Mealtime nonverbal behaviors in nursing home staff and residents with dementia: Behavioral analyses of videotaped observations.
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SUBMITTER: Liu W
PROVIDER: S-EPMC8995379 | biostudies-literature | 2022 Mar-Apr
REPOSITORIES: biostudies-literature
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Mealtime nonverbal behaviors in nursing home staff and residents with dementia: Behavioral analyses of videotaped observations.
Liu Wen W Perkhounkova Yelena Y Williams Kristine K Batchelor Melissa M Hein Maria M
Geriatric nursing (New York, N.Y.) 20220204
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 characterist ...[more]
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Project description:AimsTo characterize dyadic mealtime verbal interactions and examine the associations with staff and resident characteristics.DesignA secondary analysis of 110 videotaped mealtime observations collected from a dementia communication trial during 2011-2014.MethodsVideos involved 25 residents with dementia and 29 staff in nine nursing homes. Verbal behaviours (utterances) were coded during 2018-2019 using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing eight positive behaviours and four negative behaviours. Bivariate analyses and multivariate regression models were used.ResultsStaff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%); 85.1% of residents' utterances were positive and 14.9% negative. Staff positive utterances were correlated with their negative utterances and resident positive and negative utterances. Staff negative utterances were correlated with resident negative utterances. Resident positive and negative utterances were correlated. Resident positive utterances were significantly associated with staff care-giving length in the current nursing home (OR = 1.430, 95% CI = 1.008, 2.027). Resident negative utterances were significantly associated with resident gender (female versus male, OR = 11.892, 95% CI = 1.237, 114.289) and staff years worked as a caregiver (OR = 0.838, 95% CI = 0.710, 0.989). Staff positive and negative utterances were not associated significantly with any participant characteristics.ConclusionsStaff engage residents using primarily positive verbal strategies. Staff-resident mealtime verbal interactions were dynamic, interactive, and complex and related to multiple individual characteristics.ImpactPositive dyadic mealtime interactions are critical to engage residents in eating. Little work has characterized dyadic mealtime interactions, limiting the development of effective interventions. Findings showed staff-resident mealtime verbal interactions were primarily positive, inter-related, and associated with multiple individual characteristics. Findings inform directions to improve mealtime care practice and develop person-centred mealtime interventions targeting modifiable factors, including staff care-giving experiences.
| S-EPMC7902310 | biostudies-literature
Project description:BackgroundNursing home residents with dementia commonly experience low food intake, leading to negative functional and nutritional consequences. While the importance of staff-resident (dyadic) interactions during mealtime is acknowledged, little research has examined the role of dyadic verbal interactions on food intake.ObjectivesThis study aimed to examine the relationship between food intake and dyadic verbal interactions.MethodsThis study was a secondary analysis of 110 videotaped observations of mealtime care interactions among 25 residents with dementia and 29 staff (42 unique dyads) in 9 nursing homes. Staff positive utterances and resident positive and negative utterances (independent variables) and food intake (dependent variable) were coded from the videotaped observations using the Cue Utilization and Engagement in Dementia video coding scheme. A linear mixed model was fit to the data. The two-way interaction effects of food type and video duration with each independent variable as well as two-way interaction effects among the independent variables were tested. Covariates included in the model were the number of years staff worked as a caregiver, and resident age, gender, and eating function.ResultsThe model included three significant interaction effects involving verbal variables: the interaction effect of staff positive utterances with resident positive utterances (p=.030), the interaction effect of staff positive utterances with food type (p=.027), and the interaction effect of resident negative utterances with video duration (p=0.002). Increased number of intakes of liquid food per minute was associated with increased number of staff positive utterances per minute when residents did not make positive utterances. Decreased number of intakes of solid food per minute was associated with increased number of staff positive utterances per minute, especially when residents made between 0 and 3 positive utterances per minute. As the duration of the videos increased, the number of intakes per minute increased for residents who made one or more negative utterances and decreased for residents who made no negative utterances in the videos. The number of intakes per minute was associated with resident gender in that male residents had increased number of intakes per minute compared with female residents (p=.017), and was not associated with other participant characteristics.ConclusionIntake was associated with dyadic verbal interactions, and such relationship was complex in that it was moderated by food type and video duration. Findings support the significant role of dyadic verbal interactions on intake, and inform the development of effective, tailored mealtime care interventions to promote intake.
