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Objectives: Cerebral palsy (CP) can cause motor, sensory, cognitive, and communicative problems and poor feeding performances in children. Feeding problems could be lifethreatening and negatively affect cognitive and physical growth. This study investigates the frequency of response to oral motor skills, the frequency and severity of feeding problems, and the relationship between age and oral motor skills with feeding problems in children with CP aged 2 to 7 years. Methods: This was an observational and cross-sectional study. The participants were 60 children (26 girls and 34 boys) with CP with a mean age of 4.76±1.71 years. The screening tool for eating problems and oral motor assessment scale assessed participants' feeding and oral motor skills. The Spearman test determined the correlation between age and oral motor dysfunctions with feeding problems. Results: The present study revealed that 80% of participants indicated feeding problems in the screening tool of the eating problems test. Problems with feeding skills (51.5%) were the most frequent. Furthermore, the most frequent response of participants to "closing the lips while feeding with a spoon" was 46.7%, and "sucking with straw," equaled 55.0%," which was passive. For other items, the most frequent response of the examinees was "functional." Finally, the results showed no significant correlation (P<0.05) between age and mean scores of frequency and severity of feeding problems. A significant negative correlation was found between mean scores of oral motor skill with frequency (P<0.001, r=-0.476) and severity (P=0.001, r=-0.424) of feeding problems. Discussion: The majority of children with CP have problems with feeding and oral motor skills. Some skills in the fields of feeding and oral motor should be noticed more by speechlanguage pathologists and included in their therapeutic program, especially "feeding skills," "closing the lips while feeding with a spoon," and "sucking with straw." [ABSTRACT FROM AUTHOR]

To determine the efficacy of interventions with active parent implementation for young children with cerebral palsy (CP) to improve child and parent outcomes in low-middle income countries (LMICs). Five databases were systematically searched. Randomised or comparison studies evaluating interventions with the training of the parent and/or home practice components to implement with their child with CP (<60 months of age) were included. The modified Downs and Black scale assessed methodological quality. Data were pooled to calculate mean differences and 95% confidence intervals (95% CI). Searches yielded 189 unique articles. 11 studies from ten papers of moderate to high quality were included. Parent-implemented general developmental interventions had a small negative effect on gross motor function compared to interventionist-implemented therapy. Parent-implemented upper limb training compared to interventionist-implemented neurodevelopmental therapy had a small positive effect on bimanual hand function. Parent-implemented functional feeding training had a large significant effect on chewing function compared to parent-implemented oral motor exercises. Parent-implemented interventions targeting general child development and feeding had mixed effects on parent stress outcomes. Parent-implemented interventions in LMICs are promising to improve child bimanual hand and chewing function. Further research evaluating the efficacy of parent-implemented interventions to improve parent mental health is needed. Intensive motor training-based interventions with active parent implementation were effective to improve child gross motor, bimanual hand, and chewing function in young children with CP compared to passive, generic interventionist-implemented or health education interventions. Interventions with active parent implementation had mixed results to improve parent mental health, however, this was frequently not assessed. A consistent level of support and training provided to parents may be required to have a positive effect on parent stress. To further understand the feasibility of early interventions with active parent implementation in LMICs, data on adherence to home practice dose and session attendance and a qualitative understanding of contextual and child factors influencing parent implementation is needed. [ABSTRACT FROM AUTHOR]

While feeding challenges in autism spectrum disorder (ASD) are prevalent, they continue to pose a significant diagnostic challenge, leading to misdiagnosis and under diagnosis of factors, both contextual and inherent, that may lead to negative health outcomes. Early identification of feeding difficulties in ASD is necessary to minimize negative health outcomes and strained parent–child relationships. Family physicians and paediatricians are positioned to reduce the impact of such disordered feeding behaviours on the child, family, and health care system. Providing clinicians with a conceptual framework to systematically identify factors contributing to the 'feeding challenge' construct will ensure the appropriate intervention is provided. We present the MOBSE conceptual framework, a multidisciplinary lens for assessing feeding challenges in ASD. This will aid in the proper diagnosis of feeding challenges seen in ASD. [ABSTRACT FROM AUTHOR]

