Table 2 Summary of characteristics and results of 17 included interventions (reported in 15 studies) investigating dining environment and food service (for further detail see Additional file 2)
Study | Design | Setting, intervention type | No. | Dementia diagnosed | Dementia stage | Dementia type | Nutrition/hydration effect | Intake effect | Quality effect (including QoL or meaningful activity) and other outcomes | Duration |
|---|---|---|---|---|---|---|---|---|---|---|
Altus 2002 [19] Period 1 USA | BA | Locked dementia unit. Family-style meals | I = 5 C = NR | Yes | Mod-severe | AD & others | NR | NR | ? Resident mealtime participation, ? Communication during meals, ? Praise by nurse (all improved but statistical significance unclear) | 5 days |
Brush 2002 [20] USA | BA | 2 LTC facilities. Improved dining room lighting and table setting contrast | 25 | Yes | Mod-severe | NR | NR | ↑ E intake | → Quality & adequacy of food intake, → Functional status | 4 weeks |
Charras 2010 [21] France | CCT | Dementia units in nursing homes. Shared mealtime with staff | 18 | Yes | Severe | AD | ↑ Weight | NR | ? Greater autonomy, helping with serving and clearing up, eating independently ? Increased and higher quality resident-resident and resident-staff interaction ? Longer meals ? Better food quality ? Greater staff satisfaction (improvements based on reported observations, no significance testing) | 6 months |
Desai 2007 [22] Canada | CCT | 2 LTC facilities, Bulk food service and home-like setting | I = 22 C = 26 | Yes | NR | AD | ? BMI | ↑ E intake ↑ CHO intake ↑ Protein intake | NR | 3 weeks |
Dunne, 2004 [23] Study 1 USA | BA | LTC unit. High & low contrast red tableware | 9 | Yes | Severe | AD | NR | → % Food intake ↑ % Fluid intake | NR | 10 days |
Dunne, 2004 [23] Study 2 USA | BA | LTC unit. High & low contrast tableware (3 conditions) | 9 | Yes | Severe | AD | NR | → % Food intake → % Fluid intake | NR | 10 days each |
Edwards 2013 [24] USA | BA | Specialised dementia units. Dining area aquarium | 70 | Yes | severe | NR | → Weight* | ↑ Quantity of food & drink intake | NR | 8 weeks |
CCT | 6 Care homes. Improved dining environment & atmosphere, available snacks and drinks machines, increased food choice, extended restaurant hours | I = 57 C = 48 | NR | NR | NR | → Weight → BMI → Appears hydrated | NR | → Enjoyment of food and drink → Cognition | 1 year | |
Koss 1998 [26] USA | BA | High functioning dementia unit. Dining environment enhanced lighting and contrast | 13 | Yes | NR | AD | NR | → Quantity of food intake | NR | 3 weeks |
McDaniel 2001 [27] USA | BA | Dementia unit. Large bright cafeteria style dining room vs small darker room with relaxing music | 16 | Yes | Various | AD | → Weight | → E intake → Fluid intake | NR | 2 weeks |
Perivolaris 2006 [29] Period 1 Canada | BA | LTC facility. Enhanced dining (small welcoming dining rooms, music, bread & coffee aroma, menu board, staff using cues and prompts) | 11 | Yes | Mod-severe | Various | NR | ↑ E intake | → Feeding ability → Agitation level → Resident satisfaction ? Residents eating more leisurely, less wandering, more relaxed (according to staff notes from focus group) | 6 weeks |
BA | Nursing home. Dinner music (soothing music, familiar tunes, pop music) | 20 | Yes | Mod-severe | Various | NR | ? Weight ↑ Food quantity (pop music) → Food quantity (familiar & soothing music) | ↑ Psychological wellbeing → Motor impairment → Intellectual impairment → Emotional impairment ? more time taken for meal | 8–10 days each | |
Shatenstein 2000 [31] Canada | BA | Dementia unit. Decentralised food service | 22 | Yes | NR | AD & others | → Weight, → BMI, → TST → AC ↓ Albumin | ↑ % food intake, ↑ E intake, ↑ CHO intake, ↑ Protein intake | NR | 10 weeks |
Thomas 2009 [32] USA | BA | Nursing home. Lunchtime music (variety of styles but familiar to participants) | 12 | Yes | Mod | AD | NR | ? Quantity of food intake | ? Anecdotal reports of increased social engagement, remaining in dining area longer, responding to music with dancing, foot tapping etc. | 8Â weeks |
Van Ort 1995 [28] (contextual intervention) USA | BA | Secure nursing unit. Improved dining environment (protected mealtimes, noise & distractions minimised, meals taken in dining area, seated at tables, finger foods provided) | 7 | Yes | Severe | NR | → Weight | ? Quantity consumed | ? Greater self-feeding behaviour ? Meals did not take longer ? Those with milder dementia received more food and interacted more with their care-givers | 2 weeks |
Wong 2008 [33] Period 2 New Zealand | BA | Short stay assessment unit. 24 h snacks and earlier meals | 40 | Yes | NR | NR | ↑ BMI → AC | ? E intake | NR | 12 weeks |
Wong 2008 [33] Period 4 New Zealand | BA | Short stay assessment unit. Mealtime soothing music | 28 | Yes | NR | NR | ↑ BMI → AC | ? E intake | NR | 12 weeks |