title: Evaluating Nonverbal Behavior of Individuals with Dementia During Feeding: A Survey of the Nursing Staff in Residential Care Homes for Elderly Adults.
abstract: OBJECTIVE
  To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city.
  
  
  METHODS
  Nursing staff members (N = 131) in 12 nursing homes.
  
  
  METHODS
  Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding.
  
  
  RESULTS
  Ninety-three percent of survey participants considered the nonverbal behavior of residents with advanced dementia crucial for decisions about artificial nutrition and hydration (ANH). The same percentage had at some point encountered residents who did not open their mouths when feeding was attempted. Fifty-three percent of the participants interpreted residents' expressions of pleasure while eating as a will to live. The most frequent interpretation of residents' aversive behavior was discomfort. When residents did not open their mouth during nurse's hand feeding, 41% of the participants inferred a will to die.
  
  
  CONCLUSIONS
  Most nurses and nursing assistants consider residents' behavior during hand or tube feeding to be important, but their interpretations are heterogeneous. Various professional caregivers assume a will to live or die. Further reflection is necessary to determine how behavioral expressions should be factored into treatment decisions.
authors.affiliation: Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Kuehlmeyer
authors.affiliation: Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Anna F
authors.initials: AF
authors.lastname: Schuler
authors.affiliation: Institute of Psychogerontology, Friedrich Alexander Universität, Erlangen-Nuremberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kolb
authors.affiliation: Chair in Palliative Medicine, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Borasio
authors.affiliation: Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Jox
keywords: artificial nutrition and hydration; dementia; ethics; personal autonomy; treatment decisions