Background: Mealtime support has a direct bearing on the diet‐related health of men and women with intellectual disabilities as well as opportunities for expressing dietary preferences. Method: Semi‐structured interviews with a sample of direct support staff providing mealtime support to adults with intellectual disabilities. Results: When managing tensions between a person's dietary preferences and ensuring safe and adequate nutrition and hydration, direct support staff are sensitive to a wide range of factors. These include the following: clinical advice; service users' rights to choose; their (in)capacity to weigh up risks; how service users communicate; the constituents of a healthy diet; and a duty to protect service users' health. Conclusions: Those responsible for setting standards and regulating the care practices need to look beyond too simple ideas of choice and safety to recognize ways in which providing support at mealtimes is a complex activity with serious consequences for people's health and well‐being. [ABSTRACT FROM AUTHOR]

This study described the dietary intake profiles of 14 female (F) and 9 male (M) trained British wheelchair games players. The M group showed significantly higher daily energy (2060 ± 904 vs. 1520 ± 342 kcal·day-1), carbohydrate and protein intakes than the F group (p < .05). The energy derived from carbohydrate, protein, and fat for both F and M groups were similar (53.6%, 16.9% and 29.3% and 53.3%, 19.0% and 26.8%, respectively), yet the carbohydrate intakes were slightly lower than those recommended for athletes. Only two participants from the F group showed adequate intakes of iron, and 19 participants from both F and M groups did not meet the dietary fiber recommendation but this may be related to individualized bowel management strategies. Overall, the dietary practices encompassed aspects of the dietary guidelines recommended for sport, but balancing the energy needs of wheelchair games play with the promotion of long-term health still needs careful consideration. [ABSTRACT FROM AUTHOR]

Feeding disorders exhibited by children with developmental disabilities, which include limiting food intake or refusing to consume solid foods, often result in poor health consequences. Interventions for feeding disorders vary in terms of their acceptability to children with disabilities and their families. One specific procedure, the high-probability sequence, is a nonrestrictive approach where requests with which a child has a history of compliance are presented prior to requests associated with noncompliance. This article reviewed research concerning the application of high-probability sequencing for feeding disorders among children and adolescents with developmental disabilities. Experimental studies published between 1970 and 2018 in English as either peer-reviewed articles or dissertations were eligible for descriptive review. Identified articles (N = 15) evaluated high-probability sequencing using various single-case experimental designs. Participants (N = 21) were generally preschool-aged children (mean age = 5.7 years) diagnosed with autism spectrum disorder (ASD; n = 9) or other developmental disabilities (n = 12). Subsequent analysis of articles that met quality indicators of the What Works Clearinghouse (n = 12) suggests that research does not support the effectiveness of the procedure for increasing food acceptance. Implications for practice and future studies involving high-probability sequencing follow a discussion of findings. [ABSTRACT FROM AUTHOR]

Purpose: Mealtime difficulties are prevalent in dementia, posing major challenges to people with dementia (PWD), carers, and clinical services. Speech-language pathologists have a recognized role in providing training to carers of PWD who have mealtime difficulties. The aims of this study are (a) to identify the training needs of nurses and care staff with regard to managing mealtime difficulties in PWD, (b) to describe existing training interventions on this topic, and (c) to investigate the extent to which these interventions are relevant to the needs of nurses and care staff. Method: A systematic search was carried out to identify studies relevant to the aims of the review. Data were extracted and then synthesized using thematic analysis and a synthesis matrix. Study quality was appraised using a validated appraisal tool. Results: Various themes were identified in relation to the training needs of nurses and other care staff who manage mealtime difficulties in PWD. These were as follows: person-centered care; dealing with uncertainty; strategies, skills, and knowledge; and creating the right environment. Existing training interventions were described and compared against the training needs. The review found some correspondence between interventions and staff needs, but also some gaps. Conclusions: Training interventions on this topic should be more systematically developed and better reported to facilitate effective implementation. Evidence to date indicates that training should do more to help staff deal with uncertainty. Further research assessing the benefits of speech-language pathologists' involvement in the development of training interventions is recommended because of this profession's specialist skills and knowledge with regard to both dysphagia and communication. [ABSTRACT FROM AUTHOR]

