A path analysis on the direct and indirect effects of the unit environment on eating dependence among cognitively impaired nursing home residents.
Cognitive decline
Dementia
Eating dependence
Feeding difficulties
Mealtime difficulties
Nursing home
Path analysis
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
30 Oct 2019
30 Oct 2019
Historique:
received:
21
01
2019
accepted:
21
10
2019
entrez:
1
11
2019
pubmed:
2
11
2019
medline:
28
1
2020
Statut:
epublish
Résumé
This study aims to estimate the direct and indirect effects of the unit environment alongside individual and nursing care variables on eating dependence among residents who are cognitively impaired and living in a nursing home. A multicentre observational study was carried out in 2017: 13 Italian nursing homes were involved in data collection. Included residents were aged > 65 at baseline, living in the considered facility for the last 6 months and during the entire study period and having received at least one comprehensive assessment. Data were collected (a) at the individual level: eating dependence using the Edinburgh Feeding Evaluation in Dementia Scale and other clinical variables; (b) at the nursing care level with daily interventions to maintain eating independence assessed with a checklist; and (c) at the nursing home level, using the Therapeutic Environment Screening Survey for Nursing Homes. One thousand twenty-seven residents were included with an average age of 85.32 years old (95% CI: 84.74-85.89), mainly female (781; 76%). The path analysis explained the 57.7% variance in eating dependence. Factors preventing eating dependence were: (a) at the individual level, increased functional dependence measured with the Barthel Index (β - 2.374); eating in the dining room surrounded by residents (β - 1.802) as compared to eating alone in bed; and having a close relationship with family relatives (β - 0.854), (b) at the nursing care level, the increased number of interventions aimed at promoting independence (β - 0.524); and (c) at the NH level, high scores in 'Space setting' (β - 4.446), 'Safety' (β - 3.053), 'Lighting' (β - 2.848) and 'Outdoor access' (β - 1.225). However, environmental factors at the unit level were found to have also indirect effects by influencing the degree of functional dependence, the occurrence of night restlessness and the number of daily interventions performed by the nursing staff. Eating dependence is a complex phenomenon requiring interventions targeting individual, nursing care, and environmental levels. The NH environment had the largest direct and indirect effect on residents' eating dependence, thus suggesting that at this level appropriate interventions should be designed and implemented.
Sections du résumé
BACKGROUND
BACKGROUND
This study aims to estimate the direct and indirect effects of the unit environment alongside individual and nursing care variables on eating dependence among residents who are cognitively impaired and living in a nursing home.
METHOD
METHODS
A multicentre observational study was carried out in 2017: 13 Italian nursing homes were involved in data collection. Included residents were aged > 65 at baseline, living in the considered facility for the last 6 months and during the entire study period and having received at least one comprehensive assessment. Data were collected (a) at the individual level: eating dependence using the Edinburgh Feeding Evaluation in Dementia Scale and other clinical variables; (b) at the nursing care level with daily interventions to maintain eating independence assessed with a checklist; and (c) at the nursing home level, using the Therapeutic Environment Screening Survey for Nursing Homes.
RESULTS
RESULTS
One thousand twenty-seven residents were included with an average age of 85.32 years old (95% CI: 84.74-85.89), mainly female (781; 76%). The path analysis explained the 57.7% variance in eating dependence. Factors preventing eating dependence were: (a) at the individual level, increased functional dependence measured with the Barthel Index (β - 2.374); eating in the dining room surrounded by residents (β - 1.802) as compared to eating alone in bed; and having a close relationship with family relatives (β - 0.854), (b) at the nursing care level, the increased number of interventions aimed at promoting independence (β - 0.524); and (c) at the NH level, high scores in 'Space setting' (β - 4.446), 'Safety' (β - 3.053), 'Lighting' (β - 2.848) and 'Outdoor access' (β - 1.225). However, environmental factors at the unit level were found to have also indirect effects by influencing the degree of functional dependence, the occurrence of night restlessness and the number of daily interventions performed by the nursing staff.
CONCLUSION
CONCLUSIONS
Eating dependence is a complex phenomenon requiring interventions targeting individual, nursing care, and environmental levels. The NH environment had the largest direct and indirect effect on residents' eating dependence, thus suggesting that at this level appropriate interventions should be designed and implemented.
