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.