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

© 2016 Bunn et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). METHODS: We comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). The review was conducted with service user input in accordance with Cochrane Collaboration's guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively. RESULTS: We included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions. CONCLUSIONS: We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try. TRIAL REGISTRATION: The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611).Peer reviewedFinal Published versio

Additional file 1: of Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review

Full systematic review methodology for EDWINA (Eating and Drinking Well IN dementiA) systematic review. (DOCX 30 kb

Additional file 2: of Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review

Tables of characteristics of included studies and risk of bias summaries. (DOCX 216 kb

Raaka-aineen syöttämisen automatisointi

Työssä kehitettiin kalafileeraamon tuotantoa. Raaka-aineen purkaminen tuli automatisoida, ja työssä ideoitiin ratkaisumalleja toteutettavissa oleviksi vaihtoehdoiksi. Tavoitteena oli määrittää laitteiston vaatimukset ja kartoittaa työhön soveltuva laitteisto sekä arvio kustannuksista. Työn alkuvaiheessa käytiin läpi automatisoidun laatikonkäsittelylaitteiston vaatimukset. Tärkeimmät vaatimukset ovat laatikon siirtäminen kuormalavalta, kansien ja kiinnityspantojen poistaminen ja laatikon sisällön tyhjentäminen. Laitteiston toiminnasta ja laitteistokokoonpanosta ideoitiin eri vaihtoehtoja. Laatikon tyhjentäminen toteutettaisiin robotilla, automatisoidulla linjastolla tai niiden yhdistelmällä. Lisätietoja hankittiin laitevalmistajilta. Työn tuloksena on ehdotus raaka-aineen purkamisen automatisoimiseksi. Robotti ja kuljettimet ovat saatavilla suoraan laitevalmistajalta. Kippauslaite ja laatikoiden kiinnityspantojen poistaminen vaativat jatkokehitystä. Työtä voi käyttää apuna tuotannon kehittämisessä. Työssä on huomioitu mahdollisen uuden tuotantotilan tuomat mahdollisuudet työpisteen kehittämisessä. Uusi tuotantotila olisi suurempi, joten siellä olisi mahdollista käyttää kahta robottia ja automaattista lavanvaihtojärjestelmää. Vaihtoehtoinen ratkaisu ei sovellu nykyiseen tuotantotilaan