Improving mealtimes for people with dementia
Research type
Research Study
Full title
Improving mealtime care for people with dementia – a training intervention for care home staff
IRAS ID
249922
Contact name
James Faraday
Contact email
Sponsor organisation
Newcastle Joint Research Office
Duration of Study in the UK
1 years, 1 months, 30 days
Research summary
Research Summary
Many people with dementia have problems with eating and drinking, particularly as the dementia becomes more advanced. As a result, the person is likely to need increased care at mealtimes. Most people with advanced dementia live in care homes. They are often fully dependent on staff for help with eating and drinking. Mealtimes are fundamental human activities, and are often significant social occasions. Difficulties in this area can be especially distressing for the person, their family, and staff who provide their care.
It is anticipated that better training in mealtime care for care home staff will help people with dementia to have improved quality of life, and to stay healthy (by reducing the risk of problems like malnutrition, dehydration, and pneumonia). It would also help the staff feel empowered to do their job well. Clinical experience indicates that training only happens intermittently, and varies from place to place. It is not often designed in a way that has been proven to work.This project will develop a training intervention to support care home staff to provide the best possible mealtime care for people with dementia. It will include the following phases:
Phase 1: Systematic review. I will review existing evidence about the mealtime care provided to people with dementia in care homes, and investigate current training on this topic.
Phase 2: Ethnographic fieldwork. I will observe mealtimes in care homes, and talk to those involved in mealtimes, to explore what works well and what doesn’t.
Phase 3: Co-development workshops. I will arrange a series of workshops, to design a training intervention using the information obtained in the previous stages. The workshop participants will be: family carers of people with dementia; care home staff and managers; speech and language therapists; dieticians; experts in education/ training.
Phase 4: Feasibility study. I will test the training intervention in care homes, to see if it can be implemented successfully.
This application is for phases 2 and 3 of the project (ethnographic fieldwork, and co-development workshops). Phase 1 (systematic review) does not require ethical approval. A subsequent application will be made for phase 4 (feasibility study).
Summary of Results
Mealtimes are important to health and quality of life. Some people with dementia need support at mealtimes, particularly in care homes. It is essential that carers have the skills and knowledge needed to provide that support. The aim of this project was to understand what is really important in mealtime care for people living with dementia – and to work with key people to create a staff training programme.After initially reviewing relevant research papers and guidelines, I spent a prolonged period of time going into two care homes in north east England, carrying out an ethnographic study. This means I observed mealtimes and talked to residents and everyone involved in their care, to find out what the real issues are in practice. From this work, I identified several important characteristics of good mealtime care for residents with dementia. Firstly, it empowered residents to make choices. Secondly, it helped them to eat and drink as independently as possible. Thirdly, it emphasised the social aspects of mealtimes. Fourthly, it promoted adequate nutrition and hydration. In addition, I found that two over-arching principles could enable care home staff to provide enhanced care and overcome some inherent challenges and constraints in this work; these principles were person-centred care, and teamwork.
I used these findings to inform a series of online workshops. For the workshops, I gathered a group of people with experience and insight into mealtime care. These were family carers of people who have dementia; care home staff and managers; health and social care staff; and a specialist in training. Working together, we reviewed the evidence on mealtime care (from relevant literature and from my ethnographic study), and used it to create a prototype training programme for care home staff. Workshop members made decisions about training content, so that it covered important aspects of mealtime care. The content topics that we included in the prototype training programme were: empowerment and respect; facilitating independence; social interaction; being safe; and careful encouragement. The format of the training was also shaped by relevant research findings. Case studies based on actual events were included, to give emphasis to the real experience of people with dementia – reflecting a person-centred approach. In addition, group discussion was a fundamental part of the training prototype, to encourage collaborative problem-solving among learners – pointing to the importance of teamwork in mealtime care.
REC name
Social Care REC
REC reference
19/IEC08/0020
Date of REC Opinion
5 Jun 2019
REC opinion
Further Information Favourable Opinion