This review was led by the Evidence Synthesis Team.
Why did we do this review?
It is estimated that 37% of people with dementia in the UK are cared for within long term care or nursing homes at a cost of approximately £30,000 per person per year. Long term care homes are increasingly expected to be able to provide appropriate care for people with a range of dementia symptoms from wandering, to fear and physical or verbal aggression. Research suggests that agitated and aggressive behaviours may be worse at meal times, which interferes with eating and impacts on other residents in the care home.
How did we do this review?
The research was a systematic review. This brings together all existing research on a particular question. To find studies that might help us to answer the question we searched the relevant academic literature.
We found 11 small studies from the US, UK, Australia, Canada, Sweden, Taiwan and Belgium. Seven studies assessed the effect of playing music over the mealtime period, and two studies looked at the impact of changing the dining environment by improving the lighting or increasing the contrast of the crockery. One study assessed the impact of introducing a breakfast club to stimulate group conversation, and another study introduced the option of family meals, where meals were served at the table, rather than arriving in a pre-plated form.
What did we find?
Several alterations to mealtime environments have been evaluated: playing relaxing music, changing to a family style meal service, improving the lighting conditions and general ambience, changing the colour of crockery used and the introduction of a breakfast club.
The research suggests that small simple and inexpensive alterations to mealtime environments in care homes, in particular playing music, can help reduce symptoms of agitation and aggression.
Music in particular seemed to have a long lasting effect—beyond that of the mealtime itself.
Greater benefits may be seen in people with less severe symptoms of dementia.
Quality of the research and cautionary notes
The lack of information regarding dementia status reported in the studies makes it difficult to ascertain whether there are interventions that work better with certain subgroups of dementia progression. On a practical level, this information would be helpful for those working in residential care homes who are considering implementing such interventions and who need to know what might work best for the specific residents they care for.
Future studies in this area should use clear eligibility criteria (including details regarding dementia diagnosis), use power calculations to estimate the necessary sample size, monitor and report compliance with the intervention, register any harms, and ensure the reliability and validity of the measures used are clearly reported. Future research would also benefit from monitoring more positive behaviours, such as social engagement, mealtime independence, and conversation, to mention only a few. Suggested study designs would include larger controlled trials and cluster-randomized.
Whilst promising effects of small simple and inexpensive alterations to mealtime environments in care homes have been found, there needs to be further high quality research to test both the reliability and generalisibility of these findings.
Further work in this area would benefit from focusing on the social aspects of mealtimes, such as engagement and independence as well as overall resident well-being.