Predictive Factors of Mealtime Difficulties in Older Adults with Dementia: A cross-sectional design

Saturday, 16 November 2013: 3:55 PM

Wen Liu, MMed, BMed
School of Nursing, University of Maryland, Baltimore, MD
Feng-lan Lou, BMed
Shandong University School of Nursing, Jinan, China

Learning Objective 1: The learner will be able to find out the level of physical, cognitive and behavioral functions in older adults with dementia in Chinese nursing homes.

Learning Objective 2: The learner will be able to know the risk/protective factors of mealtime difficulties in older adults with dementia in Chinese nursing homes and their effects.

Background Mealtime difficulties in older adults with dementia indicates any difficulty or problem occurred during mealtimes associated with physical, cognitive, behavioral, social, environmental and cultural factors1-2 and effective strategies are needed to alleviate difficulties and reduce adverse outcomes3-5. This study aims to determine predictors of mealtime difficulties to provide information for developing interventions.

Methods A cross sectional design was conducted among a purposive sampling of 104 residents diagnosed with dementia in two nursing homes in China. The Edinburgh Feeding Evaluation in Dementia scale (EdFED), ADL-Barthel Index, Mini-Mental State Examination, Global Deterioration Scale and California Dementia Behavioral Questionnaire were used to measure mealtime difficulties, independence level, cognitive function, level of functioning and behavioral disturbance respectively.

Results The residents aged 77.35 (SD=11.66) years with low independence (36.01±34.36), moderate-to-severe cognitive impairment (9.86±7.32) and moderately low level of mealtime difficulties (6.79±5.60, median=6). The median of EdFED was used as cut-off point to classify residents as having mealtime difficulty or not. Mealtime difficulties were significantly associated with education, comorbidities, BMI, independence level, cognitive function and level of functioning. Generalized linear model, which explained 66.3% of total variance in mealtime difficulties with good fit, showed that severe level of functioning (OR=25.195, 95% CI: 1.947, 326.015), comorbidities (OR=10.122, 95% CI: 1.446, 70.84) and depression (OR=1.069, 95% CI: 1.011, 1.13) were risk factors, while independence level (OR=.932, 95% CI: .904, .961) a protective factor.

Conclusions Level of functioning, comorbidities and depression, increase risk of mealtime difficulties in dementia, while ADL independence reduces such risk. Nursing staff should evaluate residents’ level of functioning, depression and independence regularly to examine potential risks of mealtime difficulties.

Implications Results will provide information that can be used to develop effective strategies or interventions to promote mealtime care in older adults with dementia, alleviate risk of mealtime difficulties and thus reduce related adverse outcomes.