Holistic approach to mealtimes could help dementia sufferers

Eating together, providing social support and interaction during meals could help people with dementia avoid dehydration and malnutrition – according to new NIHR-funded research from the University of East Anglia.

Findings published reveal that while no interventions were unequivocally successful, promising approaches focused on a holistic approach to mealtimes.

The team found that eating family-style meals with care givers, playing music, and engaging with multisensory exercise – could all help boost nutrition, hydration and quality of life among people with dementia.

Lead researcher Dr Lee Hooper, from UEA’s Norwich Medical School, said: “The risk of dehydration and malnutrition are high in older people, but even higher in those with dementia.

“Malnutrition is associated with poor quality of life so understanding how to help people eat and drink well is very important in supporting health and quality of life for people with dementia.

“We wanted to find out what families or carers can do to help people with dementia eat well and drink enough.”

The team systematically reviewed research from around the world and assessed the effectiveness of 56 interventions which all aimed to improve, maintain, or facilitate food or drink intake among more than 2,200 people with dementia.

Interventions tested included changing the colour of the plate, increasing exercise, waitress service, playing different types of music, singing, doing tai-chi, creating a home-like eating environment, providing nutrition supplements, and boosting the social aspect of eating.

They also looked at whether better education and training for formal or informal care-givers could help, as well as behavioural interventions – such as giving encouragement for eating.

The research team assessed whether these interventions improved hydration status and body weight, and whether the intervention helped older people to enjoy the experience of eating or drinking, and improved their quality of life.

Dr Hooper said: “We found a number of promising interventions – including eating meals with care-givers, having family-style meals, facilitating social interaction during meals, longer mealtimes, playing soothing mealtime music, doing multisensory exercise and providing constantly accessible snacks.

“Providing education and support for formal and informal care-givers were also promising.

“But one of the problems of this research is that many of the studies we looked at were too small to draw any firm conclusions – so no interventions should be clearly ruled in or out and more research in this area is needed.

“It is probably not just what people with dementia eat and drink that is important for their nutritional wellbeing and quality of life – but a holistic mix of where they eat and drink, the atmosphere, physical and social support offered, the understanding of formal care-givers, and levels of physical activity enjoyed.”

The research was undertaken in collaboration with AgeUK Norfolk, NorseCare, the University of Hertfordshire, Norfolk and Norwich University Hospital, Norfolk and Suffolk NHS Foundation Trust, and King’s College Hospital NHS Foundation Trust.

It was funded by a National Institute for Health Research (NIHR) Fellowship Award and supported by the NIHR East of England Collaboration for Leadership in Applied Health Research and Care (CLAHRC).

Article: Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review, Diane K. Bunn, Asmaa Abdelhamid, Maddie Copley, Vicky Cowap, Angela Dickinson, Amanda Howe, Anne Killett, Fiona Poland, John F. Potter, Kate Richardson, David Smithard, Chris Fox and Lee Hooper, BioMed Central (BMC) Geriatrics, doi: 10.1186/s12877-016-0256-8, published 4 May 2016.