The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: A secondary analysis.
BACKGROUND
Nursing home residents with dementia experience increased risk for compromised eating performance due to intrapersonal, interpersonal, and environmental factors. Environmental stimulation is physical, social, and/or sensory stimulation present in the environment that can potentially trigger individuals' emotion or motivate physical reactions. Beyond the personal factors, there is a lack of evidence on how environmental stimulation influences individuals' eating performance at mealtimes.


OBJECTIVE
This study examined the association between environmental stimulation and eating performance among nursing home residents with dementia.


METHODS
This study was a secondary analysis using baseline videos selected from a communication intervention study, where videos were recorded to capture staff-resident interactions during care activities for nursing home residents with dementia. Videos were included in this study only if residents demonstrated eating activities at mealtimes.


METHODS
A total of 36 videos were selected (mean length=4min). The sample included 15 residents with dementia (mean age=86), and 19 certified nursing assistants (mean age=36) in 8 nursing homes.


METHODS
The dependent variable was eating performance as measured by the Level of Eating Independence scale (range: 15-36, with higher scores indicating better eating performance). The independent variables were characteristics of environmental stimulation measured by the Person-Environment Apathy Rating-Environment subscale (stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback). Each characteristic was rated on a 1-4 scale with higher scores indicating more desirable environmental stimulation. Multilevel models were used to examine the association between eating performance and environmental stimulation, adjusting for resident characteristics (i.e., age, gender, dementia stage, function, comorbidity, psychoactive medication use) and nesting effects of residents and staff.


RESULTS
Resident participants demonstrated moderate levels of eating performance (M=27.08, SD=5.16). Eating performance was significantly lower among older residents, those with more advanced dementia, and higher comorbidity. After controlling for resident characteristics, eating performance was significantly associated with stimulation specificity (how the stimulation is delivered and tailored to the resident), and was not associated with other environmental stimulation characteristics. For each 1 point increase in stimulation specificity, eating performance increased by 8.78 points (95% CI=0.59, 16.97).


CONCLUSIONS
Environmental stimulation that is personally tailored to a resident' needs and preferences and directly offered to a resident contributed to better eating performance among residents with dementia. The findings will direct future development and implementation of person-directed mealtime care programs and dining environment arrangements for residents with dementia in nursing homes.
The University of Iowa, College of Nursing, 432 CNB, 50 Newton Road, Iowa City, IA, 52242, USA. Electronic address: liuwenring18@gmail.com.
Wen
W
Liu
Pennsylvania State University, College of Nursing, University Park, PA, USA.
Ying-Ling
YL
Jao
University of Kansas, School of Nursing, Kansas City, KS, USA.
Kristine
K
Williams
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000451:nursing / Q000503:physiopathology*; D004435:Eating; D006801:Humans; D009735:Nursing Homes
Dementia; Eating performance; Environmental stimulation; Nursing homes; Older adults