title: An evolutionary analysis of mealtime difficulties in older adults with dementia.
abstract: OBJECTIVE
  To use the evolutionary method of concept analysis to identify attributes, antecedents and consequences of mealtime difficulties providing direction for assessment and management in older adults with dementia.
  
  
  BACKGROUND
  Mealtimes encompass more than the physical act of feeding a person with dementia. Social and contextual considerations are vital considerations to improving nutritional intake. While feeding difficulties in dementia have been analysed in the literature, this paper proposes a broader scope of mealtime considerations to alleviate nutritional deficiencies often associated with dementia.
  
  
  METHODS
  Evolutionary method of concept analysis.
  
  
  METHODS
  In 2008, literature searches using keywords (meal, history, sociology, mealtime, culture, habit, dementia, dementia) were done in CINAHL, Academic Search Premiere, MasterFILE, Americal Life and History, Communication and Mass Media Complete, EJS, Health Source Plus-Academic, PsychARTICLES and PsychINFO, ScienceDirect, Sociological Abstracts and Google. Year limits were from 1988-2008. A total of 659 abstracts were reviewed, Google, books and textbooks with relevant content.
  
  
  RESULTS
  Fourty-eight sources were used in the final analysis of mealtime difficulties in older adults with dementia. A model of mealtime difficulties delineates attributes, antecedents and consequences.
  
  
  CONCLUSIONS
  Mealtime difficulties in dementia emerged as a concept with supporting evidence-based practice guidelines in 2003. Most research has been conducted in institutional settings, but community research is growing as the shifting demographics of ageing demand attention for this setting. Interventions vary in effectiveness for alleviating sequelae of mealtime difficulties in older adults with dementia.
  
  
  CONCLUSIONS
  The conceptual model of mealtime difficulties provides a broader scope of mealtime difficulties in dementia that considers environmental, social, cultural and contextual implications with nutritional intake. The model can be used to guide future research to alleviate mealtime difficulties in older adults with dementia.
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. aselage@musc.edu
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Aselage
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Amella
mesh_terms: D000368:Aged; D003469:Culture; D003704:Dementia / Q000451:nursing* / Q000503:physiopathology; D005247:Feeding Behavior / Q000502:physiology / Q000523:psychology; D006801:Humans; D044342:Malnutrition / Q000517:prevention & control