Table 2 Conceptual frameworks and examples of available intervention studies on feeding difficulties

Structural and transient impairment; Exceed disability [35]

Less supportive environments are significantly associated with eating excess disabilities [8]

Enhancing table contrast; visual stimulation during evening meals; high and low visual contrast crockery may reduce transient impairments [21]

Swallowing impairments [36]

Offering appropriate or modified food texture; dysphagia diet food modification [12]

Mirror neurons [37]

Sharing meals with staff [12, 32]

Encouraging older adult to eat in the dining room to increase intake [29]

Montessori method [38]

Using Montessori-based activities, simplifying the process of mealtime [10]

Offering finger food in usual menu [12, 25, 31]

Spaced Retrieval [39]

Recalling the actions required to eat by gradually increasing the delay between each correct recall [8, 10]

Errorless learning model of everyday tasks [40]

Offering verbal prompts, cues, positive reinforcement [7, 8, 26]

Need-driven dementia compromised behaviour (wandering, vocalising, physical aggression) [41, 42]

Offering over lunchtime preferred; ‘quiet’; ‘relaxing’ music; at dinner time, offering music; ‘therapeutic recreation’ music [25, 31]

Reducing noise (e.g. from television) and encouraging personal conversation between patient and caregiver; avoiding distractions [31]

Progressively lowered stress threshold [43]

Assessing perceptions: when the staff perceive the patient as combative or uncooperative, less assistance is given during mealtimes [7, 27]

Family-style eating [44]

Assessing preferences in terms of breaking meals (or not) with snacks; meal timing, social involvement of caregivers; seasonal variations [7, 30]

Creating a family environment; a familiar activity prior to lunch; using standard dinnerware instead of disposable tableware and bibs; table-appropriate height versus eating in wheelchair or in bed [8, 31]

Decentralising bulk service as opposed to pre-plated meals; maintaining the ability to serve own food (not-plated) [31]

Familiarity [45]

Caring [25]

Where individuals with varying levels of dementia ate together without the staff, the person with lower dementia became the caregiver to those with severe dementia [7]

Individualising feeding assistance one-to-one; activating the primary nurse in mealtime care; the same carer feeding the patient; enhancing the quality of the interaction between the dyad; offering touch, guidance, redirection, providing compassionate care; offering mealtime assistance [7, 8, 10, 27, 32]

Reducing the separation of eating from meal preparation especially for older woman; engaging in meal creation that may stimulate the appetite; food prepared in areas adjacent to or in dining area to stimulate appetite [21, 23, 25, 27]

Enhancing dining programmes at NH level; incorporating nutrition as part of good quality care; training staff; offering feeding skills training programmes [10, 21]

Changing food service and routines, offering feeding assistance; a training programme on dementia care including supervision sessions and work groups and an environmental redesign; assessing the entire process (e.g. nutritional supplements, changes in food provision) and training carers [31, 32]

Feeding difficulties [34]

Mealtime difficulties [33]

Socio-ecological model [46, 47]

Mealtimes as active processes [48]

Five Aspects of Meal Model [49]

Making the Most of Mealtime [50]