Persons living with Alzheimer?s Disease and Related Dementias (ADRD) commonly experience functional, cognitive and behavioral symptoms that interfere with the intake process (mealtime difficulties), which lead to low food and fluid intake, and various negative functional and nutritional consequences. Despite increased risks and consequences of mealtime difficulties and low intake, caregivers are neither prepared nor aided in the management of these two significant and interrelated public health problems. Current dementia mealtime care programs primarily focus on feeding techniques, and fail to address caregiver needs for knowledge and skills in providing optimal mealtime care. Person-centered care (PCC) that is directly tailored and delivered to residents, rather than task-centered care (TCC) that focuses on completion of tasks regardless of resident needs, is highly recommended for mealtime. While evidence on the role of PCC during mealtime is emerging, little work has looked at the impact of PCC vs TCC on a broader array of mealtime difficulties and intake outcomes in a temporal manner, limiting the development of effective caregiver training programs. To address this gap, the objective of this project is to identify the patterns and distributions of and temporal associations between a) caregiver PCC and TCC behaviors, and b) resident mealtime difficulties and intake. Our team is well positioned to accomplish this project in that: a) we have access to 111 video recordings of caregiver- resident mealtime interaction from a prior R01; b) we developed and validated the Cue Utilization and Engagement in Dementia (CUED) mealtime video-coding scheme as an innovative, feasible and reliable tool to assess a) caregiver PCC and TCC behaviors, and b) resident mealtime difficulties and intake. Descriptive statistics will be used to characterize the patterns and distributions of coded behaviors (Aim 1); and sequential analysis to examine their temporal associations (Aim 2). This project is well-suited to the program announcement for developing the next generation of clinical researchers in ADRD research, and supporting innovative areas of research with significant needs to improve care for ADRD. This project is a critical first step to accomplish the long-term goal of the applicant as an early stage investigator who is developing a research program addressing optimal mealtime care to minimize mealtime difficulties and low intake in ADRD. Results of the study will be used to prepare a larger RCT that will develop and evaluate an innovative mealtime caregiver training program, preparing caregivers with knowledge and skills in maximizing (minimizing) the use of specific care approaches that reduce (trigger) mealtime difficulties and improve (decrease) intake. This next step complements the NIA strategic focus to support and conduct behavioral research in aging and ADRD population to improve health, well-being, and function as they age. Further, findings of this study is essential in providing a cost rationale for training caregivers in that the use of effective care approaches that reduce resident disruptive behaviors has great potential in reducing staff time and workload during mealtime care.
Despite the recognized increased risks and consequences of mealtime difficulties and insufficient intake, dementia caregivers are neither prepared nor aided in the management of these two interrelated and important public health care problems to achieve optimal mealtime care. Using an established and innovative computer- assisted behavioral video-coding scheme as a reliable and useful tool to assess caregiver-resident mealtime interaction, the proposed study examines the patterns of and temporal relationship between a) caregiver person-centered and task-centered behaviors, and b) resident mealtime difficulties and intake. Findings of the study will guide the development and evaluation of innovative mealtime care programs to address a significant long-term care need by helping caregivers learn how to decrease mealtime difficulties when assisting adults with ADRD to maximize individual intake and improve nutrition and quality of life as fundamental health needs as cognition declines.
