Australian Centre for Evidence Based Aged Care, Australian Institute for Primary Care and Ageing, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
Australian Centre for Evidence Based Aged Care, Australian Institute for Primary Care and Ageing, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia; Western Australian Group for Evidence Informed Healthcare Practice: A Joanna Briggs Institute Centre of Excellence, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; Australian National University, ANU Medical School, Academic Unit of General Practice, Canberra, Australia.
Int J Nurs Stud. 2019 Aug;96:99-118. doi: 10.1016/j.ijnurstu.2019.04.005. Epub 2019 Apr 17.
Dementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person's ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person's ability to engage in a meal.
The objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability.
Systematic review using the Joanna Briggs Institute review methods.
Seven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000-2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator.
Studies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format.
136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation; meal styles; environment adaptations; skills training; music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index.
There is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.
痴呆症是居住在养老院的老年人中最常见的疾病之一。痴呆症对人的进食、饮水和参与进餐活动的能力有重大影响。痴呆症影响记忆、食欲、大运动和精细运动技能、沟通能力、情绪和社交行为，所有这些都会降低人的进食能力。
综述文献，探讨促进居住在养老院的痴呆症患者的进餐功能的策略，并评估其有效性。该综述考虑了报告与营养状况、沟通、行为和进食技能及能力相关的结果测量指标的研究。
采用 Joanna Briggs 研究所的综述方法进行系统综述。
2000 年至 2017 年，在 MEDLINE、CINAHL、Cochrane 系统评价数据库、EMBASE、Current Contents、PsycINFO 和补充与综合医学数据库等 7 个数据库中搜索英文文献。符合条件的研究包括定量研究，比较了居住在养老院的痴呆症患者的进餐干预与标准护理，报告了营养、行为或功能结果，包括无对照的观察性研究。
两名评审员使用基于研究设计的 Joanna Briggs 研究所（JBI）批判性评价工具筛选和独立评价研究。使用 JBI 提取表从合格研究中提取数据，评估研究设计、人群特征、干预措施和对照、结局测量指标和发现。与进餐功能相关的结果以叙述性格式列表报告。
共确定了 136 项研究，其中 20 项符合纳入标准。研究报告的策略涉及：食物呈现；进餐方式；环境调整；技能培训；音乐治疗和动物辅助治疗。结局包括营养状况、沟通和痴呆行为和心理症状的测量指标。低质量证据表明，播放音乐和在餐厅引入鱼类可能会少量增加痴呆症患者的食物摄入量。蒙台梭利和间隔检索程序也对进食技能和营养摄入有一定的积极影响。动物辅助治疗也在体重和体重指数方面显示出统计学上的小幅度改善。
目前没有足够的证据强烈推荐任何特定的干预措施来提高痴呆症患者的进餐功能。需要通过使用有效和可靠的结局测量指标的稳健研究设计进行进一步研究，以证明进餐干预的临床显著效果。
