title: Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review.
abstract: BACKGROUND
  Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia).
  
  
  METHODS
  We comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). 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. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively.
  
  
  RESULTS
  We included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions.
  
  
  CONCLUSIONS
  We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try.
  
  
  BACKGROUND
  The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611).
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
authors.forename: Diane K
authors.initials: DK
authors.lastname: Bunn
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.|Present address: Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, UK.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Abdelhamid
authors.affiliation: Age UK Norfolk, 300 St Faith's Road, Old Catton, Norwich, NR6 7BJ, 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.
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.
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.
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.
authors.forename: Anne
authors.initials: A
authors.lastname: Killett
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, 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.|Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
authors.affiliation: Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, 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.
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.|Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, 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: D001521:Behavior Therapy / Q000379:methods; D002986:Clinical Trials as Topic / Q000379:methods; D003681:Dehydration / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D003704:Dementia / Q000175:diagnosis / Q000178:diet therapy* / Q000523:psychology*; D004326:Drinking / Q000502:physiology; D061345:Early Medical Intervention / Q000379:methods*; D004435:Eating / Q000502:physiology / Q000523:psychology*; D015444:Exercise / Q000523:psychology; D006801:Humans; D016896:Treatment Outcome
keywords: Aged; Dehydration; Dementia; Diet; Drinking; Eating; Malnutrition; Meta-analysis