title: Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis.
abstract: BACKGROUND
  Eating and drinking difficulties are recognised sources of ill health in people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions to directly improve, maintain or facilitate oral food and drink intake, nutrition and hydration status, in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Interventions included oral nutrition supplementation, food modification, dysphagia management, eating assistance and supporting the social element of eating and drinking.
  
  
  METHODS
  We comprehensively searched 13 databases for relevant intervention studies. The review was conducted with service user input in accordance with Cochrane Collaboration's guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data, carrying out random effects meta-analysis and narrative synthesis.
  
  
  RESULTS
  Forty-three controlled interventions were included, disappointingly none were judged at low risk of bias. Oral nutritional supplementation studies suggested small positive short term but unclear long term effects on nutritional status. Food modification or dysphagia management studies were smaller and of low quality, providing little evidence of an improved nutritional status. Eating assistance studies provided inconsistent evidence, but studies with a strong social element around eating/drinking, although small and of low quality provided consistent suggestion of improvements in aspects of quality of life. There were few data to address stakeholders' questions.
  
  
  CONCLUSIONS
  We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. People with cognitive impairment and their carers have to tackle eating problems despite this lack of evidence, so promising interventions are listed. The need remains for high quality trials tailored for people with cognitive impairment assessing robust outcomes.
  
  
  BACKGROUND
  The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. Asmaa.abdelhamid@rcpch.ac.uk.|Present address: Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, UK. Asmaa.abdelhamid@rcpch.ac.uk.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Abdelhamid
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. D.Bunn@uea.ac.uk.
authors.forename: Diane
authors.initials: D
authors.lastname: Bunn
authors.affiliation: Age UK Norfolk, 300 St Faith's Road, Old Catton, Norwich, NR6 7BJ, UK. Maddie.Copley@ageuknorfolk.org.uk.
authors.forename: Maddie
authors.initials: M
authors.lastname: Copley
authors.affiliation: NorseCare, Lancaster House 16 Central Avenue St Andrew's Business Park, Norwich, NR7 0HR, UK. Vicky.Cowap@norsecare.co.uk.
authors.forename: Vicky
authors.initials: V
authors.lastname: Cowap
authors.affiliation: School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK. a.m.dickinson@herts.ac.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Dickinson
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. Lucy.Gray@uea.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Gray
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. Amanda.Howe@uea.ac.uk.
authors.forename: Amanda
authors.initials: A
authors.lastname: Howe
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. A.Killett@uea.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Killett
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. Jin.Lee@uea.ac.uk.
authors.forename: Jin
authors.initials: J
authors.lastname: Lee
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. Francesca.Li@uea.ac.uk.
authors.forename: Francesca
authors.initials: F
authors.lastname: Li
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. F.Poland@uea.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Poland
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. John.Potter@uea.ac.uk.|Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. John.Potter@uea.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Potter
authors.affiliation: Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. kate.richardson@nnuh.nhs.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Richardson
authors.affiliation: King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK. david.smithard@nhs.net.
authors.forename: David
authors.initials: D
authors.lastname: Smithard
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. Chris.Fox@uea.ac.uk.|Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK. Chris.Fox@uea.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK. l.hooper@uea.ac.uk.
authors.forename: Lee
authors.initials: L
authors.lastname: Hooper
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000150:complications* / Q000503:physiopathology; D003681:Dehydration / Q000209:etiology / Q000517:prevention & control; D003704:Dementia / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D004327:Drinking Behavior / Q000502:physiology; D005247:Feeding Behavior / Q000502:physiology; D006801:Humans; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control; D044623:Nutrition Therapy / Q000379:methods*; D009752:Nutritional Status; D011788:Quality of Life; D016896:Treatment Outcome