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Table 3 Characteristics and results of included food and drink modification, swallowing intervention, eating or drinking assistance and social support interventions

From: Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis

Study Design Setting, Intervention type No. Dementia stage Dementia type Effect on Nutrition / hydration status Intake effect Quality & other outcomes Duration
Swallowing interventions
 Bautmans 2008 Belgium [56] RCT Nursing home. Cervical spine mobilization to help dysphagia 15 Severe AD NR NR ↑ Dysphagia limit 1 week
 Germain 2006 Canada [57] RCT Long term care facility. Dysphagia diet I = 8
C = 9
NR AD &
others
↑ Weight ↑ E intake NR 12 weeks
 Robbins 2008 USA [58, 102104] RCT Hospitals & nursing homes.
1. Nectar-thick or
2. Honey-thick consistency fluids
3. Chin-tuck position
Nectar 133,
Honey 123,
Chin-tuck
259
Various NR   NR → Aspiration pneumonia incidence (for thickened vs chin-tuck) 3 months
Food modification
 Beck 2010 Denmark [31, 101] RCT Elderly nursing home residents. ONS, Gratin diet, swallowing problem management, exercise and oral care vs usual care I = 54
C = 55
NR NR BMI
↑ Weight
→ E-intake
↑ Protein intake
→ Cognitive performance
→ ADL
11 weeks
 Boffelli 2004 Italy [33] CCT
(BA)
Dementia unit. Diet & environment modification, feeding assistance and supplements 29 Severe Various → BMI
→ weight
↑ Albumin
NR NR 18 months
 Jean 1997 USA [59] CCT
(BA)
Nursing home.
Finger food menu
12 NR AD &
others
? Weight loss arrest NR ? Eating independence 6 months
 Keller 2003 Canada [63, 105] CCT Long term care facilities. Individualised food service, food modification, education and dietitian time I = 33
C = 49
NR AD &
others
↑ weight NR NR 21 months
 Kenkmann 2010 UK [64, 106] RCT 6 Care homes. Dining environment & menu changes I = 57,
C = 48
NR NR → Weight,
→ BMI,
→ Hydrated
NR → Enjoyment
of food/drink
1 year
 Salas-Salvado 2005 Spain [61] RCT Geriatric institutions.
Meal replacement with commercial
lyophilised supplement
I = 15
C = 23
Severe AD ↑ Weight
↑ Serum albumin
→ E intake
→ Nutritional risk
→ Eating behaviour
→ Mortality
→ Cognitive parameters
3 months
 Soltesz 1995 USA [60] CCT
(BA)
Alzheimer’s Care Centre.
Finger food provision
43 NR AD → Weight ↑ Proportion food eaten NR 6 months
 Young 2005 Canada [54, 62, 100] RCT Nursing home.
High CHO dinners
I = 15
C 19
NR AD NR ↑ E intake NR 21 days
Eating or drinking assistance interventions
 Boffelli 2004 Italy [33] CCT
(BA)
Dementia unit, diet & environment modification, feeding assistance and supplements 29 Severe Various → BMI
→ Weight
↑ Albumin
NR NR 18 months
 Simmons 2001 USA [65, 107] CCT Nursing Homes. Staff assistance, prompting, food/drink service and exercise I = 48
C = 15
NR NR → Serum osmolality
→ BUN: creatinine ratio
→ Food
& fluid intake
NR 32 weeks
 Simmons 2008 USA [66] RCT Skilled nursing homes. Either meal time or between meal feeding assistance I = 35
C = 34
NR NR ? BMI,
? Weight
E intake NR 24 weeks
 Simmons 2010a USA [50] RCT Long-term care facilities. Between meal supplements & assistance vs usual care I1 = 18
C 20
NR NR → Weight → E intake NR 6 weeks
 Simmons 2010b USA [50] RCT Long-term care facilities. Between meal snacks & assistance vs usual care I2 = 25
C = 20
NR NR →Weight → E intake NR 6 weeks
 Wong 2008 New Zealand [67] CCT
(BA)
Short stay assessment unit.Individual mealtime assistance 7 NR NR BMI E intake NR 12 weeks
Studies with a strong social element around eating/drinking
 Altus 2002 USA [68] CCT
(BA)
Locked dementia unit.
Family-style meals −/+ staff training
5 Mod-
severe
AD &
others
NR NR ? Resident Participation in mealtime tasks
? Appropriate communication
? Praise statements
? Staff satisfaction with resident participation
5 days each period
 Charras 2010 France [69] CCT Dementia units in nursing homes.
Shared mealtime with staff
I = 8
C = 10
Severe AD Weight NR ? Autonomy
? Quality of interactions
? Food quality
6 months
 Huang 2009 Taiwan [70] CCT
(BA)
Older person care facility,
Reminiscence cooking therapy
12 Mild-mod NR NR NR → MMSE
↑ Happiness
→ Communication
? Participation
8 weeks
 Santo Pietro 1998 USA [71] CCT Dementia unit within a nursing home.
Breakfast club (communication therapy)
I = 20
C = 20
Mild-mod AD NR NR ↑ Interest & involvement
↑ Communication
12 weeks
  1. ↑ indicates statistically significant increase; ↓ indicates statistically significant reduction; → indicates no statistically significant effect; ? indicates unclear whether effect was statistically significant. Statistical significance of all effects were checked by reviewers where data were available, and reviewers results used when they differed from the original paper.
  2. AD Alzheimer’s disease, ADL activities of daily living, BA before-after, BMI body mass index, CCT controlled clinical trial, CG control group, CHO Carbohydrate, E energy, IG intervention group, NR not reported, ONS oral nutritional supplement, RCT randomised controlled trial, vs versus