Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis

Abstract

Background: Eating and drinking difficulties are recognised sources of ill health in people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions to directly improve, maintain or facilitate oral food and drink intake, nutrition and hydration status, in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Interventions included oral nutrition supplementation, food modification, dysphagia management, eating assistance and supporting the social element of eating and drinking.

Methods: We comprehensively searched 13 databases for relevant intervention studies. The review was conducted with service user input in accordance with Cochrane Collaboration's guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data, carrying out random effects meta-analysis and narrative synthesis.

Results: Forty-three controlled interventions were included, disappointingly none were judged at low risk of bias. Oral nutritional supplementation studies suggested small positive short term but unclear long term effects on nutritional status. Food modification or dysphagia management studies were smaller and of low quality, providing little evidence of an improved nutritional status. Eating assistance studies provided inconsistent evidence, but studies with a strong social element around eating/drinking, although small and of low quality provided consistent suggestion of improvements in aspects of quality of life. There were few data to address stakeholders' questions.

Conclusions: We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. People with cognitive impairment and their carers have to tackle eating problems despite this lack of evidence, so promising interventions are listed. The need remains for high quality trials tailored for people with cognitive impairment assessing robust outcomes.

Systematic review registration: The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero.

Fig. 1

EDWINA systematic review PRISMA flow diagram for studies of direct interventions*. *The number of interventions by category adds up to more than 43 (the total number of interventions in this paper) as several interventions were multicomponent, and so represented in several categories

Fig. 2

Forest plot of the effect of RCTs of ONS plus usual food vs usual food alone on weight (in kg). * de Sousa 2012 [37], Simmons 2010 [50], Stange 2011 [51], Wouter-Wesseling 2002 [53] and 2006 [52] provided change data

Fig. 3

Forest plot of the effect of RCTs of ONS plus usual food vs usual food alone on body mass index (in kg/m²)