| S-EPMC7540727 | biostudies-literature
Project description:Background. Quality staff-resident communication is crucial to promote outcomes in nursing home residents with dementia requiring assistance during mealtimes. Better understanding of staff-resident language characteristics in mealtime interactions help promote effective communication, yet evidence is limited. This study aimed to examine factors associated with language characteristics in staff-resident mealtime interactions. Methods. This was a secondary analysis of 160 mealtime videos involving 36 staff and 27 residents with dementia (53 unique staff-resident dyads) in 9 nursing homes. We examined the associations of speaker (resident vs. staff), utterance quality (negative vs. positive), intervention (pre- vs. post-communication intervention), and resident dementia stage and comorbidities with expression length (number of words in each utterance) and addressing partner by name (whether staff or resident named their partner in each utterance), respectively. Results. Staff (utterance n = 2990, 99.1% positive, mean = 4.3 words per utterance) predominated conversations and had more positive, longer utterances than residents (utterance n = 890, 86.7% positive, mean = 2.6 words per utterance). As residents progressed from moderately-severe to severe dementia, both residents and staff produced shorter utterances (z=-2.66, p = .009). Staff (18%) named residents more often than residents (2.0%; z = 8.14, p < .0001) and when assisting residents with more severe dementia (z = 2.65, p = .008). Conclusions. Staff-resident communication was primarily positive, staff-initiated, and resident-oriented. Utterance quality and dementia stage were associated with staff-resident language characteristics. Staff play a critical role in mealtime care communication and should continue to initiate resident-oriented interactions using simple, short expressions to accommodate resident declining language abilities, particularly those with severe dementia. Staff should practice addressing residents by their names more frequently to promote individualized, targeted, person-centered mealtime care. Future work may further examine staff-resident language characteristics at word and other levels using more diverse samples.
| S-EPMC10153391 | biostudies-literature
Project description:BackgroundQuality staff-resident communication is crucial to promote outcomes in nursing home residents with dementia requiring assistance during mealtimes. Better understanding of staff-resident language characteristics in mealtime interactions help promote effective communication, yet evidence is limited. This study aimed to examine factors associated with language characteristics in staff-resident mealtime interactions.MethodsThis was a secondary analysis of 160 mealtime videos involving 36 nursing staff and 27 residents with moderately severe to severe dementia in 9 nursing homes. Mixed-effects models was used to examine the relationships between factors and language characteristics in staff-resident mealtime interactions. The independent variables were speaker (resident vs. staff), utterance quality (negative vs. positive), intervention (pre- vs. post-communication intervention), and resident dementia stage and comorbidities. The dependent variables were expression length (number of words in each utterance) and addressing partner by name (whether staff or resident named their partner in each utterance). All models included staff, resident, and staff-resident dyad as random effects.ResultsStaff (utterance n = 2990, 99.1% positive, mean = 4.3 words per utterance) predominated conversations and had more positive, longer utterances than residents (utterance n = 890, 86.7% positive, mean = 2.6 words per utterance). As residents progressed from moderately severe to severe dementia, both residents and staff produced shorter utterances (z=-2.66, p = .009). Staff (18%) named residents more often than residents (2.0%; z = 8.14, p < .0001) and when assisting residents with more severe dementia (z = 2.65, p = .008).ConclusionsStaff-resident communication was primarily positive, staff-initiated, and resident-oriented. Utterance quality and dementia stage were associated with staff-resident language characteristics. Staff play a critical role in mealtime care communication and should continue to initiate resident-oriented interactions using simple, short expressions to accommodate resident declining language abilities, particularly those with severe dementia. Staff should practice addressing residents by their names more frequently to promote individualized, targeted, person-centered mealtime care. Future work may further examine staff-resident language characteristics at other levels of language using more diverse samples.
