Individualized Eating Program Lowers Depression in Dementia Patients

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Institutionalized dementia patients who received individualized instruction on good eating habits had fewer symptoms of depression six months later, according to a new Taiwanese study published in the Journal of Advanced Nursing.

“The improvement in nutritional status may have led to reduced fatigue and increased vitality,” said the researchers. “Once the participants perceived the improvements in their health, pessimism, the sense of multiple illnesses, hopelessness, or even worthlessness seldom emerged.”

Nutritional status and body mass index increased in patients who received the individualized program, decreased in the control group, and showed little change with the non-individualized program, said the researchers.

Dementia patients often miss out on proper nutrition. As the researchers explained, “identifying foods, transferring foods, chewing, and swallowing” become progressively more difficult for patients with cognitive problems.

Furthermore, previous studies have linked poor nutritional status to depression, in otherwise healthy adults and in those with dementia.

In the current study, the researchers combined Montessori-type methods with a technique called “spaced retrieval.” The goal was to help dementia patients eat more and eat more regularly.

Spaced retrieval is a teaching method that helps people recall information. It involves challenging the person to remember something for increasing time intervals. If it is successfully remembered after 2 minutes, a second challenge will require recall after 4 minutes. When recall fails, the challenge is repeated again at the last successful interval.

Montessori-based activities were chosen to reinforce healthy eating behaviors because cognitive abilities in dementia patients often resemble those of young children.

For the study, the researchers randomized 90 patients to usual care or to an individualized or non-individualized version of the program. Both versions included sessions lasting 35-40 minutes three times a week. The training focused on eight basic eating behaviors, from remembering mealtimes to swallowing after chewing.

In the individualized program, training was progressively intensified for individual patients if they showed mastery at a given level. The number of sessions also depended on individual patients’ needs. For example, a patient with mild dementia might receive 23 sessions whereas a person with severe dementia might receive 35.

In the non-individualized program, training intensity increased only when more than half the participants had shown mastery. The number of sessions was fixed at 24 over an eight-week period.

About 4 percent to 18 percent in each study group were taking antidepressants, 32 percent to 45 percent were taking antipsychotic medications, and 20 percent to 29 percent were on anti-anxiety drugs.

“The greatest improvement of nutritional status and depressive symptoms resulting from the individualized intervention occurred between the immediate post-training period and the one-month followup,” noted researchers Li-Chan Lin, Ph.D., R.N., of National Yang-Ming University and Hua-Shan Wu, Ph.D., R.N., of Shan Medical University.

Because of this, they suggested that additional “booster sessions” may be helpful in maintaining or increasing the short-term gains.

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By Traci Pedersen Associate News Editor
Reviewed by John M. Grohol, Psy.D. on March 3, 2013

For full paper, see: http://onlinelibrary.wiley.com/doi/10.1111/jan.12097/abstract

Wu H.-S. & Lin L.-C. (2013) The moderating effect of nutritional status on depressive symptoms in veteran elders with dementia: a spaced retrieval combined with Montessori-based activities. Journal of Advanced Nursing 00(0), 000–000.doi: 10.1111/jan.12097

Keywords:

dementia;
depressive symptom;
nursing;
nutritional status;
repeated measures;
spaced retrieval combined with Montessori-based activities;
quasi-experimental design

Abstract
Aim

To examine the long-term effects of fixed/individualized spaced retrieval combined with Montessori-based activities on nutritional status and body mass index and nutritional improvement's moderating effect on depressive symptoms for people with dementia during a specific follow-up period.

Background

The decrease in food intake, often combined with poor nutrition, may induce depressive symptoms in people with dementia.

Design

A single-blind, quasi-experimental study with repeated measures.

Methods

Twenty-five fixed group participants received spaced retrieval combined with Montessori-based activities over 24 sessions. Thirty-eight individualized group participants received the same intervention with different sessions, which was adjusted according to each participant's learning response. Twenty-seven control group participants just received routine care. The Chinese version of the Mini-Nutritional Assessment and Cornell Scale for Depression in Dementia scores and body mass index were recorded at pre-test, posttest and 1-, 3- and 6-month follow-ups. Data were collected between July 2008–February 2010.

Results

The Mini-Nutritional Assessment scores and body mass index of the fixed and individualized groups could be significantly increased over time. Additionally, the Cornell Scale for Depression in Dementia scores could be significantly reduced as a result of the improvement of the Mini-Nutritional Assessment scores arising from the individualized intervention.

Conclusion

The depressive symptoms of residents with dementia could be moderated by the individualized intervention through nutritional improvement. Trained clinical nurse specialists can use this individualized intervention for residents with dementia who also have poor nutrition and depressive symptoms.