Louise Mole


In this thesis I developed a complex intervention to help people living at home with dementia to eat well, and improve nutritional care. This was achieved through four studies conducted using multiple methods. A scoping review found 61 studies reported in 63 articles after searching six databases from inception to July 2016. Content analysis was used, and the overarching categories were: ‘timely identification of nutritional risk and subsequent regular monitoring of nutritional status’, ‘multi-component tailored interventions’, and the ‘influence of the caregiving dyad on nutritional status’. Most studies were cross-sectional (n=24), cohort (n=15) or qualitative (n=9). Only three were randomised controlled trials. People living at home with dementia are identified as a vulnerable group (n=35), however only four studies tested interventions to improve nutritional care. In two qualitative studies, semi-structured interviews were used (alongside diaries and a vignette) to explore the experiences of the nutritional care of people living with dementia at home from the perspectives of family members, healthcare professionals and homecare workers. Eight family carers (mean age of 69.6 years) and seven healthcare professionals and homecare workers (mean time spent in profession = 8.9 years) were purposively recruited and interviewed between October 2017 and March 2018. An Interpretative phenomenological analysis approach was used. Three superordinate themes were identified for family carers: ‘becoming carer and cook’, ‘changing role and relationships’, and ‘emotional eating’. Four superordinate themes were identified for healthcare professionals and homecare workers: ‘responsibility to care’, ‘practice restrained by policy’, ‘in it together’, and ‘improving nutritional care’. Family carers, healthcare professionals and homecare workers feel that they do not have adequate knowledge to support someone if they are nutritionally compromised. They are conscious about ‘doing the right thing’ when it comes to providing nutritional care. The acceptability and feasibility of three podcasts designed for homecare workers about providing nutritional care to someone with dementia were trialled. Six homecare workers took part between October and December 2019, attending a focus group, and completing a quiz. Normalisation process theory underpinned the thematic analysis of qualitative data. Knowledge improved from a score of 5.5 (median) before listening to 7.5 (median) after listening. Eight themes represented the views of the participants. Podcasts about nutritional care and dementia are acceptable to homecare workers, and knowledge of the nutritional concerns associated with dementia improved. Family carers and people living at home with dementia should be supported when making appropriate food and drink choices, preventing the risk of malnutrition. It is anticipated that the findings of the studies included in this thesis, will encourage healthcare professionals and researchers to place more focus on the nutritional needs of people with dementia living at home. Further development is required for podcasts, and evaluation of their impact in terms of practice and clinical outcomes are required.

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