OBJECTIVE. We identified and described the strategies parents use to support the mealtime participation of their child with autism spectrum disorder (ASD). METHOD. Twelve families with children with ASD (ages 2--7 yr) participated in videotaped mealtime observations. Qualitative content analysis was used to identify strategies families used to facilitate participation. RESULTS. Six categories were identified: (1) parent intervening and ignoring, (2) meal preparation and adaptability, (3) play and imagination, (4) distractions, (5) positive reinforcements, and (6) modeling. Props--common child objects that support the child's mealtime participation--were used in the context of multiple strategies. In addition, increased parental vigilance emerged as an important component of all family mealtimes. CONCLUSION. Families used multiple strategies within and across mealtimes, highlighting the individualistic nature of feeding challenges. Understanding parent mealtime strategies allows for further investigation into the efficacy and development of intervention strategies to promote mealtime participation of children with ASD. [ABSTRACT FROM AUTHOR]

Purpose: Although cerebral palsy is the most prevalent health condition linked to childhood disability in Bangladesh, support and rehabilitation for this group is limited and intervention development is slow. An initiative to address these unmet needs was the development of a parent/caregiver training programme for the rehabilitation of children with cerebral palsy. The aim of this study was to explore what was important in the everyday lives of children with cerebral palsy in rural Bangladesh and take their views into account to inform the training programme. Methods: Qualitative data was collected from 12 children with cerebral palsy, between 5 -14 years of age. The children were purposively selected from among those who attended the training programme. A participatory method called the 'Feeling Dice' was used to elicit children's feelings about their everyday lives. The approach was easy to use, acceptable in the local context, the children enjoyed the activity, and it generated rich information. Results:'Inclusion in play' and 'being able to attend school' made the children happy and were their two main priorities, yet were not key issues for parents. The children were frustrated by their dependence on others for day-to-day activities such as feeding, bathing, and transport to school. Children also played an important part in encouraging their parents to attend the training course. Conclusion: This study showed that valuable information can be gathered from children with cerebral palsy by using a simple and adaptable participatory research tool. Children's views and priorities sometimes differed from those of their parents and carers, and is useful for developing more relevant and valid interventions. Children need to be recognised as important 'agents of change' within their own rehabilitation. This methodology is in harmony with the UNCRPD recommendations, and supports inclusive and rights-based intervention development. [ABSTRACT FROM AUTHOR]

Date Presented 04/22/2023 Feeding challenges in a national sample of autistic children (N = 427) are characterized, including early feeding challenges, independent feeding, mealtime routines, caregiver strategies, and reported food and environmental sensitivities. Primary Author and Speaker: Brittany St John Additional Authors and Speakers: Alana Wooley, Hsiang-Ting Chen, Karla Ausderau [ABSTRACT FROM AUTHOR]

Abstract: Background: Feeding children with cerebral palsy (CP) is challenging and can lead to poor health outcomes. Using a facility‐based intervention, we assessed the effect of a practical nutrition programme on feeding skills in caregivers of children with CP attending a pediatric clinic in urban Tanzania. Methods: A randomized‐controlled intervention study, involving 2‐block stratified sample of under‐5 CP children attending a specialized pediatric clinic at the Muhimbili National Hospital was done. One hundred ten moderate‐to‐severe, new and follow‐up cases of children with CP were randomly allocated to the intervention (N = 63) and control groups (N = 47). A short nutrition education on feeding and positioning skills was provided to caregivers and occupational therapy sessions to CP children. Bivariate and multivariable logistic regression analyses of collected data were done. Statistical significance was assessed at p < .05. Findings: The intervention significantly improved feeding skills of caregiver in the select indicators assessed. More caregivers appropriately positioned the children (AOR = 5.29; 95% CI: 2.00–13.96), fed children slowly (AOR: 5.17, 95% CI: 1.99–13.44), and involved the child during the feeding process (AOR = 3.46; 95% CI: 1.42–8.44). During feeding, caregiver's reported being less stressed (AOR = 2.53, 95% CI: 1.04–6.13) and the child's mood was more likely to be reported as improved (AOR = 3.15, 95% CI: 1.33–7.474). Although changes were observed in oral motor feeding skills (AOR = 1.67; 95% CI: 0.72–3.91) and functional feeding skills (AOR = 2.28; 95% CI: 0.86–6.06), they did not reach statistical significance in the multivariable models. Conclusion: Strengthening nutrition education and services for caregivers of children with CP has great value in the care of children with special needs and may improve the health outcomes of children as well as reduce stress among parents/caregivers. [ABSTRACT FROM AUTHOR]

