Improving mealtime care for people with dementia : a training intervention for care homes

Abstract

Background Many people living with dementia have difficulties at mealtimes, which can result in serious complications including ill-health, stress, hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. This thesis describes work to develop an evidence-based training intervention to improve mealtime care for people with dementia in care homes. Method There were three phases to the study. The first phase was a literature review of relevant scientific papers and published guidelines. Evidence was synthesised from diverse sources to identify themes in mealtime care for residents with dementia. The second phase was an ethnography conducted in UK care homes, to explore current practice in mealtime care, and identify good practice. This included mealtime observations, and semi-structured interviews with care home staff, family carers, and visiting health and social care professionals. The third phase was a series of co-development workshops, in which key stakeholders worked together to create a prototype training intervention, using evidence from phases one and two. Results The study found that priorities in mealtime care, such as providing choice, facilitating independence, and promoting adequate nutrition/hydration, were often in tension with one another. In addition, mealtimes operated within a complex system which constrained care. A person-centred approach, focusing on residents’ history, capabilities, preferences and prognosis, helped to resolve tensions between competing priorities in mealtime care. Teamwork between care staff, kitchen staff, management, external health and care professionals, and family carers was key in overcoming contextual constraints. These findings informed the development of a prototype training intervention, in which collaborative learning was emphasised. ii Conclusion This thesis contributes to the field through the co-development of a new prototype intervention to improve mealtime care for people with dementia in care homes. The intervention is informed by new knowledge about good practice in mealtime care for this population, and about how care home staff can overcome contextual constraints on practice. Future work will test the feasibility and acceptability of the prototype training intervention.