Mealtime nonverbal behaviors in nursing home staff and residents with dementia: Behavioral analyses of videotaped observations

This study characterized mealtime nonverbal behaviors of nursing home staff and residents with dementia and examined the relationships between individual characteristics and nonverbal behaviors. Videotaped observations (N=110) involving 25 residents and 29 staff (42 unique staff-resident dyads) in 9 nursing homes were coded using the refined Cue Utilization and Engagement in Dementia Mealtime Video-Coding Scheme. Wilcoxon rank-sum test or Kruskal-Wallis test were used for continuous characteristics, and Fisher's exact test for categorical characteristics. Residents primarily exhibited challenging behaviors including resistive behaviors (35.7%), chewing/swallowing difficulties (33.5%), and functional impairments (9.9%), followed by positive/neutral behaviors (20.9%). Staff primarily used person-centered behavioral strategies, including modifications of: 1) resident abilities (41.9%), 2) care approaches (35.1%), and 3) dining environment (13.6%), followed by task-centered behaviors (9.3%). Residents challenging behaviors were correlated with staff person-centered behavioral strategies. Dyadic nonverbal behaviors were correlated with multiple individual characteristics. Understanding dyadic nonverbal interactions facilitates use of person-centered, multilevel, behavioral strategies to optimize mealtime outcomes.