Development and Effects of a Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities

Hyun Hwa Hong; Mee Ock Gu

doi:10.4040/jkan.2018.48.2.167

Journal List > J Korean Acad Nurs > v.48(2) > 1003298

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Hong and Gu: Development and Effects of a Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities

Original Article

J Korean Acad Nurs 2018;48(2):167-181.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.2.167

Development and Effects of a Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities

Hyun Hwa Hong¹, Mee Ock Gu^2,

¹Department of Nursing, College of Health Sciences, Kyungnam University, Changwon

²College of Nursing · Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

Address reprint requests to : Gu, Mee Ock College of Nursing, Gyeongsang National University, 816-15 Jinju-daero, Jinju, Gyeongnam 52727, Korea Tel: +82-55-772-8226 Fax: +82-55-772-8222 E-mail: mogu@gnu.ac.kr

Received 27 November 2017 Revised 12 March 2018 Accepted 14 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

We developed and tested the effects of a coping skill training program for caregivers in feeding difficulty among older adults with dementia in long-term care facilities.

Methods

A non-equivalent control group pretest-posttest design was used. The subjects comprised 34 caregivers (experimental group: 17, control group: 17) and 40 older adults with dementia (experimental group: 20, control group: 20). The developed program was delivered in 4-hour sessions over 6 weeks (including 2 weeks of lectures and lab practice on feeding difficulty coping skills, and 4 weeks of field practice). Data were collected before, immediately after, and 4 weeks after the program (January 3 to April 6, 2016). The data were analyzed using t-test and repeated measures ANOVA using SPSS/WIN 20.0.

Results

Compared to their counterparts in the control group, caregivers in the experimental group showed a significantly greater improvement in feeding knowledge and feeding behavior, while older adults with dementia showed greater improvements in feeding difficulty and Body Mass Index.

Conclusion

The study findings indicate that this coping skill training program for caregivers in feeding difficulty is an effective intervention for older adults with dementia in long-term care facilities.

Keywords: Long-Term Care, Dementia, Feeding Behavior, Education

References

1. Ministry of Health & Welfare. 3rd comprehensive plan for dementia management (’16-’20) [Internet]. Seoul: Author;c2015. [cited 2015 Dec 21]. Available from:. http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=329062&page=1.

2. Choi ID, Lee YM. Study on the efficient integration of longterm care facilities and geriatric hospitals by using NHIC survey data. Journal of the Korean Gerontological Society. 2010; 30(3):855–869.

3. Chang CC, Roberts BL. Feeding difficulty in older adults with dementia. Journal of Clinical Nursing. 2008; 17(17):2266–2274. https://doi.org/10.1111/j.1365-2702.2007.02275.x.

4. Watson R, Green SM. Feeding and dementia: A systematic literature review. Journal of Advanced Nursing. 2006; 54(1):86–93. https://doi.org/10.1111/j.1365-2648.2006.03793.x.

5. Volicer L, Seltzer B, Rheaume Y, Fabiszewski K, Herz L, Shapiro R, et al. Progression of Alzheimer type dementia in institutionalized patients: A cross-sectional study. Journal of Applied Gerontology. 1987; 6(1):83–94. https://doi.org/10.1177/073346488700600107.

6. Jansen S, Ball L, Desbrow B, Morgan K, Moyle W, Hughes R. Nutrition and dementia care: Informing dietetic practice. Nutrition & Dietetics. 2015; 72(1):36–46. https://doi.org/10.1111/1747-0080.12144.

7. Amella EJ. Factors influencing the proportion of food consumed by nursing home residents with dementia. Journal of the American Geriatrics Society. 1999; 47(7):879–885. https://doi.org/10.1111/j.1532-5415.1999.tb03849.x.

8. Simmons SF, Osterweil D, Schnelle JF. Improving food intake in nursing home residents with feeding assistance: A staffing analysis. Journal of Gerontology: Medical Sciences. 2001; 56(12):M790–M794. https://doi.org/10.1093/gerona/56.12.M790.

