Assisted Living Facilities and Nursing Homes Should Strive to Optimize Residents’ Eating Performance

The prevalence of cognitive impairment among residents of assisted living facilities and nursing homes is significantly high (68-72%), among which 42% have moderate to severe impairment. Older adult residents in long-term care who are cognitively impaired suffer greater functional decline pertaining to eating compared to those without dementia. 22% of assisted living residents with cognitive impairment showed functional loss in eating and needed assistance, among which 24% had moderate impairment and 65% had severe impairment. Nursing home residents with severe cognitive impairment showed the greatest loss in eating ability compared with the other activities of daily living (ADLs) within half a year after admission. Eating performance is the functional ability to transfer food into the mouth, and is a critical predictor of physical and psychosocial health, as well as quality of life for long-term care residents. The negative effects of compromised eating performance include inadequate intake and weight loss, malnutrition and breathing problems, eating disability, and even death.

The decline in eating performance ability among long-term care residents with dementia commonly surpasses what is anticipated with aging and progression of dementia. Multilevel factors, such as low staffing levels and policies to prevent weight loss in long-term care settings, influence the risk of compromised eating performance among older adult residents. Care providers may place primary focus on maintaining caloric intake and assist too much with eating as a means of completing feeding quickly. Inappropriate, as well as excessive help with feeding, regardless of patients’ self-eating ability, could reinforce unintended dependence, restrict residents’ autonomy, and encourage resistance to care.

A study found that multilevel, multicomponent, individualized care can effectively engage long-term care residents with dementia in their most optimum level of function pertaining to eating. In accordance with previous research, supplemental approaches at the intrapersonal, interpersonal, environmental, and policy levels, could be effective when incorporated into intervention strategies.

Specifically, in regards to the intrapersonal level, certain eating task-specific training programs for patients may improve procedural memory and step-by-step practice pertaining to eating and improved eating performance. Furthermore, a few functional exercise programs enhanced muscle strength, balance, and gait, and influenced improved extremity range of motion and performance of getting up from a chair and activities of daily living among long-term care residents with cognitive decline. Improvement in physical capability and performance of overall activities of daily living could further assist performance in eating-specific tasks. At the interpersonal level, a number of feeding skill training programs for nursing staff enhanced their knowledge, skills, and behaviors in regards to giving appropriate assistance to optimize patients’ eating performance.

At the environmental level, finger foods that are easily manageable and use of assistive tools (for example, adaptive bowls, plates, and utensils; no-spill cups; and adaptive seat height) also improved independence in eating. It is crucial that these finger foods and tools be provided for residents based on their preferences and underlying physical and cognitive abilities. Lastly, at the policy level, adequate staff and care practice policies aiming to optimize eating performance rather than solely maintaining nutrition intake and preventing weight loss can also help enhance eating performance and help residents maintain their optimal level of function.