The purpose of this study is to develop and systematically test nursing interventions designed to manage mealtime difficulties and promote functional mealtime behaviors among institutionalized persons with Alzheimer's Disease (AD)). In this study, mealtime behaviors are defined as a chain of behaviors typically associated with eating, including those that involve preparation for eating, the eating behaviors themselves, and those that logically follow eating and conclude mealtime. The chain of behaviors is comprised of units of activity that include handwashing in preparation for the meal, the eating or feeding activities themselves, toileting, handwashing and toothbrushing as a conclusion to the meal. This sequential chain can be conceptualized as self-contained, with a prescribed, identifiable beginning and ending. The self-contained chain of mealtime behaviors, as an entity, may be differentiated from all other daily units of sequential activities and used as a marker for organizing and compartmentalizing daily activities. e study is designed to: 1. develop and test a systematic nursing intervention focused on the context of care during mealtime; 2. develop and test a systematic nursing intervention focused on the care behaviors occurring during mealtime; and 3. describe the separate and interactive effects of context and behavior on preserving and/or improving functional mealtime behaviors. The study will be accomplished in two phases. Phase I, the Observation Phase, is designed to answer eight research questions about the context, sequence and behaviors associated with mealtime in the institutional setting using an exploratory descriptive design. Four subjects will participate in Phase 1. Phase 11, the Intervention Phase, is designed to test a series of hypotheses that predict the effect of the contextual and behavioral interventions over time using a nested, repeated measures experimental design. Video recordings of mealtime behaviors will be used. Eight subjects will participate in Phase II. This project is the third in a series of studies designed by these investigators. It will serve as the basis for continued research designed to prevent imposed disability and preserve functional behavior among institutionalized elderly with a diagnosis of Alzheimer's Disease..
