducing dementia-related negative behaviors and improving the dining environment.”
Whear is not the only one who hopes for more careful attention to interventions during meals.
In the same issue of the journal, Whear’s findings receive a bold “Amen” from University of Waterloo Professor Heather Keller and her colleagues. “We would like to add to this recommendation that intervention research must be based on a conceptual framework based on current evidence showing that there are different influences on the various activities (e.g. arriving, eating, waiting, socializing) that occur during a meal , and there are several intermediate … and final results “to consider, writes Keller.
Keller and her colleagues say family-style meals or even “home” models designed by Eden Alternative appear to improve both nutrition and morale for people with dementia. The problem is that residents and carers around the world could really benefit if someone could understand how and why, those
approaches work, Waterloo researchers say.
“The use of person-centered strategies, such as meeting individual needs and preferences at mealtimes, has been qualitatively explored, but has yet to be quantitatively evaluated against best outcomes,” says Keller.
To think differently (and clearly) about meal times, suppliers should borrow the approach of restaurants and food retailers, say Keller and his colleagues. Keller relies on “The Five Aspects of Meal Model”, a complex-adaptive formula that considers everything in the room (table, lighting, furniture), the type of encounter (family meal, social club), the food itself, and how the place is managed.
These four elements add up in what restaurateurs call “the dining atmosphere,” say Keller and his colleagues.
“This picture suggests that there is an intersection between the quality of the food or meal and the experience of the meal,” writes Keller. “We believe these two domains (meal quality and meal experience) are critical for food intake [behavior problems] and other findings during meals, and that a third domain of “access to food”, which can limit or alter food intake, should also be considered when planning interventions. ”
Overall, Keller and his colleagues say, suppliers (and researchers) should think as broadly as possible when considering how to make meals more effective and less stressful for residents.
Meals “are complex,” writes Keller. Vendors should carefully weigh all the variables that go into a meal, from a resident’s ability to feed themselves to staff training, dining room decor, government funding, or food regulations. That more holistic approach to the problem will surely produce better results than the one-pointedness of previous efforts, says Keller.