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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)

From: Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review

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
Kenkmann 2010 [25, 79] UK 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
→ 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
Ragneskog 1996 [30, 80] Sweden 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,
→ 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. 8 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
  1. *Calculated P value = 0.65 but paper reports significant t-test results
  2. AC various measures of arm circumference, AD Alzheimer’s Disease, BA before after (pre-post) study, BMI body mass index, CCT clinical controlled trial, CHO carbohydrate, C control, E energy, Hb haemoglobin, I intervention, ICW intracellular water, LTC long term care, MCI mild cognitive impairment, MMSE mini mental state examination, MNA mini-nutritional assessment, Mod moderate, N/A not applicable, NR not reported, ONS oral nutrition supplement, PEM protein energy malnutrition, QoL quality of life, RCT randomised controlled trial, TSF triceps skinfold measure, TST triceps skinfold thickness