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Cited by 178Dysphagia Assessment and ManagementNutrition and Health in AgingDementia and Cognitive Impairment Research

Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis

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Abdelhamid, Asmaa, Bunn, Diane, Copley, Maddie, Cowap, Vicky, Dickinson, Angela, Gray, Lucy, Howe, Amanda, Killett, Anne +8 more·2016·BMC Geriatrics
DOI 10.1186/s12877-016-0196-3PMC PMC4722767
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Abstract

BACKGROUND: Eating and drinking difficulties are recognised sources of ill health in people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions to directly improve, maintain or facilitate oral food and drink intake, nutrition and hydration status, in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Interventions included oral nutrition supplementation, food modification, dysphagia management, eating assistance and supporting the social element of eating and drinking. METHODS: We comprehensively searched 13 databases for relevant intervention studies. The review was conducted with service user input in accordance with Cochrane Collaboration's guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data, carrying out random effects meta-analysis and narrative synthesis. RESULTS: Forty-three controlled interventions were included, disappointingly none were judged at low risk of bias. Oral nutritional supplementation studies suggested small positive short term but unclear long term effects on nutritional status. Food modification or dysphagia management studies were smaller and of low quality, providing little evidence of an improved nutritional status. Eating assistance studies provided inconsistent evidence, but studies with a strong social element around eating/drinking, although small and of low quality provided consistent suggestion of improvements in aspects of quality of life. There were few data to address stakeholders' questions. CONCLUSIONS: We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. People with cognitive impairment and their carers have to tackle eating problems despite this lack of evidence, so promising interventions are listed. The need remains for high quality trials tailored for people with cognitive impairment assessing robust outcomes. SYSTEMATIC REVIEW REGISTRATION: The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero.

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  • Most trials aiming to increase fluid intake in older adults assessed fluid intake, hydration status and health outcomes poorly, so success in increasing fluid intake is unclear.

    “Unfortunately, most trials assessed fluid intake hydration status and health outcomes poorly, so success in increasing fluid intake is unclear.”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [219]

    The Discussion reports insufficient high-quality evidence to establish whether the interventions were effective and calls for more robust hydration and health outcomes. The Strengths and limitations section also notes a lack of clear hydration-status data. These findings support the concern about poor assessment and uncertain effectiveness, but the review concerns people with dementia, not older adults generally, and does not establish that most trials poorly assessed all three named outcomes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Cognitive impairment is present on average in most care home populations.

    “which included cohorts of older adults not labeled as having dementia but where a cognitive assessment showed that on average cognitive impairment was present (63,219,264), as it is in most care home populations.”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [219]

    The Results (page unavailable) say that cognitive impairment was assumed from cognitive scores or setting in 12 included interventions, and that most interventions took place in institutional or hospital settings. This supports the narrower point that some studied cohorts had cognitive impairment without a stated dementia diagnosis, but it does not establish that cognitive impairment is present on average in most care home populations. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Studies with a strong social element, where socializing around food and drink was supported, tended to improve quality of life, nutritional status and fluid intake.

    “but a key suggestion from assessments of nutrition more generally was that studies with a strong social element, where socializing around food and drink was supported, tended to improve quality of life, nutritional status and fluid intake (219).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [219]

    The Results section reports that small studies of social activities around meals found improvements in interaction and enjoyment, and one family-style-meal study found increased weight. The Discussion says social interventions consistently suggested possible improvements in aspects of quality of life. It does not report improved fluid intake from those interventions, and the nutritional finding is limited to one study; no page numbers were provided in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Authors
Abdelhamid, A., Bunn, D., Copley, M., Cowap, V., Dickinson, A., Gray, L., Howe, A., Killett, A., Lee, J., Li, F., Poland, F., Potter, J., Richardson, K., Smithard, D., Fox, C., & Hooper, L.
Affiliations
  • University of East Anglia (GB)
  • Age UK (GB)
  • University of Hertfordshire (GB)
  • Norfolk and Norwich University Hospital (GB)
  • King's College Hospital NHS Foundation Trust (GB)
Corresponding author
Hooper, Lee
ORCID
Venue
BMC Geriatrics
Publisher
Springer Science and Business Media LLC
Published
2016-01-22
Volume
16
Issue
1
Pages
26-26
ISSN
1471-2318 (ISSN-L)
DOI
10.1186/s12877-016-0196-3
PMC
PMC4722767
OpenAlex
W2259579583
Cited by
178
References
6
Citations by year
2026: 6 · 2025: 13 · 2024: 15 · 2023: 15 · 2022: 20 · 2021: 23 · 2020: 27 · 2019: 25 · 2018: 17 · 2017: 14 · 2016: 2 · 2014: 1
FWCI
3.81
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMC Geriatrics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion, cc-by)
Funders
  • NIHR Collaboration for Leadership in Applied Health Research & Care, East of England (DEM-04)
  • Research Trainees Coordinating Centre (CDF-2011-04-025)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
dementia, eating difficulties, oral intake, dysphagia management, oral nutritional supplementation, food modification, feeding assistance, social eating, nutrition, hydration, cognitive impairment, quality of life, caregivers
MeSH terms
Aged, Deglutition Disorders, Dehydration, Dementia, Drinking Behavior, Feeding Behavior, Humans, Nutritional Status, Quality of Life, Treatment Outcome, Malnutrition, Nutrition Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

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