| S-EPMC10517558 | biostudies-literature
Project description:Background and objectivesNursing home (NH) staff mealtime care approaches are associated with behaviors of residents with dementia, but their impact on food intake remains unexplored. This study examined the role of staff person-centered and task-centered approaches and resident positive, neutral, and challenging behaviors on food intake.Research design and methodsVideotaped mealtime observations (N = 160) involving 36 staff and 27 residents (53 unique staff-resident dyads) in 9 NHs were coded using the refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme. The dependent variable was resident food intake. The independent variables were staff person-centered approaches that support resident abilities, staff-resident (dyadic) interactions, and dining environments, staff task-centered approaches, and resident positive, neutral, and challenging behaviors. Resident challenging behaviors included mealtime functional impairments and resistive behaviors. Linear mixed modeling was used. Moderating effects of staff approaches, food type, and length of dyadic mealtime interactions (ie, video duration) were examined.ResultsThe relationship between food intake and resident mealtime functional impairments was moderated by food type (p < .001). The relationship between food intake and resident resistive behaviors was moderated by food type (p = .002) and staff person-centered verbal approaches (p = .001). The relationships between food intake and staff person-centered nonverbal approaches (p = .003) and resident positive/neutral nonverbal behaviors (p = .004) were moderated by the length of dyadic mealtime interactions.Discussion and implicationsFood intake was associated with staff person-centered approaches and resident positive/neutral and challenging behaviors. Findings emphasize the importance of facilitating positive dyadic interactions using individualized, context-based, multifaceted, person-centered care. Future research on temporal and causal relationships is warranted in larger diverse samples.
| S-EPMC9495496 | biostudies-literature
Project description:AimTo examine the association of resident characteristics, staff mealtime assistance and environmental stimulation with the pace of food intake.DesignA secondary analysis of 36 baseline eating videos involving 19 nursing assistants and 15 residents with dementia in eight nursing homes from a communication intervention study.MethodsThe outcome variable was the pace of food intake (the number of bites and drinks per minute). The exploratory variables were resident characteristics (age, gender, dementia stage and eating performance), staff mealtime assistance (frequency of verbal, visual, partial and full physical assistance) and environmental stimulation. Multi-level models were used to examine the association.ResultsA faster pace of food intake is associated with being male, better eating performance, staff provision of visual and physical assistance and better quality of environmental stimulation that involved interaction. The pace of food intake was not associated with resident age, staff verbal assistance or partial physical assistance.
| S-EPMC6650688 | biostudies-literature
Project description:Background and objectivesOptimal dyadic interactions are critical to quality mealtime care and outcomes. Prior work supports associative relationships between staff approaches and individual mealtime behaviors, yet evidence on temporal relationships is limited. This study examined temporal associations between staff approaches and resident behaviors during mealtimes.Research design and methodsVideotaped mealtime observations (N = 160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analyses using 5-, 10-, and 15-second time windows were conducted for resident positive, neutral, and challenging behaviors as antecedents as well as consequences of staff person-centered and task-centered approaches.ResultsResidents exhibited positive verbal (35.0%) and positive/neutral nonverbal (12.6%) behaviors, as well as challenging behaviors including functional impairments (27.7%) and resistive behaviors (24.7%). Staff primarily used person-centered approaches (54.1% verbal, 40.3% nonverbal); task-centered approaches were less frequent (5.6%). Immediately (within 5 seconds) after staff person-centered approaches, resident positive/neutral and resistive behaviors were more likely, and functional impairments less likely. After staff task-centered approaches, resident positive verbal and resistive behaviors were less likely. After resident positive/neutral behaviors, staff person-centered approaches were more likely. After resident functional impairments, staff person-centered verbal approaches were less likely, and task-centered approaches more likely. After resident resistive behaviors, all staff approaches were more likely. The strength of temporal relationships diminished in 10-second and 15-second time windows.Discussion and implicationsStaff-resident positive interactions were associated with more subsequent positive interactions. Person-centered care was associated with fewer subsequent resident functional impairments and more subsequent resistive behaviors. Resident resistive behaviors were associated with more subsequent person-centered and task-centered care. Findings confirm the importance of facilitating positive staff-resident interactions and managing functional impairments using person-centered care. Resistive behaviors require additional awareness and attention beyond commonly used person-centered care approaches. Further investigation of temporal relationships is needed using larger diverse samples.
