Behavioral Challenges and Adaptive Strategies in Providing Mealtime Care to Residents With Dementia: A Qualitative Study of Nursing Home Clinical and Administrative Staff

Abstract

This study examined how nursing home staff adapt to challenging mealtime behaviors in residents with dementia, such as turning away or refusing food. Ten focus groups were conducted with 52 clinical and administrative staff from three southeastern U.S. nursing homes. Transcripts were analyzed using four key codes: feeding behaviors, interventions, training, and communication. Staff described a range of mealtime challenges, including cognitive and functional decline, dysphagia, and elopement. Feeding-related behaviors like refusing to eat reflect the complexity of care required. Staff reported adapting interventions based on residents’ abilities, their own interactions, or environmental factors. Most strategies aligned with evidence-based practices, though one novel tactic involved “sprinkling sugar” to stimulate appetite. Findings suggest that reframing feeding behaviors as communication may improve care and reinforces the need for tailored interventions. Differences in staff perspectives emphasize the value of cross-role collaboration in managing mealtime challenges and improving outcomes for residents with dementia.