Title: Improving mealtime care for people with dementia – a training intervention for care home staff
Funder: Health Education England

Abstract: Eating and drinking difficulties are prevalent in people with dementia (PwD), putting them at risk of aspiration pneumonia and undernutrition/dehydration (and consequently hospital admission), and posing major challenges to carers and clinical services. These difficulties are more common in advanced dementia, and so are particularly prevalent among PwD living in care homes. Here, staff are responsible for promoting optimal and safe oral intake (which often includes providing assistance with eating/drinking), and for responding to difficulties at mealtimes. It is essential, therefore, that staff who care for PwD are well-trained in providing care at mealtimes. This would result in better health outcomes and quality of life for PwD, greater empowerment for care home staff, and a better use of clinical resources. Speech and Language Therapists (SLTs) have a remit from their professional body to provide training of this kind, however current training provision is sporadic, and not evidence-based. There is a paucity of adequate training on mealtime care for PwD reported in the literature. Recent systematic reviews have highlighted that more rigorous research is needed on the topic of mealtime care in PwD, and in particular that future training interventions should be more systematically developed and evaluated, take greater account of the views of stakeholders (for example, PwD, care home staff, families), and have increased involvement from relevant professionals including SLTs and Dieticians. Aims To develop and test the feasibility of a training intervention to support and enable care home staff to provide optimal mealtime care for people with dementia. A prototype training intervention will be developed, which is informed by relevant theory and evidence, and integrates the experience and expertise of key stakeholders to ensure the content is appropriate and the format is feasible. Plan of investigation The project has four phases: (1) Systematic review of existing evidence on optimal mealtime care for PwD in care homes, and current training provision; (2) Ethnographic study to investigate (i) current and good practice in mealtime care for PwD in care homes; (ii) barriers and facilitators to providing optimal mealtime care for PwD in care homes; (3) Co-development work involving key stakeholders in an iterative process, integrating existing evidence from the literature and qualitative findings to develop a prototype training intervention; (4) Feasibility study of the prototype training intervention in three care homes, to obtain data on the amenability of the intervention to embed in everyday practice, and consider how best to evaluate it. Outputs The outputs of the project will include: an evidence-based prototype training intervention for use with care home staff caring for PwD; new knowledge about the amenability of the intervention to embed in everyday practice, with a view to a future pilot study (including knowledge about the suitability of candidate outcome measures); new knowledge about multi-disciplinary development of interventions in care homes through integrating research evidence and stakeholder involvement.

Lay abstract: Many people with dementia have problems with eating and drinking, particularly as the dementia becomes more advanced. Examples include: difficulty recognising food and drink; problems using cutlery; reduced range of tastes and preferences; difficulties with chewing and swallowing. As the dementia progresses, the person is likely to need more care and support at mealtimes. Most people with advanced dementia live in care homes. They are often fully dependent on care staff for help with eating and drinking. It is the staff's responsibility to help the person eat and drink safely, to be well-nourished and hydrated, and to have an enjoyable mealtime experience. Mealtimes are fundamental human activities, and are often significant social and emotional occasions; therefore, difficulties in this area can be especially distressing for the person, their family, and staff who provide their care. It is anticipated that better training in mealtime care for care home staff will help people with dementia to have improved quality of life, and to stay healthy (by reducing the risk of problems like malnutrition, and pneumonia). It would also help the staff feel empowered to do their job well, providing additional benefits to patients through improved care. Speech and Language Therapists (SLTs) have a remit from their professional body to provide training of this kind. However, at the present time, training only happens intermittently, and varies from place to place. It is not often designed in a way that has been proven to work. This PhD project will develop a training intervention to support and enable care home staff to provide the best possible mealtime care for people with dementia. The training intervention will be developed as follows. (1) I will review existing evidence about the mealtime care provided to people with dementia in care homes, and investigate current training provision on this topic for care home staff. (2) I will observe mealtimes in care homes, and talk to those involved in mealtimes, to explore what works well and what doesn't. (3) I will arrange a series of workshops, to design a training intervention using the information obtained in parts (1) and (2). The participants at these workshops will be: people with dementia / carers; care home staff and managers; SLTs; Dieticians; experts in training. (4) I will test the training intervention in three care homes, to see if it can be implemented successfully in a care home (for example, to check if it is acceptable to care home staff, and find out how likely it is to change their practice and therefore to be of benefit to the people they are caring for). The project will result in a training programme to support and enable care home staff to provide the best possible care at mealtimes. It will also provide new knowledge about how to develop interventions in care homes.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: NEUROLOGICAL