Background/aim: Enteral feedings are part of the daily mealtime experience for many caregivers of children with cerebral palsy. The scope of occupational therapy practice incorporates multiple aspects of the enteral feeding process. Yet, the research in this area is very limited. The purpose of this study was to provide practitioners with better understanding of the impact enteral feedings of children with cerebral palsy have on family mealtime routines. Methods: Using a complimentary mixed method approach, data were obtained through an online survey containing the Satisfaction Questionnaire with Gastrostomy Feeding (SAGA‐8) and supplementary questions, and qualitative semi‐structured phone interviews. Participants were caregivers of children with cerebral palsy who receive their primary nutrition through a gastrostomy tube. Results: This study's cohort consisted of n = 36, SAGA‐8, and n = 6 in‐depth interviews. The mean age of children of was 9.4 (6.94 SD) with a mean age of 3.4 (5.35 SD) when enteral feeding was introduced. While families' overall situations positively changed after the gastronomy tube placement, environmental barriers and length of feeding time continued to present a challenge to mealtime routines. The mixed methods data analysis revealed that successful adjustment to having a child with a gastronomy tube and problem solving are closely linked and a consistent part of mealtime experience. Conclusion: Findings highlighted the necessity of comprehensive support from health professionals in achieving positive mealtime experience. Themes in this study indicated that caregivers would benefit from a professional with knowledge in the development and integration of rituals and routines to support positive outcomes. [ABSTRACT FROM AUTHOR]

Parental feeding behaviors and concern about child weight are associated with obesity among youth who are typically developing. Little is known about this relationship among parents of youth with special needs, despite these children having higher obesity risk. This study used an online survey to explore associations among parental feeding behaviors, parent weight concerns, demographics, and child weight status in a sample of 356 parents of children diagnosed with autism spectrum disorder, spina bifida, and Down syndrome. Specific parental feeding behaviors were significantly related to the child’s weight and intensified when the parent was concerned about the child’s weight. Child’s diagnosis, family income, parent age, and parent gender influenced select feeding behaviors. Obesity has significant health ramifications and negatively affects an individual’s ability to self-manage, which is crucial in individuals with special needs. These findings present an opportunity for the health care community to educate and promote healthy feeding practices in this vulnerable population. [ABSTRACT FROM AUTHOR]

Nutritional research in elderly disabled is difficult in noninstitutionalized people. The dietary intake of a noninstitutionalized disabled population of the eastern region of Spain was evaluated to detect possible nutritional deviations. A total of 329 participants aged 65 and over were recruited. Most participants were overweight. Carbohydrates did not reach 50% of total Kcal/day. Insufficient micronutrient intakes and high consumption of simple carbohydrates and saturated fats (SFA) were found. A decreasing trend of water intake (p < .05) as well as an increasing trend of alcohol consumption (p < .05) with increasing age was found. The area of residence had a relevant impact on nutritional, dietary, and anthropometric characteristics of our population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate of how assistive cutlery design effects perception of the user. Studies regarding the usage and development of assistive cutlery have primarily focused on the ergonomics, whereas research into the aesthetics of assistive cutlery has been minimal. A method based on Canter's ''Room Inference Protocol'' from the field of environmental psychology was used to evaluate the aesthetics of the assistive cutlery. A series of images were digitally composited and a survey was deployed online, with an outcome of 562 usable responses. The results demonstrated that the female model with assistive cutlery was perceived to be less attractive, less stylish and less sporty in comparison with the male model that was utilising identical pieces of assistive cutlery. The research contributes to the existing literature in the field, complimenting the study by Torrens and Smith and validating the need for greater aesthetic consideration in addition to an ergonomically acceptable response for assistive cutlery. This in turn highlights the importance of industrial design for the context and adaptations of use, rather than just a design response given to the physical manifestation of a product. [ABSTRACT FROM AUTHOR]