9. Amella EJ. Feeding and hydration issues for older adults with dementia. Nursing Clinics of North America. 2004; 39(3):607–623. https://doi.org/10.1016/j.cnur.2004.02.014.

10. Liu W, Galik E, Boltz M, Nahm ES, Resnick B. Optimizing eating performance for older adults with dementia living in long-term care: A systematic review. Worldviews on Evidence Based Nursing. 2015; 12(4):228–235. https://doi.org/10.1111/wvn.12100.

11. Oh JJ. Assisting demented patients with feeding in nursing homes. Journal of the Korean Gerontological Society. 2006; 26(2):315–328.

12. Batchelor-Murphy M, Amella EJ, Zapka J, Mueller M, Beck C. Feasibility of a web-based dementia feeding skills training program for nursing home staff. Geriatric Nursing. 2015; 36(3):212–218. https://doi.org/10.1016/j.gerinurse.2015.02.003.

13. Chang CC, Lin LC. Effects of a feeding skills training programme on nursing assistants and dementia patients. Journal of Clinical Nursing. 2005; 14(10):1185–1192. https://doi.org/10.1111/j.1365-2702.2005.01240.x.

14. Chang CC, Wykle ML, Madigan EA. The effect of a feeding skills training program for nursing assistants who feed dementia patients in Taiwanese nursing homes. Geriatric Nursing. 2006; 27(4):229–237. https://doi.org/10.1016/j.gerinurse.2006.03.007.

15. Chang CC. Effects of a feeding skills training program on knowledge, attitude, perceived behavior control, intention, and behavior of formal caregivers toward feeding dementia patients in Taiwan nursing homes [dissertation]. Cleveland (OH): Case Western Reserve University;2005. p. 1–230.

16. Watson R. Measuring feeding difficulty in patients with dementia: Perspectives and problems. Journal of Advanced Nursing. 1993; 18(1):25–31. https://doi.org/10.1046/j.1365-2648.1993.18010025.x.

17. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. International Journal of Nursing Studies. 2014; 51(1):14–27. https://doi.org/10.1016/j.ijnurstu.2012.12.021.

18. Chang CC, Roberts BL. Strategies for feeding patients with dementia. American Journal of Nursing. 2011; 111(4):36–44. https://doi.org/10.1097/01.naj.0000396553.01996.5e.

19. Hong HH, Gu MO. Feeding difficulty and its influencing factors of elders with dementia in long-term care facilities. Journal of the Korea Academia-Industrial Cooperation Society. 2015; 16(2):1240–1252. https://doi.org/10.5762/kais.2015.16.2.1240.

20. Lee J, Ryu SA. Factors associated with feeding difficulty in long-term care facility older adults with dementia. Journal of Korean Gerontology Nursing. 2017; 19(1):1–12. https://doi.org/10.17079/jkgn.2017.19.1.1.

21. Baek SY. Effects of a feeding assistance education on care providers for elderly patients in a geriatric hospital [master’s thesis]. Busan: Busan University;2014. p. 1–98.

22. Park MS, Choi-Kwon S. The effects of oral care education on caregivers’ knowledge, attitude, & behavior toward oral hygiene for elderly residents in a nursing home. Journal of Korean Academy of Nursing. 2011; 41(5):684–693. https://doi.org/10.4040/jkan.2011.41.5.684.

23. Coleman P. Improving oral health care for the frail elderly: A review of widespread problems and best practices. Geriatric Nursing. 2002; 23(4):189–199. https://doi.org/10.1067/mgn.2002.126964.

24. MacEntee MI, Wyatt CCL, Beattie BL, Paterson B, Levy-Milne R, McCandless L, et al. Provision of mouth-care in long-term care facilities: An educational trial. Community Dentistry and Oral Epidemiology. 2007; 35(1):25–34. https://doi.org/10.1111/j.1600-0528.2007.00318.x.

25. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs (NJ): Prentice-Hall;1980. p. 1–278.

26. Hui J, Wenqin Y, Yan G. Family-paid caregivers in hospital health care in China. Journal of Nursing Management. 2013; 21(8):1026–1033. https://doi.org/10.1111/jonm.12017.

27. Suominen MH, Kivisto SM, Pitkala KH. The effects of nutrition education on professionals’ practice and on the nutrition of aged residents in dementia wards. European Journal of Clinical Nutrition. 2007; 61(10):1226–1232. https://doi.org/10.1038/sj.ejcn.1602639.

28. Inoue S, Zimmet P. The Asia-Pacific perspective: Redefining obesity and its treatment. International Obesity Task Force. Melbourne: Health Communications Australia;2000. Feb. Report No.: 0-9577082-1-1.

29. Lorefält B, Wilhelmsson S. A multifaceted intervention model can give a lasting improvement of older peoples’ nutritional status. Journal of Nutrition Health & Aging. 2012; 16(4):378–382. https://doi.org/10.1007/s12603-011-0362-4.

Figure 1.

Flow diagram of the study participants.

Table 1.

Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities

Session	Topics	Contents	Time (min)	Method
1	Overview of dementia and	•Definition, symptoms, and stages of dementia	60	Lecture
	nutrition in older adults	•Importance of nutrition in older adults with dementia
	with dementia
	Basic dietary guidelines	•Meal environment for promoting appetite
	for older adults with	•Attitude toward feeding
	dementia	•Interaction between caregivers and older adults with dementia at mealtime
		•Careful supervision during mealtime
		•Others
	Feeding difficulties and	•What are the feeding difficulties in the initial phase of eating (agnosia)	30	Practice
	coping skills	•Coping skills for agnosia
	Initial phase of eating	- Simplifying the food tray
	(agnosia)	- Providing one kind of food at a time
		- Serving ready-to-eat foods (e.g., peeled fruits)
		- Monitoring eating by sitting next to the older adults
2	Initial phase of eating	•What are the feeding difficulties in the initial phase of eating (apraxia)	60	Lecture
	(apraxia)	•Coping skills for apraxia
		- Techniques to deal with refusal to eat (sensory cueing, mirroring)
		- Techniques to facilitate eating
		- Using appropriate utensils
		- Providing finger foods
		- Providing foods that take longer to eat
	Oral preparatory	•What are the feeding difficulties in the oral preparatory phase/oral phase of eating?
	phase/Oral phase of	•Coping skills
	eating	- Improvement of sensory input
		- Dietary modification according to oral condition
		- Passive exercise (lip, tongue, cheek, chin)
		- Sensory stimulation (lip, tongue, cheek)
		- Promoting swallowing and removing residues in oral cavity
	Pharyngeal phase of	•What are the feeding difficulties in the pharyngeal phase of eating?	30	Practice
	eating	•Coping skills
		- Prevention of aspiration
		- Suction
		- Heimlich maneuver
	Termination phase of	•What are the feeding difficulties in the termination phase of eating?
	eating	•Coping skills
		- Encouraging eating
	All phases of eating	•What are the feeding difficulties in all phases of eating?
		•Coping skills
		- Assisting good posture for eating
		- Assisting eating
		- Exercises for promoting the upper limb function
		- Controlling drowsiness during eating
3~6	Coping skills for feeding	•Coping skills	60	Individual
	difficulties (one -to -one	- Initial phase of eating (agnosia)		hands-on
	field practice)	- Initial phase of eating (apraxia) - Oral preparatory phase/Oral phase of eating		training 15 min/
		- Pharyngeal phase of eating		week for
		- Termination phase of eating		4 weeks
		- All phases of eating

min=minute.

Table 2.

