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Cited by 113Dementia and Cognitive Impairment ResearchNutrition and Health in AgingDysphagia Assessment and Management

Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review

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Bunn, Diane K., Abdelhamid, Asmaa, Copley, Maddie, Cowap, Vicky, Dickinson, Angela, Howe, Amanda, Killett, Anne, Poland, Fiona +5 more·2016·BMC Geriatrics
DOI 10.1186/s12877-016-0256-8PMC PMC4855348
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Abstract

BACKGROUND: Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). METHODS: We comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). 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. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively. RESULTS: We included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions. CONCLUSIONS: We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try. TRIAL REGISTRATION: The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611).

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  • 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 [63]

    The Results (page unavailable) say that, in some reviewed interventions, dementia or mild cognitive impairment was inferred from cognitive scores or the care setting rather than a stated diagnosis. That supports the point about some cohorts not labeled as having dementia, but the review does not establish that cognitive impairment is present on average in most care home populations. (LLM, conf=0.82)

    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 [264]

    The Methods (Criteria for inclusion; page unavailable) allowed studies whose participants had cognitive scores indicating impairment, and the Results (page unavailable) say dementia or MCI was sometimes inferred from cognitive scores or setting. These selected cohorts do not establish that cognitive impairment is present on average in most care home populations. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Three relevant systematic literature reviews of high or average quality were identified, examining training for staff in residential care, people with dementia and/or their formal or informal care-givers, and informal carers and community care workers.

    “Three relevant systematic literature reviews (SLRs) of high (63,64) or average quality (65) were identified, which examined the effectiveness of training for staff in residential care (64), people with dementia and/or their formal or informal care-givers (63) and informal carers and community care workers (65).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [63]

  • The SLR by Bunn et al. included interventions with an educational and/or awareness component for persons with dementia and/or their formal or informal care-givers; the overall effect on nutritional status in the three RCTs included was very limited.

    “The SLR by Bunn et al. (63) included interventions with an educational and/or awareness component for persons J o u r n a l P r e -p r o o f with dementia and/or their formal or informal care-givers.The overall effect on nutritional status in the three RCTs included was very limited.”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [63]

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Authors
Bunn, D. K., Abdelhamid, A., Copley, M., Cowap, V., Dickinson, A., Howe, A., Killett, A., Poland, F., Potter, J. F., 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
2016-05-04
Volume
16
Issue
1
Pages
89-89
ISSN
1471-2318 (ISSN-L)
DOI
10.1186/s12877-016-0256-8
PMC
PMC4855348
OpenAlex
W2344110129
Cited by
113
References
6
Citations by year
2026: 5 · 2025: 12 · 2024: 6 · 2023: 5 · 2022: 15 · 2021: 15 · 2020: 19 · 2019: 14 · 2018: 13 · 2017: 7 · 2016: 1 · 2015: 1
FWCI
1.67
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, cc-by)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
Funders
  • National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care, East of England (CLAHRC EoE) (DEM-04)
  • National Institute for Health Research Fellowship Award (CDF-2011-04-025)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
Keywords
dementia, malnutrition, dehydration, indirect intervention, spaced retrieval, Montessori activities, breakfast clubs, cognitive impairment, older adults
MeSH terms
Behavior Therapy, Clinical Trials as Topic, Dehydration, Dementia, Drinking, Eating, Humans, Exercise, Treatment Outcome, Early Medical Intervention

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