The incidence of persons who are unable to self-feed increases with age. Approximately 45 percent of patients with dementia live in nursing homes and need assistance with eating. Insufficient nutrition can lead to declines in mental and physical function, weight loss, worsening of chronic illnesses and premature death. Amella studied the interactions between patients and Certified Nursing Assistants (CNAs) during feeding to determine which factors are predictive of the amount of food consumed by patients with dementia.

The study assigned a CNA to work with a particular resident for one month. Patients were included if they were at least 61 years of age, had been a resident of the nursing home for at least six weeks, had been diagnosed with dementia and relied on a caregiver for assistance with feeding but were not on a limited calorie-intake diet. The Interaction Behavior Measure was used to rate the behaviors and verbalizations of the CNA. A low rating signified a “dysfunctional” interaction. The empathy of the CNA was also measured. The time to complete the meal was recorded, and the amount of food consumed was calculated by weighing the patient's tray before and after the meal.

There were 53 pairs of residents and CNAs included. The mean Mini-Mental State Examination score was 4.2 ± 5.5. The length of the meal was 15.66 minutes, and the mean amount of food eaten was 19.32 oz, representing 63 percent of the available food. The quality of the resident's behavior was significantly and positively correlated to the proportion of food consumed. However, the CNA's behavior was not significantly correlated to the proportion of food consumed. The CNA's willingness to let the resident control the interaction had a positive effect on the amount of food consumed. A better relationship between the nursing assistant and the resident was also correlated with a greater consumption of food.

The author concludes that the CNA's behavior can have a positive impact on the amount of food eaten by a nursing home resident with dementia. Amella also notes that the CNAs paid attention to the task of feeding a resident but did not always attend to the aspects of the interaction that could improve the outcome, such as bantering and conversing with the resident and showing empathy for the resident's needs.

editor's note: Although there are standard approaches to the evaluation of an elderly resident with unexplained weight loss, this study underscores the importance of caregiver interactions in the process. Although not a substitute for a thorough work-up, education about patient-caregiver interaction for CNAs in a nursing home may eliminate some unintended weight loss in residents.—g.b.h.