Comparison of Hand Feeding Techniques for Persons With Dementia

Comparison of Hand Feeding Techniques for Persons With Dementia Living in the Nursing Home

The purpose of this study is to test three hand feeding techniques that can be used to provide feeding assistance to persons with dementia - direct hand feeding, hand-over-hand feeding, and hand-under-hand feeding.

Study Overview

• Status: Completed
• Conditions: Dementia
• Intervention / Treatment: Behavioral: Hand feeding techniques

Detailed Description

Proposed Aim 1: To collect pilot data related to using three hand feeding techniques for feeding persons with dementia (PWD) in the nursing home (NH) setting: (1) direct hand feeding; (2) hand-over-hand feeding; and, (3) hand-under-hand feeding. Primary outcomes are impact on frequency of aversive feeding behaviors, meal intake, and time spent assisting with feeding.

Proposed Aim 2: Evaluate implementation of the hand feeding intervention for larger randomized study of feeding techniques.

Aim 2a: Conduct a process evaluation for method of recruiting, screening, and obtaining informed consent of legally authorized representatives (LARs)/ assent of PWD.

Aim 2b: Establish fidelity to treatment for all three hand feeding interventions.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Apex, North Carolina, United States, 27502
      • Rex Apex
    • Chapel Hill, North Carolina, United States, 27517
      • Carolina Meadows
    • Durham, North Carolina, United States, 27704
      • Carver Living Center
    • Durham, North Carolina, United States, 27705
      • Croasdaile
    • Durham, North Carolina, United States, 27705
      • Hillcrest
    • Durham, North Carolina, United States, 27705
      • Pettigrew
    • Durham, North Carolina, United States, 27712
      • Treyburn
    • Wilmington, North Carolina, United States, 28401
      • Kindred Cypress Pointe
    • Wilmington, North Carolina, United States, 28401
      • Wilmington Health & Rehabilitation Center
    • Wilmington, North Carolina, United States, 28403
      • Liberty Commons Nursing Center
    • Wilmington, North Carolina, United States, 28411
      • Davis Health Care Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 58 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Resident of nursing home 6 weeks prior to intervention delivery
• 60+ years old
• Have a legally authorized representative to provide informed consent
• medical diagnosis of dementia
• required extensive assistance to total dependence for feeding
• Brief Interview for Mental Status (BIMS) score of 0-12

Exclusion Criteria:

• Positive diagnosis of Human Immunodeficiency Virus (HIV), Parkinson's, and/or Traumatic Brain Injury
• Any swallowing disorder
• Presence of feeding tube that is sole source for meal delivery
• Significant auditory or visual impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: Double

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Hand feeding intervention delivery; Trained Research Feeding Assistants (TRFA), blind to the study outcomes, will assist enrolled PWDs with all three meals for two days using a pre-specified hand feeding technique. Videotaping will occur for two enrolled PWD during the six day time frame to promote efficiency. Coding of the video will be done by a trained Data Technician after meals have been recorded to determine frequency of aversive feeding behaviors, calculate meal intake, and time spent assisting with the meal.

Behavioral: Hand feeding techniques; Direct hand feeding technique: When the feeding assistant holds the object (e.g., fork, spoon, cup) intended to provide food or fluids to the PWD without any active involvement on the part of the PWD. Hand-over-hand feeding technique: Occurs when the PWD is holding the object (e.g., fork, spoon, cup) in an attempt to feed/ drink for themselves. If the PWD has trouble with this activity, the feeding assistant puts his or her hand over the hand of the PWD, in an effort to guide/ support/ assist the PWD with the activity. Hand-under-hand feeding technique: Occurs when the feeding assistant holds the object (e.g., fork, spoon, cup) and places the PWD hand over the top of their hand; therefore, the feeding assistants hand is under the hand of the PWD in a more supportive position.; Other Names: Direct hand feeding, hand over hand feeding, and hand under hand feeding.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in frequency of aversive feeding behaviors	Changes in behaviors of person with dementia being assisted with 3 meals daily over 6 days	Day 6
Changes in time spent providing feeding assistance	Changes in time spent providing feeding assistance to a person with dementia being assisted with 3 meals daily over 6 days	Day 6
Changes in meal intake	Changes in meal intake for a person with dementia being assisted with 3 meals daily over 6 days	Day 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional ability and feeding behaviors exhibited by person with dementia	Coding of video recorded meals from Outcomes 1-3	Day 6
Characterize feeding assistant responses to functional ability and feeding behaviors	Coding of video recorded meals from Outcomes 1-3	6 days
Develop decision-making algorithm of adaptive approaches used by feeding assistant	Coding of video recorded meals from Outcomes 1-3	6 days

Collaborators and Investigators

• Sponsor: Duke University
• Collaborators: The John A. Hartford Foundation
• Investigators: Principal Investigator: Melissa B Aselage, PhD,RN,FNP, Duke University School of Nursing; Study Chair: Ruth Anderson, PhD,RN,FAAN, Duke University School of Nursing; Study Chair: Elaine J Amella, PhD,RN,FAAN, Medical University of South Carolina

Study record dates

Study Major Dates

• Study Start: March 1, 2012
• Primary Completion (Actual): September 1, 2014
• Study Completion (Actual): October 1, 2014

Study Registration Dates

• First Submitted: January 29, 2013
• First Submitted That Met QC Criteria: January 29, 2013
• First Posted (Estimate): January 31, 2013

Study Record Updates

• Last Update Posted (Estimate): October 6, 2016
• Last Update Submitted That Met QC Criteria: October 5, 2016
• Last Verified: October 1, 2016

More Information

Terms related to this study

• Keywords: dementia; nursing home; feeding difficulty; eating difficulty; careful hand feeding
• Additional Relevant MeSH Terms: Mental Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Dementia
• Other Study ID Numbers: Pro00035130

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided