title: Effectiveness of mealtime interventions on behavior symptoms of people with dementia living in care homes: a systematic review.
abstract: OBJECTIVE
  Elderly residents with dementia commonly exhibit increased agitation at mealtimes. This interferes with eating and can be distressing for both the individual and fellow residents. This review examines the effectiveness of mealtime interventions aimed at improving behavioral symptoms in elderly people living with dementia in residential care.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline, PsycINFO, Embase, HMIC, AMED (OvidSP); CDSR, CENTRAL, DARE (Cochrane Library, Wiley); CINAHL (EBSCOhost); British Nursing Index (NHS Evidence); ASSIA (ProQuest); Social Science Citation Index (Web of Knowledge); EThOS (British Library); Social Care Online and OpenGrey from inception to November 2012. Forward and backward citation chases, hand searches of other review articles identified in the search, and key journals.
  All comparative studies were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Data were not suitable for meta-analysis so narrative synthesis was carried out.
  
  
  RESULTS
  A total of 6118 articles were identified in the original search. Eleven articles were finally included. Mealtime interventions were categorized into 4 types: music, changes to food service, dining environment alteration, and group conversation. Study quality was poor, making it difficult to reach firm conclusions. Although all studies showed a trend in favor of the intervention, only 6 reported a statistically significant improvement in behavioral symptoms. Four studies suggest cumulative or lingering effects of music on agitated and aggressive behaviors.
  
  
  CONCLUSIONS
  There is some evidence to suggest that mealtime interventions improve behavioral symptoms in elderly people with dementia living in residential care, although weak study designs limit the generalizability of the findings. Well designed, controlled trials are needed to further understand the utility of mealtime interventions in this setting.
authors.affiliation: PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK. Electronic address: r.s.whear@exeter.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Whear
authors.affiliation: PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Abbott
authors.affiliation: PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Thompson-Coon
authors.affiliation: PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Bethel
authors.affiliation: PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Morwenna
authors.initials: M
authors.lastname: Rogers
authors.affiliation: Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Hemsley
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK.
authors.forename: Will
authors.initials: W
authors.lastname: Stahl-Timmins
authors.affiliation: PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Stein
mesh_terms: D000368:Aged; D032763:Behavior Control / Q000379:methods / Q000592:standards; D003704:Dementia / Q000523:psychology*; D006801:Humans; D062407:Meals; D009735:Nursing Homes; D015397:Program Evaluation
keywords: Dementia; mealtime; residential care; systematic review