Wen Liu

Background and Objectives It is critical to use validated instruments to diagnose and manage chewing and swallowing problems of persons living with dementia. The study aimed to synthesize the characteristics and psychometric quality of instruments that assess the chewing and swallowing abilities of persons living with dementia. Research Design and Methods The systematic review was used to conduct this study. We searched 5 electric databases for records published from January 1, 1980, to July 8, 2022. Records were eligible if they included any instrument to assess chewing ability or swallowing ability in the dementia population. Eight characteristics of eligible instruments were extracted from the records: (1) development process, (2) operationalized concept/construct, (3) sample and setting, (4) administration method, (5) items, (6) scoring format/interpretation, (7) reliability, and (8) validity. The psychometric assessment for self-report and observational tool was used to evaluate 12 psychometric properties of eligible instruments. Results In total, 11,074 records were reviewed. Thirty-five eligible instruments, including observational tools, self-report questionnaires, and physiological instruments, were identified from 60 records. All 8 instruments assessing chewing ability were evaluated as having low psychometric quality, and only 3 out of 27 instruments assessing swallowing ability were evaluated as having moderate psychometric quality. Fifteen instruments were tested for only 1 type of psychometric property, limiting the overall evaluation of psychometric evidence. Discussion and Implications The study findings inform the use and adaptation of appropriate instruments for practice and research. All existing instruments warrant further validation in larger samples to expand use in diverse care settings. This review described and evaluated current instruments measuring chewing and swallowing abilities and potential use in research and clinical practice to plan for and evaluate the effectiveness of mealtime and oral care practice and reduce health-related negative outcomes of persons living with dementia.

Introduction Mealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person‐centred and task‐centred care and positive/neutral and challenging mealtime behaviours in persons with dementia. Methods This study was a secondary behavioural analyses of videotaped mealtime observations ( n = 110) involving 42 unique staff‐resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video‐coding scheme was used to code videos during 2019–2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person‐centred and task‐centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression. Results Staff person‐centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09–1.76), functional impairments (OR = 0.81, 95% CI = 0.66–1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18–2.31). Staff person‐centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02–1.74). Staff task‐centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours. Conclusion This study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person‐centred approaches and resident positive and challenging behaviours. Person‐centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.