Food intake was temporally associated with mealtime behaviors of residents with dementia and staff care approaches in nursing homes: a timed-event window-based sequential approach

AIMS: To examine temporal relationships of resident food intake with resident mealtime behaviors and staff mealtime care approaches. METHODS: This study was a secondary analysis of 160 videos capturing dyadic mealtime interactions among 27 residents with dementia and 36 care staff in 9 nursing homes. Videos were coded using the refined Cue Utilization and Engagement in Dementia Mealtime Video-Coding Scheme to characterize resident mealtime behaviors, staff mealtime care approaches, and resident food intake process. Sequential analysis was conducted with resident mealtime behaviors and staff mealtime care approaches conceptualized as antecedents of resident successful food intake. RESULTS: Decreased pace of resident-initiated food intake was correlated with preceding resident mealtime functional impairments and resistive behaviors. Increased pace of staff-initiated food intake was correlated with preceding staff mealtime person-oriented verbal approaches. Decreased pace of staff-initiated food intake was correlated with preceding resident mealtime positive/neutral nonverbal behaviors and functional impairments, and staff mealtime task-oriented care approaches. CONCLUSION: Findings suggest resident mealtime behaviors and staff care approaches may serve as temporal indicators of pace of food intake. Higher rates of food intake co-occurred with resident-oriented positive communication, support addressing functional impairments, responses to resistive behaviors, greater use of person-centered care, and less use of task-centered care. Findings highlight potential targets for mealtime care practices aimed at supporting food intake, particularly resident-initiated intake, which reflects resident functional independence and active engagement in mealtime activities with or without staff assistance. Future investigation of full-meal dyadic interactions capturing diverse meal types and accounting for clustering effects is needed.