Resistance at mealtimes for persons with dementia

Abstract

Background: For persons unable to feed themselves, resistance to assistance with meals may result in increased morbidity and premature mortality because of inadequate nutritional intake. Additionally, unwillingness to accept food offered has social and ethical implications in all cultures and may influence caregiving.

Objective: As part of a larger study, this analysis sought to determine if resistance or willingness to accept assistance at meals by persons with dementia could be predicted by various personal interaction and contextual factors.

Design: Resistance was studied in a sample of 53 nursing home residents with late-stage dementia who were assisted at meals by CNAs. Using the EdFED-Q (Edinburgh Feeding Evaluation in Dementia Questionnaire), two groups of individuals who were being fed were identified: those who resisted assistance (n = 23) and those who accepted assistance (n = 30). Proportion of food consumed was determined by percentage of weight decrease in food offered.

Results: Differences between the two groups were identified. Although not differing in degree of cognitive impairment as measured by the MMSE or Body Mass Index, significant differences (p < .05) were found in level of functioning as measured by the Global Deterioration Scale, the proportion of food consumed and amount of time taken to assist with the meal. Resistors showed significantly different interaction behaviors in 8 of the 10 on the Interaction Behavior Measure-Modified when correlated with food consumed (r = .49 - .68, p < .02).

Conclusion: When examining resistance to feeding a variety of factors must be examined, including the quality of the interaction between the caregiver and the person being fed.