Impact of Handfeeding Assistance on Nutritional Intake for Nursing Home Residents

Friday, 28 July 2017

Melissa K. Batchelor-Murphy, PhD1
Susan M. Kennerly, PhD2
Susan D. Horn, PhD3
Ryan Barrett, MS4
Nancy Bergstrom, PhD5
Lisa Boss, PhD, MSN, BSN6
Tracey L. Yap, PhD1
(1)School of Nursing, Duke University, Durham, NC, USA
(2)College of Nursing, East Carolina University, Greenville, NC, USA
(3)School of Medicine, University of Utah, Salt Lake City, UT, USA
(4)International Severity Information Systems, Inc. and the Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
(5)Center on Aging, University of Texas Health Science Center at Houston, Houston, TX, USA
(6)Memorial Hermann Northeast Medical Center, Humble, TX, USA


Poor nutrition with weight loss remains the largest reversible health problem in nursing home (NH) settings. Cognition and functional ability play a large role in whether or not a resident can engage independently in self-feeding, will require set-up assistance, or be completely dependent on NH staff to provide support.1 The purpose of this secondary analysis was to examine the impact of cognition (residents with or without dementia) on nutritional outcomes of meal intake based on (1) level of feeding assistance provided, and (2) overall caloric intake for residents who were offered snacks and supplements between meals.


As part of a large, multisite clinical trial conducted in the United States and Canada (N = 786)2, residents with and without dementia (n = 592; n = 194) were examined according to the level of feeding assistance required during mealtimes (independent, setup only, needs help eating) over a 21-day period. Outcomes analyzed were percent of meal intake by meal (Breakfast (B), Lunch (L), Dinner (D)), and overall daily intake (meals + snacks/ supplements).

Results:  Residents with dementia who required meal setup assistance had significantly lower meal intake for all three meals (B, p = 0.0046); L, p = <.0001; D, p = <.0001). Residents without dementia experienced significantly lower intake for Breakfast (p = 0.036) and Dinner (p = 0.006), but not for Lunch (p = 0.14). When snacks and supplements were offered between meals, residents with dementia consumed approximately 163 additional calories/ day, and residents without dementia consumed approximately 156 additional calories/ day.

Conclusion: All NH residents are vulnerable to low intake during mealtimes. This study adds new evidence showing that completely dependent residents may not be the most vulnerable group for lower overall daily intake. Instead, two other groups of residents are at highest risk, those that only require setup assistance for meals, and those with cognitive impairment.

Implications for Practice: Nursing home staff should closely monitor meal intake for residents who require setup assistance for meals, and those with cognitive impairment. These two groups should be considered particularly at risk for lower daily intake, and allow for early detection of low meal intake. Early detection can lead to earlier intervention, allowing staff to provide more handfeeding support for these vulnerable groups of residents.