By Sylvia Foley, AJN senior editor
Feeding difficulties in people with dementia are common, but the way such difficulties manifest can vary widely, and there is no single, one-size-fits-all solution. Nurse researchers Chia-Chi Chang and Beverly L. Roberts open their April CE article, “Strategies for Feeding Patients with Dementia,” with some disturbing statistics that make clear the scope of the problem:
People with dementia constitute roughly 25% of hospital patients ages 65 and older and 47% of nursing home residents. And more than half of them lose some ability to feed themselves, which puts them at high risk for inadequate food intake and malnutrition. Patients who are unable to eat independently must rely on caregivers to assist them . . . Unfortunately, caregivers may be unable to identify the various types of feeding problems that accompany dementia or unaware of the feeding practices required to address them.
In an earlier literature review published in the Journal of Clinical Nursing, Chang and Roberts evaluated three tools used to assess feeding difficulties in people with dementia, then created a conceptual model depicting such difficulties, contributing factors, and outcomes. Now, in this CE article, the authors take their work a step further. They describe a range of assessment and intervention practices, matched to specific feeding difficulties and observed behaviors, that caregivers can try. For example:
- if a patient refuses or displays an aversion toward food, as evidenced by pushing the feeder or the food away, spitting out food, or refusing to open her or his mouth,
- then strategies might include feeding the patient at another time, seeking help from another nurse or nursing assistant, offering verbal encouragement, sitting down and making eye contact with the patient, and offering familiar foods.
A table breaks the information down for readers by type of feeding difficulty, listing associated observed behaviors and suggested multidisciplinary and nursing strategies. The literature is cited where applicable. “Although these strategies haven’t been validated in randomized clinical trials,” the authors explain, “they’ve repeatedly been endorsed by expert opinion and described as effective in observational and case studies, survey research, and literature reviews.” Suggestions on how facilities can best allocate personnel and on areas for further research are also provided.
As one expert said in a news article on the overuse of feeding tubes that ran in AJN last May, “Feeding a patient with dementia—or any patient at the end of life—is a true art.” Have you had success with any of these strategies?