School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.
School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
Australas J Ageing. 2023 Jun;42(2):280-292. doi: 10.1111/ajag.13192. Epub 2023 Mar 28.
This systematic review and meta-analysis aimed to examine non-pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status.
The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non-RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta-analysis.
The systematic review and meta-analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta-analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of -1.36 (95% confidence interval: -1.84 to -0.89, p < 0.001) and on self-feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta-analysis, these interventions had no effect on improving the nutritional status of people with dementia.
None of the included RCTs met the Cochrane risk-of-bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions.
本系统评价和荟萃分析旨在研究非药物干预措施，以帮助患有痴呆症且存在进食困难的患者改善营养状况。
使用 PsycINFO、Medline、PubMed、CINAHL 和 Cochrane 对文章进行检索。两名独立的研究者对合格的研究进行了批判性评估。使用 PRISMA 指南和清单。使用评估随机对照试验（RCT）和非 RCT 研究质量的工具评估偏倚风险的可能性。采用叙述性综合方法进行综合。使用 Cochrane 评论管理（RevMan 5.4）进行荟萃分析。
系统评价和荟萃分析包括 7 篇文献。确定了 6 种干预措施，并将其分为：痴呆症患者的进食能力训练、员工培训和喂养辅助和支持。荟萃分析发现，进食能力训练对进食困难的影响有证据，以爱丁堡痴呆症进食评估量表（EdFED）量化，加权均数差为-1.36（95%置信区间：-1.84 至-0.89，p<0.001）和自我进食时间。间隔检索干预对 EdFED 有积极影响。系统评价发现，尽管喂养辅助对进食困难有积极影响，但员工培训没有效果。根据荟萃分析，这些干预措施对改善痴呆症患者的营养状况没有影响。
没有一项纳入的 RCT 符合 Cochrane 随机试验的偏倚风险标准。本研究发现，对痴呆症患者的直接训练和护理人员的间接喂养支持可减少用餐时的困难。需要更多的 RCT 研究来确定这些干预措施的疗效。
