Optimizing Eating Performance for Long-term Care Residents with dementia

Abstract

Background Eating is the most basic activities of daily living (ADLs) to perform, the last ADL to lose and the first to restore. Many individual and environmental factors influence eating performance among long-term care (LTC) residents with dementia. Function-Focused Care for Cognitively impaired (FFC-CI), a philosophy of care in which nurses optimize function and physical activity during all care interactions with residents, was developed to best address these factors and thereby optimize eating performance among residents. Purpose To examine the influence of specific intrapersonal, interpersonal, environmental and policy factors on eating performance; and evaluate the impact of FFC-CI on eating performance over a 6 month period among LTC residents with moderate-to-severe cognitive impairment. Methods This study was a secondary data analysis including 199 residents in eight LTC facilities from two cluster-randomized controlled trials. Data were collected at baseline, 3 and 6 months. Resident descriptive data, eating performance, cognitive function, sitting balance, physical capability, depression and agitation were included in the analysis. Binary logistic regression was used to examine the adjusted effects of factors on eating performance, and Generalized Estimating Equations to evaluate the impact of FFC-CI. Results At baseline, almost one third (32.2%) of the 199 residents needed help with eating. After adjusting the type of LTC facility, co-morbidities, chair-sitting balance, agitation and depression, compromised eating performance was associated with severe cognitive impairment (OR = 2.70, 95% CI: 1.24, 5.87) and low physical capability (OR = 1.13, 95% CI: 1.01, 1.28). There was no significant treatment effect between groups on eating performance (p = .195). Conclusion This study supported the association of eating performance with cognitive impairment and physical capability, and a need to revise FFC-CI to better address eating performance. Targeted interventions should be implemented to reduce the impact of cognitive decline on eating performance and promote physical capability. Future work needs to utilize validated multiple-item measures for eating performance, and examine the influence of additional interpersonal and environmental factors. In addition, future work may benefit from a stronger focus on eating performance rather than the more commonly addressed functional tasks such as bathing, dressing and ambulation.