Eating Difficulties and Relationship With Nutritional Status Among Patients With Dementia

10.1097/jnr.0000000000000538

Ozlem CILIZ；Zeliha TULEK；Hasmet HANAGASI；Basar BILGIC；I. Hakan GURVIT

dementia ； eating difficulties ； self-feeding skills ； malnutrition

The Journal of Nursing Research

31卷1期（2023 / 02 / 01）

1 - 9

英文

Background: One of the most common behavioral problems in patients with dementia is eating problems, which are known to increase the risk of malnutrition. However, few studies have been conducted in this patient group regarding the relationship between eating difficulties and nutritional status. Purpose: This study was designed to determine the eating difficulties faced by patients with dementia and to evaluate the relationship in this population between eating difficulties and malnutrition. Methods: This study was carried out in a dementia outpatient clinic of a university hospital in Istanbul, Turkey. This cross-sectional, case-control study included 50 patients and 50 healthy controls as participants. Participants were assessed for eating difficulties and for nutritional, cognitive, and functional statuses. Results: The patients with dementia had more difficulties in terms of self-feeding skills. Although problems related to manipulating food on the plate and the use of utensils were not seen in the control group, these problems were found in 30% of the participants in the dementia group (p < .001). Moreover, 30% of the patients in the dementia group were unable to eat without assistance (p < .001). Associations were found between eating difficulties and age, duration of illness, and cognitive and functional (basic and instrumental activities of daily living) statuses. In addition, self-feeding skills were found to be associated with nutritional status. Rate of malnutrition or risk of malnutrition was higher in patients with dementia than in those in the control group. Conclusions: In this study, compared with the control group, patients with dementia had more problems in self-feeding skills such as manipulation of food on a plate, use of utensils, need for assistive tools, ability to eat without assistance, and negative eating behaviors (refusal to eat).An association was found between eating difficulties and nutritional status. Evaluating eating difficulties is recommended in patients with dementia to prevent nutritional deterioration.

