Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations

Aims and Objectives: This study examined the sequential relationships of food intake and the moderating role of the characteristics of intake and resident conditions. Background: Nursing home residents commonly experience insufficient food intake. While multilevel factors influence intake, evidence on sequential relationships is lacking. Design: The study was an observational study using secondary, behavioural analyses following the STROBE Statement. Methods: Videotaped observations (N = 160) collected from a dementia communication trial during 2011–2014 were coded using the refined Cue Utilisation and Engagement in Dementia Mealtime Video-coding Scheme during 2018–2019. The 160 videos involved 27 residents living with dementia and 36 staff in 9 nursing homes. Independent variables were the state (solid intake, liquid intake, no intake) of an intake episode occurring during mealtime (current episode), eating technique (resident-initiated, staff-facilitated) used in the next episode occurring after the current episode (subsequent episode), interval between adjacent episodes, and resident comorbidities and dementia stage. The dependent variable was the state of subsequent episode. Results: Successful liquid and solid intake increased odds of subsequent liquid and solid intake. Comorbidities were associated with decreased odds of subsequent liquid and solid intake for staff-facilitated episodes. When liquid intake occurred, staff-facilitation decreased odds of subsequent liquid intake; longer intervals between adjacent episodes increased odds of subsequent solid intake. Conclusion: Food intake was strongly and sequentially associated, and such temporal relationships were dependent on characteristics of the intake process and resident conditions. Relevance to Clinical Practice: The study findings supported that initiating successful intake facilitates continuity of successful intake during mealtime. Behavioural interventions tailored by comorbidities that modify characteristics of the food intake process may improve food intake.