Homogeneity Test of General Characteristics and Dependent Variables between Experimental and Control Group in Caregivers (N=34)

Characteristics	Categories/Range	Exp. (n=17)	Cont. (n=17)	χ² or t	p
		n (%) or M±SD	n (%) or M±SD
Age (yr)^†	≤50	3 (17.6)	3 (17.6)	0.15	.928
	51~55	8 (47.1)	9 (52.9)
	≥56	6 (35.3)	5 (29.4)
		52.82±6.10	52.53±7.30	0.13	.899
Gender^†	Male	2 (11.8)	0 (0.0)		.485
	Female	15 (88.2)	17 (100.0)
Religion^†	No	2 (11.8)	6 (35.3)		.225
	Yes	15 (88.2)	11 (64.7)
Educational level	High school	14 (82.4)	11 (64.7)	1.36	.244
	≥College	3 (17.6)	6 (35.3)
Total working experience (yr)	<5	7 (41.2)	5 (29.4)	0.52	.473
	≥5	10 (58.8)	12 (70.6)
		4.76±2.54	5.67±1.86	−1.19	.241
Working experience at current job as a	<5	10 (58.8)	5 (29.4)	2.98	.084
caregiver (yr)
	≥5	7 (41.2)	12 (70.6)
		4.14±2.52	5.63±1.93	−1.94	.061
Types of working^†	Fixed	1 (5.9)	3 (17.6)		.601
	3 shift	16 (94.1)	14 (82.4)
Knowledge of feeding	0~1	0.57±0.12	0.55±0.08	0.46	.647
Attitude toward feeding	1~5	2.13±0.40	2.18±0.25	−0.40	.691
Feeding behaviors	0~4	2.71±0.35	2.63±0.21	0.41	.684

Cont.=Control group; Exp.=Experimental group; M±SD=Mean±Standard Deviation.

^†Fisher’s exact test.

Table 3.

Homogeneity Test of General Characteristics and Dependent Variables between Experimental and Control Group in Older Adults with Dementia (N=40)

Characteristics	Categories	Total	Exp. (n=20)	Cont. (n=20)	χ² or t	p
		n (%) or M±SD	n (%) or M±SD	n (%) or M±SD
Age (yr)	≤80	12 (30.0)	8 (40.0)	4 (20.0)	2.01	.366
	81∼85	13 (32.5)	6 (30.0)	7 (35.0)
	≥86	15 (37.5)	6 (30.0)	9 (45.0)
		82.30±8.74	80.85±9.49	83.75±7.90	−1.05	.300
Gender^†	Male	5 (12.5)	3 (15.0)	2 (10.0)		>.999
	Female	35 (87.5)	17 (85.0)	18 (90.0)
Educational level	Illiteracy	21 (52.5)	13 (65.0)	8 (40.0)	2.51	.113
	≥Elementary	19 (47.5)	7 (35.0)	12 (60.0)
Duration of residence (yr)	<3	19 (47.5)	12 (60.0)	7 (35.0)	2.53	.282
	3~<5	10 (25.0)	4 (20.0)	6 (30.0)
	≥5	11 (27.5)	4 (20.0)	7 (35.0)
		4.00±3.37	3.36±2.93	4.64±3.73	−1.21	.235
Types of Dementia^†	Alzheimer’s	21 (52.5)	14 (70.0)	7 (35.0)	5.60	.061
	Vascular	15 (37.5)	4 (20.0)	11 (55.0)
	Mixed	4 (10.0)	2 (10.0)	2 (10.0)
Duration of illness (yr)	<3	11 (27.5)	8 (40.0)	3 (15.0)	3.22	.200
	3~<5	16 (40.0)	7 (35.0)	9 (45.0)
	≥6	13 (32.5)	5 (25.0)	8 (40.0)
		5.23±3.66	4.47±3.23	6.00±3.98	−1.33	.191
Teeth condition	Normal	20 (50.0)	7 (35.0)	13 (65.0)	5.40	.067
	Denture (full or partial)	10 (25.0)	8 (40.0)	2 (10.0)
	No teeth	10 (25.0)	5 (25.0)	5 (25.0)
Types of diet^†	Regular	12 (30.0)	6 (30.0)	6 (30.0)	3.69	.297
	Soft	13 (32.5)	8 (40.0)	5 (25.0)
	Liquid	12 (30.0)	6 (30.0)	6 (30.0)
	Others	3 (7.5)		3 (15.0)
Feeding difficulty			0.41±0.15	0.40±0.16	0.33	.746
Food intake (gm)			215.15±85.03	255.26±60.56	−1.72	.094
BMI (kg/m²)			18.15±3.56	18.97±3.34	−0.75	.459

