NUTRITION CARE FOR LONG-TERM CARE RESIDENTS WITH DEMENTIA IN URBAN AND RURAL CONTEXTS: AN EVIDENCE BASED PRACTICE EXAMINATION OF THE ROLE OF CARE AIDES AND REGISTERED DIETITIANS
This doctoral dissertation contributes to the body of knowledge pertaining to nutrition care for persons with dementia. The aging population adds to the increased risk for and prevalence of dementia globally. Alongside this is a recognition of the need for care strategies for persons with dementia, and preventive strategies to delay onset of dementia or to delay secondary or tertiary comorbidity associated with dementia. Of strong interest is the field of nutrition, in terms of dietary strategies for primary prevention of dementia, for secondary and tertiary prevention of comorbidities, and for medical nutrition therapies to treat those with dementia, across the spectrum of dementing illnesses and degree of severity. Over the course of three related studies, nutrition care for long-term care (LTC residents was addressed using an evidence-based practice lens. Study 1 investigated care aides’ perception of nutrition care for urban and rural LTC residents with dementia. Key findings included the complexity of operationalizing person centered care into nutrition care activities, the mechanistic focus on feeding, and many organizational factors that direct nutrition care for care aides and residents with dementia. Study 2 examined the role of registered dietitians (RDs) in providing nutrition care for residents with dementia in urban and rural LTC. The key finding in this study was the downstream role of RDs in dementia care. As opposed to a more upstream preventive model of care, RDs were consulted or involved only at late stages or when comorbid decline had occurred, limiting their abilities to use their specialized nutrition knowledge and skills effectively. The 3rd study was an umbrella review of the peer-reviewed body of systematic reviews on nutrition care for residents with dementia in LTC. The major findings of this study include the lack of consistency in terms of nutritional outcomes considered and intervention tested, as well as a considerable gap in the published literature regarding both care aides and RDs. Taken together, these studies make a valuable contribution to the growing body of research on nutrition care and dementia. There is a need to continue to work with RDs and care aides in developing and testing interventions that can enhance both the physical health and quality of life for LTC residents with dementia.
Nutrition, Dementia, Long-term care, Care Aide, Dietitian
Doctor of Philosophy (Ph.D.)
Pharmacy and Nutrition