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Enhancing independent eating among older adults with dementia: A scoping review of the state of the conceptual and research literature

Palese, Alvisa; Bressan, Valentina; Hayter, Mark; Watson, Roger


Alvisa Palese

Valentina Bressan

Mark Hayter

Roger Watson


Addressing eating difficulties among older individuals with dementia living in nursing homes requires evidence-based interventions. However, to date, there is limited evidence of effective interventions designed to maintain and/or increase independent eating. In a field in which evidence is still lacking, a critical analysis of the state of research describing its main features can help identify methodological gaps that future studies should address. Hence, the aim of this study was to map the state of the research designed to maintain and/or promote independent eating in older individuals with dementia living in nursing homes.

A scoping review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Reviews and conceptual analyses performed with different methodological approaches, published in indexed journals, and written in English were included. Keywords Were searched for in the MEDLINE, the Cumulative Index of Nursing and Allied Health, and in the Scopus databases to identify papers published up to 31 May 2018.

17 reviews were included, assessing interventions’ effectiveness (n = 15) and providing conceptual frameworks for eating/mealtime difficulties (n = 2). Conceptual frameworks supporting interventions’ effectiveness have rarely been described in available studies. Moreover, interventions tested have been categorized according to non-homogeneous frameworks. Their effectiveness has been measured against (1) eating performance, (2) clinical outcomes, and (3) adverse event occurrence.

An increased use of conceptual frameworks in studies, as well as greater clarity in intervention categorization and outcomes, is necessary to enhance the reviews’ value in providing useful cumulative knowledge in this field. Interventions delivered should embody different components that integrate individual, social, cultural, and environmental factors, while when evaluating an intervention’s effectiveness, eating performance, clinical outcomes and adverse events should be considered. Together with more robust studies, involving clinicians could prove to be useful, as their knowledge of practice developed from direct experience can help develop innovative research questions.


Palese, A., Bressan, V., Hayter, M., & Watson, R. (2020). Enhancing independent eating among older adults with dementia: A scoping review of the state of the conceptual and research literature. BMC Nursing, 19(1),

Journal Article Type Review
Acceptance Date Apr 17, 2020
Online Publication Date Apr 21, 2020
Publication Date Apr 21, 2020
Deposit Date Apr 29, 2020
Publicly Available Date Apr 29, 2020
Journal BMC Nursing
Electronic ISSN 1472-6955
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 19
Issue 1
Article Number 32
Keywords Eating difficulties; Mealtime difficulties; Eating performance; Dementia; Eating intervention; Nursing homes
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Copyright Statement
© The Author(s). 2020 Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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