Improving Care for People with Dementia in NHS Continuing Care Facilities: Enhancing the Mealtime Experience for Older Patients, their Relatives and Staff

The study focused on mealtimes in two NHS Continuing Care facilities for people with dementia. The overall aim of the study was to collaboratively develop and implement smallscale interventions to improve the tone and nature of meals on the ward, enhance service user, relative and staff experiences of meals and mealtimes, and improve service user nutrition and hydration levels. It was predicted that interventions collaboratively developed with service users, relatives/carers and staff would likely be adopted and effective. In order to evaluate mealtimes and their change over time, the study employed mixed methodologies and measured physiological (e.g. nutrition and hydration), environmental (e.g. mealtime setup) and psycho-social (e.g. engagement and emotion) dimensions of mealtimes. The study found that while all stakeholder groups on both wards generated a high volume of ideas for improvement, organisational and micro-cultural factors adversely affected implementation. Also, the chosen interventions successfully addressed physiological aspects of mealtime experiences (overall, patients on both wards gained weight, which was in contradiction to both research and practitioner expectations; see Abbasi & Rudman, 1994). However, social aspects of mealtimes were often overlooked by ward staff and did not show substantial improvement. Additionally, comparisons of research sites revealed that micro-cultural processes within the wards determined both the way mealtimes were experienced and their potential for change/improvement. The study, therefore, demonstrated that while enhancing mealtime experiences on Continuing Care wards is possible, it is also a highly complex and multifaceted process, often not taken into account by organisational and national-level policies and care guidelines