1. Çebi, M.,Babacan, G.,Öktem Tanör, Ö.,Gürvit, H.(2020).Discrimination ability of the Short Test of Mental Status (STMS) compared to the Mini Mental State Examination (MMSE) in the spectrum of normal cognition, mild cognitive impairment, and probable Alzheimer's disease dementia: The Turkish standardization study.Journal of Clinical and Experimental Neuropsychology,42(5),450-458.
2. Chandra, S. R.,Issac, T. G.,Abbas, M. M.(2015).Apraxias in neurodegenerative dementias.Indian Journal of Psychological Medicine,37(1),42-47.
3. Chang, C. C.(2012).Prevalence and factors associated with feeding difficulty in institutionalized elderly with dementia in Taiwan.The Journal of Nutrition, Health & Aging,16(3),258-261.
4. Chang, C. C.,Roberts, B. L.(2011).Strategies for feeding patients with dementia.The American Journal of Nursing,111(4),36-44.
5. Chang, C.-C.,Lin, Y.- F.,Chiu, C.-H.,Liao, Y.-M.,Ho, M.-H.,Lin, Y.- K.,Chou, K.-R.,Liu, M. F.(2017).Prevalence and factors associated with food intake difficulties among residents with dementia.PLOS ONE,12(2),e0171770.
6. Cipriani, G.,Carlesi, C.,Lucetti, C.,Danti, S.,Nuti, A.(2016).Eating behaviors and dietary changes in patients with dementia.American Journal of Alzheimer's Disease and Other Dementias,31(8),706-716.
7. Folstein, M. F.,Folstein, S. E.,McHugh, P. R.(1975)."Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.Journal of Psychiatric Research,12(3),189-198.
8. Gauthier, S.,Rosa-Neto, P.,Morais, J. A.,Webster, C.(2021).,Alzheimer's Disease International.
9. Gungen, C.,Ertan, T.,Eker, E.,Yasar, R.,Engin, F.(2002).Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population.Turkish Journal of Psychiatry,13(4),273-281.
10. Gurvit, H.,Emre, M.,Tinaz, S.,Bilgic, B.,Hanagasi, H.,Sahin, H.,Gurol, E.,Kvaloy, J. T.,Harmanci, H.(2008).The prevalence of dementia in an urban Turkish population.American Journal of Alzheimer's Disease & Other Dementias,23(1),67-76.
11. Hopman-Rock, M.,van Hirtum, H.,de Vreede, P.,Freiberger, E.(2019).Activities of daily living in older community-dwelling persons: A systematic review of psychometric properties of instruments.Aging Clinical and Experimental Research,31(7),917-925.
12. Hoshino, D.,Watanabe, Y.,Edahiro, A.,Kugimiya, Y.,Igarashi, K.,Motokawa, K.,Ohara, Y.,Hirano, H.,Myers, M.,Hironaka, S.,Maruoka, Y.(2020).Association between simple evaluation of eating and swallowing function and mortality among patients with advanced dementia in nursing homes: 1-year prospective cohort study.Archives of Gerontology and Geriatrics,87,103969.
13. Kai, K.,Hashimoto, M.,Amano, K.,Tanaka, H.,Fukuhara, R.,Ikeda, M.(2015).Relationship between eating disturbance and dementia severity in patients with Alzheimer's disease.PLOS ONE,10(8),e0133666.
14. Keller, H. H.,Carrier, N.,Slaughter, S. E.,Lengyel, C.,Steele, C. M.,Duizer, L.,Morrison, J.,Brown, K. S.,Chaudhury, H.,Yoon, M. N.,Duncan, A. M.,Boscart, V.,Heckman, G.,Villalon, L.(2017).Prevalence and determinants of poor food intake of residents living in long-term care.Journal of the American Medical Directors Association,18(11),941-947.
15. Küçükdeveci, A. A.,Yavuzer, G.,Tennant, A.,Süldür, N.,Sonel, B.,Arasil, T.(2000).Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey.Scandinavian Journal of Rehabilitation Medicine,32(2),87-92.
16. Küçükgüçlü, Ö.,Söylemez, B. A.,Yener, G.,Barutcu, C. D.,Akyol, M. A.(2017).Examining factors affecting caregiver burden: A comparison of frontotemporal dementia and Alzheimer's disease.American Journal of Alzheimer's Disease & Other Dementias,32(4),200-206.
17. Lee, G.(2020).Impaired cognitive function is associated with motor function and activities of daily living in mild to moderate Alzheimer's dementia.Current Alzheimer Research,17(7),680-686.
18. Lee, K. M.,Song, J. A.(2015).Factors influencing the degree of eating ability among people with dementia.Journal of Clinical Nursing,24(11-12),1707-1717.
19. Lin, L. C.,Watson, R.,Lee, Y. C.,Chou, Y. C.,Wu, S. C.(2008).Edinburgh Feeding Evaluation in Dementia (EdFED) scale: Cross-cultural validation of the Chinese version.Journal of Advanced Nursing,62(1),116-123.
20. Liu, W.,Jao, Y. L.,Williams, K.(2017).The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: A secondary analysis.International Journal of Nursing Studies,71,70-79.
21. Liu, W.,Tripp-Reimer, T.,Williams, K.,Shaw, C.(2020).Facilitators and barriers to optimizing eating performance among cognitively impaired older adults: A qualitative study of nursing assistants' perspectives.Dementia,19(6),2090-2113.
22. Mann, K.,Lengyel, C. O.,Slaughter, S. E.,Carrier, N.,Keller, H.(2019).Resident and staff mealtime actions and energy intake of long-term care residents with cognitive impairment: Analysis of the making the most of mealtimes study.Journal of Gerontological Nursing,45(8),32-42.
23. Miyamoto, K.,Higashino, S.,Mochizuki, K.,Goda, T.,Koyama, H.(2011).Evaluation of weight loss in the community-dwelling elderly with dementia as assessed by eating behavior and mental status.Asia Pacific Journal of Clinical Nutrition,20(1),9-13.
24. Pfeffer, R. I.,Kurosaki, T. T.,Harrah, C. H.,Chance, J. M.,Filos, S.(1982).Measurement of functional activities in older adults in the community.Journal of Gerontology,37(3),323-329.
25. Roque, M.,Salva, A.,Vellas, B.(2013).Malnutrition in community-dwelling adults with dementia (NutriAlz Trial).The Journal of Nutrition, Health & Aging,17(4),295-299.
26. Rubenstein, L. Z.,Harker, J. O.,Salva, A.,Guigoz, Y.,Vellas, B.(2001).Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF).The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences,56(6),M366-M372.
27. Rullier, L.,Lagarde, A.,Bouisson, J.,Bergua, V.,Barberger-Gateau, P.(2013).Nutritional status of community-dwelling older people with dementia: Associations with individual and family caregivers' characteristics.International Journal of Geriatric Psychiatry,28(6),580-588.
28. Sarikaya, D.,Halil, M.,Kuyumcu, M. E.,Kilic, M. K.,Yesil, Y.,Kara, O.,Ozturk, S.,Gungor, E.,Karabulut, E.,Balam Yavuz, B.,Cankurtaran, M.,Ariogul, S.(2015).Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults.Archives of Gerontology and Geriatrics,61(1),56-60.
29. Saucedo Figueredo, M. C.,Morilla Herrera, J. C.,Ramos Gil, R.,Arjona Gomez, M. N.,Garcia Dillana, F.,Martinez Blanco, J.,Morales Asencio, J. M.(2016).Validation of the Spanish version of the Edinburgh feeding evaluation in dementia scale applied to institutionalized older persons with dementia: A study protocol.Nursing Open,3(4),236-242.
30. Selekler, K.,Cangöz, B.,Karakoç, E.(2004).Adaptation and norm determination study of the functional activities questionnaire (FAQ) on Turkish adults (ages 50 and over).Turkish Journal of Neurology,10(2),102-107.
31. Slaughter, S. E.,Eliasziw, M.,Morgan, D.,Drummond, N.(2011).Incidence and predictors of eating disability among nursing home residents with middle-stage dementia.Clinical Nutrition,30(2),172-177.
32. The World Bank. (2019). Life expectancy at birth, total (years). https://data.worldbank.org/indicator/SP.DYN.LE00.IN?view=chart
33. Tombini, M.,Sicari, M.,Pellegrino, G.,Ursini, F.,Insarda, P.,Di Lazzaro, V.(2016).Nutritional status of patients with Alzheimer's disease and their caregivers.Journal of Alzheimer's Disease,54(4),1619-1627.
34. Westergren, A.(2019).The Minimal Eating Observation Form-Version II revisited: Validity and reliability.Journal of Nursing Measurement,27(3),478-492.
35. Westergren, A.,Lindholm, C.,Mattsson, A.,Ulander, K.(2009).Minimal eating observation form: Reliability and validity.The Journal of Nutrition, Health & Aging,13(1),6-12.
36. World Health Organization(2018).Towards a dementia plan: A WHO guide.Author.