Identifiants
pubmed: 31666063
doi: 10.1186/s12913-019-4667-z
pii: 10.1186/s12913-019-4667-z
pmc: PMC6822399
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
775Références
J Adv Nurs. 2014 Oct;70(10):2167-80
pubmed: 24738712
J Clin Nurs. 2008 Sep;17(17):2266-74
pubmed: 18705703
J Nurs Scholarsh. 2005;37(2):134-40; discussion 140
pubmed: 15960057
J Am Med Dir Assoc. 2017 Nov 1;18(11):941-947
pubmed: 28668663
Nat Clin Pract Neurol. 2009 Jan;5(1):24-34
pubmed: 19129788
Appl Nurs Res. 2015 Nov;28(4):391-6
pubmed: 26608444
Nurs Outlook. 2011 Jul-Aug;59(4):210-4
pubmed: 21757077
J Acad Nutr Diet. 2015 Nov;115(11):1815-31
pubmed: 26233887
BMC Geriatr. 2016 Jan 22;16:26
pubmed: 26801619
Health Serv Res. 2015 Apr;50(2):560-78
pubmed: 25256014
J Adv Nurs. 2017 Dec;73(12):2796-2816
pubmed: 28207946
Int J Nurs Stud. 2014 Jan;51(1):14-27
pubmed: 23340328
Md State Med J. 1965 Feb;14:61-5
pubmed: 14258950
JBI Libr Syst Rev. 2012;10(58):4622-4632
pubmed: 27820527
Epidemiol Psychiatr Sci. 2018 Jun;27(3):278-287
pubmed: 28065176
J Am Med Dir Assoc. 2016 Aug 1;17(8):694-705
pubmed: 27233488
J Gerontol B Psychol Sci Soc Sci. 2002 Mar;57(2):S69-78
pubmed: 11867668
Perspect Psychiatr Care. 2019 Jan;55(1):48-60
pubmed: 29766513
Health Policy. 2018 Mar;122(3):301-308
pubmed: 29409682
BMC Med Res Methodol. 2006 Dec 11;6:56
pubmed: 17156475
BMC Geriatr. 2015 Apr 19;15:49
pubmed: 25928621
SSM Popul Health. 2016 Nov 30;3:9-19
pubmed: 29349200
BMC Geriatr. 2016 Oct 3;16(1):169
pubmed: 27716187
BMC Geriatr. 2017 Feb 10;17(1):49
pubmed: 28183274
Cochrane Database Syst Rev. 2018 Jul 18;7:CD011542
pubmed: 30021248
J Am Med Dir Assoc. 2013 Nov;14(11):817-20
pubmed: 23810390
Mech Ageing Dev. 2017 Jul;165(Pt B):68-74
pubmed: 28461103
Worldviews Evid Based Nurs. 2015 Aug;12(4):228-35
pubmed: 26122316
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
Int J Nurs Stud. 1996 Aug;33(4):385-93
pubmed: 8836763
Int J Geriatr Psychiatry. 2010 Oct;25(10):953-9
pubmed: 20054841
Int J Nurs Stud. 2017 Jun;71:70-79
pubmed: 28340390
J Am Med Dir Assoc. 2012 Jun;13(5):487.e1-7
pubmed: 22326948
J Am Geriatr Soc. 2012 Sep;60(9):1624-31
pubmed: 22985138
Age Ageing. 2000 Mar;29(2):165-72
pubmed: 10791452
PLoS One. 2018 Feb 27;13(2):e0192690
pubmed: 29486002
Arch Gerontol Geriatr. 2017 Jul;71:122-128
pubmed: 28431307
Lancet. 2014 Mar 8;383(9920):911-22
pubmed: 23992774
BMC Health Serv Res. 2017 Mar 21;17(1):226
pubmed: 28327120
J Appl Gerontol. 2014 Aug;33(5):522-40
pubmed: 24652906
BMC Geriatr. 2016 May 04;16:89
pubmed: 27142469
Int J Nurs Stud. 2016 Sep;61:230-47
pubmed: 27400029
J Gerontol. 1994 Jul;49(4):M174-82
pubmed: 8014392
Gerontologist. 2001 Apr;41(2):173-9
pubmed: 11327482
J Am Geriatr Soc. 2006 Sep;54(9):1436-41
pubmed: 16970655
Arch Gerontol Geriatr. 2009 May-Jun;48(3):317-24
pubmed: 18395810