Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia

J Am Geriatr Soc. 2017 Apr;65(4):e89-e94. doi: 10.1111/jgs.14728. Epub 2017 Feb 6.


Background: Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake.

Objectives: To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand (DH), Over Hand (OH), and Under Hand (UH).

Design: A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences.

Setting and participants: 30 residents living with advanced dementia in 11 U.S. NHs.

Measurements: Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale.

Intervention: Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N = 540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every 2 days.

Results: Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67 ± 15.2%) and UH (65 ± 15.0%) with both significantly greater than OH (60 ± 15.1%). Feeding behaviors were more frequent with OH (8.3 ± 1.8%), relative to DH (8.0 ± 1.8) and UH (7.7 ± 1.8).

Conclusion: All three techniques are time neutral. UH and DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding.

Keywords: dementia; feeding behaviors; handfeeding; mealtime difficulties; nursing home.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Dementia / physiopathology*
  • Eating*
  • Energy Intake
  • Feeding Behavior*
  • Female
  • Humans
  • Male
  • Nursing Homes
  • Pilot Projects
  • Prospective Studies
  • Time Factors
  • United States