Skinfold thickness values, which are used in many studies to evaluate the nutritional status of disabled people, are measured by a caliper. The usage of this measurement device in disabled people, and especially children with autism, is very difficult. The aim of this study is to find a solution to this problem by using a model that produces high accuracy predictions without needing a caliper. In this study, an artificial neural network application was realized for the determination of skinfold thickness in individuals. In order to train the artificial neural network (ANN) model, the body weights, body mass indexes, waist circumferences, abdomen circumferences, and hip circumferences of 400 children and adolescents between the ages of 6 and 18 were measured. 138 sets of the data collected from the 400 children and adolescents were selected to be used with the ANN, and a data set was formed. 70% of this data set (96 in number) was used for the training of the model, 15% (21 in number) was used for testing the model, and the remaining 15% was used for approving the model. As a result of the study, a prediction with 97.7% accuracy was obtained, and a highly close relationship between the output of the artificial neural network and the target was found. [ABSTRACT FROM AUTHOR]

CONTEXT: Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting. OBJECTIVE: To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes. DATA SOURCES: Medline, Embase, and Cochrane Register databases searched from inception to March 2014. STUDY SELECTION: Articles examining health outcomes of neurologically impaired children living with feeding tubes. DATA EXTRACTION: Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development. RESULTS: We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes. LIMITATIONS: We were unable to investigate effect size of outcomes because quantitative data were not collected. CONCLUSIONS: The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS. [ABSTRACT FROM AUTHOR]

Objectives To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia. Design Cross-sectional survey. Setting A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city. Participants Nursing staff members (N = 131) in 12 nursing homes. Measurements Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding. Results Ninety-three percent of survey participants considered the nonverbal behavior of residents with advanced dementia crucial for decisions about artificial nutrition and hydration ( ANH). The same percentage had at some point encountered residents who did not open their mouths when feeding was attempted. Fifty-three percent of the participants interpreted residents' expressions of pleasure while eating as a will to live. The most frequent interpretation of residents' aversive behavior was discomfort. When residents did not open their mouth during nurse's hand feeding, 41% of the participants inferred a will to die. Conclusion Most nurses and nursing assistants consider residents' behavior during hand or tube feeding to be important, but their interpretations are heterogeneous. Various professional caregivers assume a will to live or die. Further reflection is necessary to determine how behavioral expressions should be factored into treatment decisions. [ABSTRACT FROM AUTHOR]

This article focuses on the case of celiac disease, an autoimmune disease for which the medical treatment is a gluten-free diet, and the social implications of its inclusion as a disability. Under what circumstances is celiac disease a disability and what are the consequences of such considerations? The article evaluates the expansion of the definition of disability and its inclusion of individuals with celiac disease, and also considers the macro-level and micro-level consequences and social implications for both individuals with celiac disease themselves and also for the field of disability studies. [ABSTRACT FROM AUTHOR]

Background Adults with intellectual disabilities ( ID) experience a wide range of eating, drinking and/or swallowing ( EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill health and die younger than their peers in the general population with no ID. Methods Using an exploratory, population-based cohort study design, we set out to examine health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill health, and all-cause mortality. This study was conducted in two counties in the East of England. Results In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up 1 year later, 127 individuals were alive, eight had died and seven could not be contacted. Almost all participants had one or more consultations with a general practitioner ( GP) each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalizations. Although their annual number of GP visits was broadly comparable with that of the general population, one-fifth of this population's primary healthcare use was directly attributable to EDS-related ill health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardized mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems). Conclusions All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness. [ABSTRACT FROM AUTHOR]

There is increasing international interest in the links between malnutrition and disability: both are major global public health problems, both are key human rights concerns, and both are currently prominent within the global health agenda. In this review, interactions between the two fields are explored and it is argued that strengthening links would lead to important mutual benefits and synergies. At numerous points throughout the life-cycle, malnutrition can cause or contribute to an individual's physical, sensory, intellectual or mental health disability. By working more closely together, these problems can be transformed into opportunities: nutrition services and programmes for children and adults can act as entry points to address and, in some cases, avoid or mitigate disability; disability programmes can improve nutrition for the children and adults they serve. For this to happen, however, political commitment and resources are needed, as are better data. [ABSTRACT FROM AUTHOR]