| S-EPMC10396369 | biostudies-literature
Project description:IntroductionMealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person-centred and task-centred care and positive/neutral and challenging mealtime behaviours in persons with dementia.MethodsThis study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff-resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme was used to code videos during 2019-2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person-centred and task-centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression.ResultsStaff person-centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09-1.76), functional impairments (OR = 0.81, 95% CI = 0.66-1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18-2.31). Staff person-centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02-1.74). Staff task-centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours.ConclusionThis study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person-centred approaches and resident positive and challenging behaviours. Person-centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.
| S-EPMC9976786 | biostudies-literature
Project description:ContextNonverbal pain behaviors are effective indicators of pain among persons who have difficulty communicating. In nursing homes, racial/ethnic differences in self-reported pain and pain management have been documented.ObjectivesWe sought to examine racial/ethnic differences in nonverbal pain behaviors and pain management among residents with staff-assessed pain.MethodsWe used the U.S. national Minimum Data Set 3.0 and identified 994,510 newly admitted nursing home residents for whom staff evaluated pain behaviors and pain treatments between 2010 and 2016. Adjusted prevalence ratios (aPRs) and 95% CIs estimated using robust Poisson models compared pain behaviors and treatments across racial/ethnic groups.ResultsVocal complaints were most commonly recorded (18.3% non-Hispanic black residents, 19.3% of Hispanic residents, and 30.3% of non-Hispanic white residents). Documentation of pain behaviors was less frequent among non-Hispanic black and Hispanic residents than non-Hispanic white residents (e.g., vocal complaints: aPRBlack: 0.76; 95% CI: 0.73-0.78; with similar estimates for other pain behaviors). Non-Hispanic blacks (47.3%) and Hispanics (48.6%) were less likely to receive any type of pharmacologic pain intervention compared with non-Hispanic white residents (59.3%) (aPRBlack: 0.87; 95% CI: 0.86-0.88; aPRHispanics: 0.87; 95% CI: 0.84-0.89).ConclusionAmong residents requiring staff assessment of pain because they are unable to self-report, nursing home staff documented pain and its treatment less often in Non-Hispanic blacks and Hispanics than in non-Hispanic white residents. Studies to understand the role of differences in expression of pain, explicit bias, and implicit bias are needed to inform interventions to reduce disparities in pain documentation and treatment.
| S-EPMC8094375 | biostudies-literature
Project description:ObjectivesAgitated behaviors (behaviors) are common in nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD). Pragmatic trials of behavior management interventions rely on routinely collected Minimum Data Set (MDS) data to evaluate study outcomes, despite known underreporting. We describe a method to augment MDS-based behavioral measures with structured and unstructured data from NH electronic medical records (EMR).DesignRepeated cross-sectional analyses of EMR data from a single multistate NH corporation.Setting and participantsLong-stay residents (at least 90 days in NH) with ADRD from January 2020 through August 2022.MethodsQuarterly and annual assessments of NH residents with ADRD during the study period were identified. For MDS, any behavior was defined as a score of 1 or higher on the Agitated and Reactive Behavior Scale. For structured EMR data, any behavior was defined as increased resident agitation, verbal aggression, or physical aggression on the Interventions to Reduce Acute Care Transfers, Change in Condition form (INTERACT). For unstructured EMR data, any behavior was defined using keyword searches of free-text orders.ResultsA total of 77,936 MDS assessments for 19,705 long-stay residents with ADRD in 322 NHs were identified; 14.8% (SD 35.6) of residents had behaviors per month using MDS alone, 16.2% (SD 36.9) using MDS and INTERACT, and 18.6% (SD 38.9) using MDS, INTERACT, and orders. Supplementing MDS with EMR data increased behavior identification by 3.8 percentage points (a 25.7% relative increase). Less than 0.5% had behaviors noted in all 3 sources consistently across study months.Conclusions and implicationsUsing EMR data increased detectable behaviors vs the MDS alone. The 3 sources captured different types of behaviors and using them together may be a more comprehensive identification strategy. These results are important for better targeting of interventions and allocation of resources to improve the quality of life for NH residents with ADRD-related behaviors.
| S-EPMC11606745 | biostudies-literature