Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia.
BACKGROUND
Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake.


OBJECTIVE
To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand (DH), Over Hand (OH), and Under Hand (UH).


METHODS
A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences.


METHODS
30 residents living with advanced dementia in 11 U.S. NHs.


METHODS
Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale.


METHODS
Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N = 540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every 2 days.


RESULTS
Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67 ± 15.2%) and UH (65 ± 15.0%) with both significantly greater than OH (60 ± 15.1%). Feeding behaviors were more frequent with OH (8.3 ± 1.8%), relative to DH (8.0 ± 1.8) and UH (7.7 ± 1.8).


CONCLUSIONS
All three techniques are time neutral. UH and DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding.
Duke University School of Nursing, Durham, North Carolina.
Melissa K
MK
Batchelor-Murphy
Duke University School of Nursing, Durham, North Carolina.
Eleanor S
ES
McConnell
College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
Elaine J
EJ
Amella
University of North Carolina School of Nursing, Chapel Hill, North Carolina.
Ruth A
RA
Anderson
Duke University Medical Center/Durham VA Medical Center, Durham, North Carolina.
Connie W
CW
Bales
Duke University School of Nursing, Durham, North Carolina.
Susan
S
Silva
Duke University School of Nursing, Durham, North Carolina.
Angel
A
Barnes
University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Cornelia
C
Beck
Duke University Medical Center, Durham, North Carolina.
Cathleen S
CS
Colon-Emeric
D000368:Aged; D003704:Dementia / Q000503:physiopathology*; D004435:Eating; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D014481:United States
dementia; feeding behaviors; handfeeding; mealtime difficulties; nursing home