Aims To explore factors at the family caregiver and nursing home administrative levels that may affect participation in a clinical trial to determine the efficacy of hand feeding vs. percutaneous gastrostomy tube feeding in persons with late-stage dementia. Background Decision-making regarding use of tube feeding vs. hand feeding for persons with late-stage dementia is fraught with practical, emotional and ethical issues and is not informed by high levels of evidence. Design Qualitative case study. Methods Transcripts of focus groups with family caregivers were reviewed for themes guided by behavioural theory. Analyses of notes from contacts with nursing home administrators and staff were reviewed for themes guided by an organizational readiness model. Data were collected between the years 2009-2012. Results Factors related to caregiver willingness to participate included understanding of the prognosis of dementia, perceptions of feeding needs and clarity about research protocols. Nursing home willingness to participate was influenced by corporate approval, concerns about legal and regulatory issues, and prior relationships with investigators. Conclusion Participation in rigorous trials requires lengthy navigation of complex corporate requirements and training competent study staff. Objective deliberation by caregivers will depend on appropriate recruitment timing, design of recruitment materials and understanding of study requirements. The clinical standards and policy environment and the secular trends there-in have relevance to the responses of people at all levels. [ABSTRACT FROM AUTHOR]

Aim To analyse the influence of serving method on compliance and consumption of nutritional supplement drinks in older adults with cognitive impairment. Background Oral nutritional supplement drinks have positive benefits on increasing nutritional status in undernourished older people leading to weight gain. However, consumption of these drinks is low and therefore limits their effectiveness. Design This study was a non-blind randomized control trial where participants either consumed nutritional supplement drinks in a glass/beaker or consumed them through a straw inserted directly into the container. Method Participants with long-standing cognitive impairment were recruited from nursing homes ( n = 31) and hospitals ( n = 14). Participants were randomized to serving method. Nursing and care staff were instructed to give the supplement drinks three times per day on alternate days over a week by the allocated serving method. The researcher weighed the amount of supplement drink remaining after consumption. Data were collected over 12 months in 2011-2012. Results Forty-five people participated in this study, mean age 86·7 ( sd 7·5) years. After randomization, there was no significant difference between the baseline characteristics of the two groups. Participants randomized to consume nutritional drinks from a glass/beaker drank statistically significantly more than those who consumed them via a straw inserted directly into the container. However, supplements allocated to be given in a glass/beaker were more frequently omitted. Conclusion Nutritional supplement drinks should be given to people with dementia who are able to feed themselves in a glass or a beaker if staffing resources allow ( NIHR CSP ref 31101). [ABSTRACT FROM AUTHOR]

Abstract: Objective: Elderly residents with dementia commonly exhibit increased agitation at mealtimes. This interferes with eating and can be distressing for both the individual and fellow residents. This review examines the effectiveness of mealtime interventions aimed at improving behavioral symptoms in elderly people living with dementia in residential care. Design: Systematic review. Data sources: Medline, PsycINFO, Embase, HMIC, AMED (OvidSP); CDSR, CENTRAL, DARE (Cochrane Library, Wiley); CINAHL (EBSCOhost); British Nursing Index (NHS Evidence); ASSIA (ProQuest); Social Science Citation Index (Web of Knowledge); EThOS (British Library); Social Care Online and OpenGrey from inception to November 2012. Forward and backward citation chases, hand searches of other review articles identified in the search, and key journals. Types of study: All comparative studies were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Data were not suitable for meta-analysis so narrative synthesis was carried out. Results: A total of 6118 articles were identified in the original search. Eleven articles were finally included. Mealtime interventions were categorized into 4 types: music, changes to food service, dining environment alteration, and group conversation. Study quality was poor, making it difficult to reach firm conclusions. Although all studies showed a trend in favor of the intervention, only 6 reported a statistically significant improvement in behavioral symptoms. Four studies suggest cumulative or lingering effects of music on agitated and aggressive behaviors. Conclusion: There is some evidence to suggest that mealtime interventions improve behavioral symptoms in elderly people with dementia living in residential care, although weak study designs limit the generalizability of the findings. Well designed, controlled trials are needed to further understand the utility of mealtime interventions in this setting. [Copyright &y& Elsevier]

