An occupational view of improving mealtimes for people with dementia in acute hospitals: a mixed methods study

Background and aimsPoor food and fluid intake in older people with dementia is reported in acute hospitals globally. Poor intake can lead to increased mortality rates and longer hospital stays. Mealtimes are a key component of nutritional care in hospitals and involve complex cognitive processes. Additional sensory, behavioural and physical challenges make the process of eating difficult for people with dementia. There is limited research identifying factors influencing mealtime experience and engagement in the eating process for people with dementia during admission to an acute hospital ward. This research project is the first to explore the phenomena of mealtimes for people with dementia in hospital from the perspective of an Occupational Therapist.The aims of this research project were addressed in two phases. Phase 1 aimed to describe factors observed to influence mealtime experience and engagement in the eating process. Phase 2 explored hospital staff perspectives of factors influencing mealtime experience and engagement. The research project also aimed to identify any interventions or strategies to improve mealtimes for people with dementia in the participating hospitals.MethodsA fixed, sequential mixed methods design was applied to the research project, which was conducted in two phases. Phase 1 adopted a concurrent mixed methods design. Structured observations, using Dementia Care Mapping, described levels of well-being and engagement at mealtimes. Qualitative field notes supplemented this data to add depth and meaning to the quantitative coding. Quantitative and qualitative data were merged to present a joint display of the combined findings. Phase 2 was informed by the findings from phase 1. Semi-structuredinterviews were conducted with staff caring for people with dementia on the participating hospital wards.FindingsParticipants were observed to experience mealtimes positively and engage well in the eating process for 24% of the time. For 19% of the time people experienced mealtimes negatively and were disengaged from the eating process. Factors influencing experience and engagement at mealtimes derived from a plethora of complex variables. System-driven factors, with a task-focused approach to care, negatively influenced engagement in the eating process. Person-centred care, promoting meals as a meaningful occupation for individuals, encouraged positive experiences and focused engagement in the eating process at mealtimes. The hospital environment is not always conducive to encouraging cognitive access to mealtimes.Conclusions and implications for practiceThe findings were applied to the Person-Environment-Occupation Fit model. The closer the three elements fit, the greater the positive influence on occupational performance, specifically engagement in the eating process. Recommendations are outlined from the findings, which can be applied to the model, to promote mealtimes as a meaningful occupation. These include family and carer visitor involvement in the meal process, the use of volunteers, a separate dining environment, training and education for staff, improving food selection processes and using Occupational Therapy expertise in providing mealtime care