BMI=Body Mass Index; Cont.=Control group; Exp.=Experimental group; M±SD=Mean±Standard Deviation.

^†Fisher’s exact test.

Table 4.

Effects of a Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities

Variables	Groups	Pretest	Posttest 1	Posttest 2	Sources	F (p)	Pretest vs Posttest 1	Posttest 1 vs Posttest 2
		M±SD	M±SD	M±SD			t (p)	t (p)
Caregivers
Knowledge of	Exp.	0.57±0.12	0.69±0.13	0.72±0.10	Group	10.00 (.003)	3.86 (.001)	−0.70 (.493)
feeding	(n=17)
	Cont.	0.55±0.08	0.56±0.11	0.60±0.10	Time	13.00 (<.001)	0.44 (.668)	0.25 (.806)
	(n=17)
					Group×Time	4.91 (.010)
Attitude toward	Exp.	2.13±0.40	2.03±0.46	2.01±0.48	Group	1.71 (.200)	0.84 (.414)	−0.21 (.840)
feeding	(n=17)
	Cont.	2.18±0.25	2.20±0.19	2.20±0.22	Time	0.24 (.747)	1.43 (.173)	0.00 (>.999)
	(n=17)
					Group×Time	0.43 (.614)
Feeding	Exp.	2.71±0.35	3.10±0.37	3.10±0.37	Group	9.37 (.004)	4.46 (<.001	) -0.68 (.506)
behaviors	(n=17)
	Cont.	2.63±0.21	2.79±0.30	2.69±0.28	Time	10.68 (<.001)	2.45 (.026)	0.25 (.806)
	(n=17)
					Group×Time	3.76 (.029)
Older adults with dementia
Feeding	Exp.	0.41±0.15	0.37±0.13	0.33±0.15	Group	0.87 (.356)	−3.04 (.007)	−1.29 (.212)
difficulty	(n=20)
	Cont.	0.40±0.16	0.44±0.19	0.41±0.18	Time	2.45 (.107)	1.90 (.073)	−1.50 (.151)
	(n=20)
					Group×Time	4.86 (.017)
Food intake	Exp.	215.15±85.03	229.90±69.59	239.63±62.84	4 Group	1.37 (.249)	−1.38 (.184)	0.93 (.363)
(gm)	(n=20)
	Cont.	255.26±60.56	245.85±67.70	252.48±56.71	1 Time	1.16 (.319)	−0.91 (.374)	1.07 (.299)
	(n=20)
					Group×Time	2.02 (.140)
BMI (kg/m²)	Exp.	18.15±3.56	18.46±3.57	18.66±3.56	Group	0.17 (.683)	5.45 (<.001)	2.96 (.008)
	(n=20)
	Cont.	18.97±3.34	18.88±3.26	18.76±3.30	Time	3.87 (.036)	−1.59 (.127)	−1.27 (.219)
	(n=20)
					Group×Time	20.75 (<.001)

BMI=Body Mass Index; Cont.=Control group; Exp.=Experimental group; M±SD=Mean±Standard Deviation.

Posttest 1=immediately after program; Posttest 2=4 weeks after program.

TOOLS

Similar articles