Objectives: To evaluate the effects of interventions on mealtime difficulties in older adults with dementia. Design: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. Data sources: Pubmed, Medline (OVID), CINAHL (EBSCOHost), EBM Reviews (OVID) and PsychINFO (OVID) were searched between January 2004 and September 2012 by using keywords as dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, nutrition, intervention, experimental, quasi-experimental and any matched terms. Other sources included Google Scholar and relevant bibliographies. Review methods: Eligibility criteria were established by defining the population, intervention, comparator, outcomes, timing and setting of interest. Studies were reviewed by title and abstract screening, and full-text assessing for eligibility. Data were abstracted from eligible studies using a self-made structured tool. Eligible studies were classified by intervention, accessed for quality using the Quality Assessment Tool for Quantitative Studies, and graded for evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group criteria. Results: Twenty-two intervention studies (9 RCTs), including a total of 2082 older adults with dementia and 95 professionals from more than 85 long-term care facilities, were selected, and classified into five types: nutritional supplements, training/education programs, environ- ment/routine modification, feeding assistance and mixed interventions. Eight studies were strong, eleven moderate and three weak in quality. Limitations of body of research included lack of randomization and/or control group, small sample size without power analysis, lack of theory-based interventions and blinding, inadequate statistical analysis and plausible confounding bias. ''Nutritional supplements'' showed moderate evidence to increase food intake, body weight and BMI. ''Training/education programs'' demonstrated moderate evidence to increase eating time and decrease feeding difficulty. Both ''training/education programs'' and ''feeding assistance'' were insufficient to increase food intake. ''Environment/ routine modification'' indicated low evidence to increase food intake, and insufficient to decrease agitation. Evidence was sparse on nutritional status, eating ability, behavior disturbance, behavioral and cognitive function, or level of dependence. Conclusions: This review provides updated evidence for clinical practice and points out priorities for nursing research. Current evidence is based on a body of research with moderate quality and existing limitations, and needs to be further explored with more rigorous studies. [ABSTRACT FROM AUTHOR]

Purpose: Children with cerebral palsy who have associated feeding difficulties are at risk of aspiration and poor nutrition. This study aimed to measure the changes in knowledge, confidence, anxiety and behaviour among 25 Sri Lankan mothers with responsibility for feeding children diagnosed with cerebral palsy, after they attended an experiential workshop. Method: Data collection was done through pre- and post-workshop questionnaires, observations and semi-structured interviews. Results: There was a significant improvement in reported levels of knowledge and confidence and a decrease in the caregivers ' level of anxiety during mealtimes. The qualitative data analysis indicated changes in participant knowledge, particularly about the signs of aspiration and positioning during mealtimes. Observations showed better adherence to recommendations on communication, bolus size and utensils. Conclusion: The findings support the utility of experiential training for caregivers, to ensure that children with cerebral palsy are fed safely. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: In advanced dementia, feeding problems are nearly universal, and families face difficult decisions about feeding options. Initial interviews for a randomized trial were used to describe surrogates’ perceptions of feeding options, and to determine whether a decision aid on feeding options in advanced dementia would improve knowledge, reduce expectation of benefit from tube feeding, and reduce conflict over treatment choices for persons with advanced dementia. Design: Semistructured interview with prestudy and poststudy design for surrogates in the intervention group. Setting: Twenty-four skilled nursing facilities across North Carolina participating in a cluster randomized trial. Participants: Two hundred and fifty-five surrogate decision makers for nursing home residents with advanced dementia and feeding problems, in control (n = 129) and intervention (n = 126) groups. Intervention: For intervention surrogates only, an audiovisual-print decision aid provided information on dementia, feeding problems in dementia, advantages and disadvantages of feeding tubes or assisted oral feeding options, and the role of surrogates in making these decisions. Measurements: The interview included open-ended items asking surrogates to report advantages and disadvantages of tube feeding and assisted oral feeding. Knowledge of feeding options was measured with 19 true/false items and items measuring expectation of benefit from tube feeding. Surrogates reported which of these two feeding options they preferred for the person with dementia, and how confident they were in this choice; their level of conflict about the choice was measured using the decisional conflict scale. Results: Before the decision aid, surrogates described advantages and disadvantages of assisted oral feeding and tube feeding in practical, ethical, and medical terms. After review of the decision aid, intervention surrogates had improved knowledge scores (15.5 vs 16.8; P < .001), decreased expectation of benefits from tube feeding (2.73 vs 2.32; P = .001), and reduced decisional conflict (2.24 vs 1.91; P < .001). Surrogates preferred assisted oral feeding initially and reported more certainty about this choice after the decision aid. Conclusions: A structured decision aid can be used to improve decision making about feeding options in dementia care. [Copyright &y& Elsevier]

