Comparison of Hand Feeding Techniques for Persons With Dementia

Study Overview
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Brief Summary
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The purpose of this study is to test three hand feeding techniques that can be used to provide feeding assistance to persons with dementia - direct hand feeding, hand-over-hand feeding, and hand-under-hand feeding.

Detailed Description
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Proposed Aim 1: To collect pilot data related to using three hand feeding techniques for feeding persons with dementia (PWD) in the nursing home (NH) setting: (1) direct hand feeding; (2) hand-over-hand feeding; and, (3) hand-under-hand feeding. Primary outcomes are impact on frequency of aversive feeding behaviors, meal intake, and time spent assisting with feeding. Proposed Aim 2: Evaluate implementation of the hand feeding intervention for larger randomized study of feeding techniques. Aim 2a: Conduct a process evaluation for method of recruiting, screening, and obtaining informed consent of legally authorized representatives (LARs)/ assent of PWD. Aim 2b: Establish fidelity to treatment for all three hand feeding interventions.

Official Title
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Comparison of Hand Feeding Techniques for Persons With Dementia Living in the Nursing Home

Conditions
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Dementia

Intervention / Treatment
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* Behavioral: Hand feeding techniques


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Resident of nursing home 6 weeks prior to intervention delivery 60+ years old Have a legally authorized representative to provide informed consent medical diagnosis of dementia required extensive assistance to total dependence for feeding Brief Interview for Mental Status (BIMS) score of 0-12 Exclusion Criteria: Positive diagnosis of Human Immunodeficiency Virus (HIV), Parkinson's, and/or Traumatic Brain Injury Any swallowing disorder Presence of feeding tube that is sole source for meal delivery Significant auditory or visual impairment

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hand feeding intervention delivery<br>Trained Research Feeding Assistants (TRFA), blind to the study outcomes, will assist enrolled PWDs with all three meals for two days using a pre-specified hand feeding technique. Videotaping will occur for two enrolled PWD during the six day time frame to promote efficiency. Coding of the video will be done by a trained Data Technician after meals have been recorded to determine frequency of aversive feeding behaviors, calculate meal intake, and time spent assisting with the meal. | Behavioral: Hand feeding techniques<br>* Direct hand feeding technique: When the feeding assistant holds the object (e.g., fork, spoon, cup) intended to provide food or fluids to the PWD without any active involvement on the part of the PWD. Hand-over-hand feeding technique: Occurs when the PWD is holding the object (e.g., fork, spoon, cup) in an attempt to feed/ drink for themselves. If the PWD has trouble with this activity, the feeding assistant puts his or her hand over the hand of the PWD, in an effort to guide/ support/ assist the PWD with the activity. Hand-under-hand feeding technique: Occurs when the feeding assistant holds the object (e.g., fork, spoon, cup) and places the PWD hand over the top of their hand; therefore, the feeding assistants hand is under the hand of the PWD in a more supportive position.<br>* Other names: Direct hand feeding, hand over hand feeding, and hand under hand feeding.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in frequency of aversive feeding behaviors | Changes in behaviors of person with dementia being assisted with 3 meals daily over 6 days | Day 6 | 
| Changes in time spent providing feeding assistance | Changes in time spent providing feeding assistance to a person with dementia being assisted with 3 meals daily over 6 days | Day 6 | 
| Changes in meal intake | Changes in meal intake for a person with dementia being assisted with 3 meals daily over 6 days | Day 6 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional ability and feeding behaviors exhibited by person with dementia | Coding of video recorded meals from Outcomes 1-3 | Day 6 | 
| Characterize feeding assistant responses to functional ability and feeding behaviors | Coding of video recorded meals from Outcomes 1-3 | 6 days | 
| Develop decision-making algorithm of adaptive approaches used by feeding assistant | Coding of video recorded meals from Outcomes 1-3 | 6 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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feeding difficulty, eating difficulty, dementia, nursing home, careful hand feeding