Intentional rounding delivering tailored prompts to promote independent eating in older people during lunchtime meals in Nursing Home: a pragmatic clustered pre-post intervention study.

backgroundEating difficulties may lead to malnutrition in older adults living in nursing homes (NHs). Prompts to encourage independence have been shown to be effective. However, due to limited resources and the varying quality of dining rooms where residents sit together at the table, it is difficult to provide tailored prompts.

objectiveEvaluating the effects of interventions based on tailored prompts delivered by deliberately circling the tables (hereinafter, intentional rounding) in the dining room where residents sit to eat their meals on (a) independence in eating, (b) fluid and (c) food intake, and (d) time taken to eat the meal, compared with usual care in NHs with different quality environments.

methodsA pre- and post-intervention pragmatic cluster study with 106 residents of four Italian NHs (NH1, 2, 3 and 4). During lunch, residents were seated at a table and received tailored prompts with a positive focus, mediated by intentional rounding. Data was collected at baseline (T0 and T1, three weeks), during the implementation of the intervention (T2 and T3, one week each) and at follow-up (T4, after one week interruption of the intervention). Self-feeding dependency (Edinburgh Feeding Evaluation in Dementia scale), food and fluid intake (from 0 to 100% of total meal or fluid served) and meal duration (in minutes) were analysed using Seemingly Unrelated Regression, adjusting for the quality of the NH environment and the number of family caregivers present.

resultsEating performance improved in all residents and food and fluid intake increased from baseline (T0) to the end of the intervention (T3); however, residents did not maintain their intake after the intervention was interrupted. The time required for residents to complete the meal was > 19 min at T0 and > 21 min at T3. There were differences in the effectiveness of the intervention depending on the quality of the environment in the NHs.

conclusionsCompared to usual daily care, prompts from caregivers through scheduled rounds at the tables where residents sit to eat their lunch are effective in improving feeding performance and food and fluid intake. However, after one week, when usual care is resumed, all outcomes deteriorate slightly, indicating that the interventions require continuity. CLINICAL TRIAL NUMBER: Not applicable.