Abstract: Weight loss and poor nutrition have been important considerations in measuring quality of nursing home care since 1987. Our purpose was to examine, synthesize, and provide a systematic review of the current literature on the prevalence and definitions of nutritional problems in nursing home residents. In the fall of 2011, we performed MEDLINE searches of English-language articles published after January 1, 1990. Articles were systematically selected for inclusion if they presented prevalence data for general nursing home populations on at least one of the following: weight loss, low body mass index, Mini-Nutritional Assessment or other measure of malnutrition, poor oral intake, or dependency for feeding. Data on each study, including study author, year, setting, population, type of study (study design), measures, and results, were systematically extracted onto standard matrix tables by consensus by a team of two fellowship-trained medical school faculty geriatrician clinician–researchers with significant experience in long term care. The MEDLINE search yielded 672 studies plus 229 studies identified through related citations and reference lists. Of the 77 studies included, 11 articles provided prevalence data from the baseline data of an intervention study, and 66 articles provided prevalence data in the context of an observational study of nutrition. There is a wide range of prevalence of low body mass index, poor appetite, malnutrition, and eating disability reported among nursing home residents. Studies demonstrate a lack of standardized definitions and great variability among countries. Of all the measures, the Minimum Data Set (MDS) weight loss definition of ≥5% in 1 month or ≥10% in 6 months had the narrowest range of prevalence rate: 6% to 15%. Weight loss, as measured by the MDS, may be the most easily replicated indicator of nutritional problems in nursing home residents for medical directors to follow for quality-improvement purposes. Additional studies are needed, reporting the prevalence of the MDS weight loss definition among international nursing home residents. [Copyright &y& Elsevier]

This paper illustrates negotiations around risk between lay people and clinicians in relation to gastrostomy interventions for disabled children. These negotiations centre on differing interpretations of what constitutes risk in relation to the safety of oral feeding and a child's need for a feeding tube between parents, carers and clinical specialties. Drawing on Heyman's distinction between risk managers and risk owners, we show that not only do clinicians act as risk managers and parents and carers as risk owners, but that these distinctions often become blurred either because of the shifting dynamics of relations of care or because of the specificity of clinical practice. Parents become risk managers in relation to carers' roles, while clinicians become risk owners in relation to particular procedures which define their practice. This has implications for lay and expert interactions as well as professional accountability for those caring for children with complex medical conditions. Although not an empirical article, we draw on empirical work in the UK. We analyse both parental and professional constructions of risk based on observations of co-ordinating a clinical trial designed to evaluate the effectiveness of gastrostomy surgery. We also examine the diverse value systems used by different groups of professionals and lay carers which inform judgements about risk and feeding. We conclude by arguing that issues of risk in contemporary health care are not just examples of ‘manufactured uncertainty’ or of ‘negotiated power’ but constitute a dialectical relationship which breaks down the essentialist dualism of lay and professional constructions of risk. [ABSTRACT FROM PUBLISHER]

Aims and objectives. This study examines the phenomenon of assisted feeding among people with language impairment. Background. Patients' experience of assisted feeding is influenced by the caregivers' availability and their other responsibilities. Also, caregivers and patients may have different values with respect to assisted feeding. Methods. Instances of assisted feeding ( n = 42) were observed among people with language impairment admitted to a neurological ward. Field notes were taken simultaneously and in some cases a few simple questions were posed to the caregivers or the patients. All notes and answers were analysed using the phenomenological guidelines of Dahlberg and colleagues (2008, Studentlitteratur AB, Stockholm). Result. The essence of assisted feeding among people living with language impairment was identified to be a transaction characterised by efficiency. The constituents of the essence were in the shadow of institutional structures, accidental relationships with potential humiliation, meal-related conventions versus respect for the individual's wishes, sense of joy threatened by goal-related determination' time being significant for the course of the meal. Conclusion. This study shows that assisted feeding is not important enough to postpone other activities in a neurological ward. Although assisted feeding is an opportunity to enjoy mutual contact and exchange information between the patient and the caregiver, it is a situation where the nutritional aspect of the meal tends to take precedence. We recommend that the focus of recent years on the patients' nutritional status is now supplemented by improvement in the relational and affective aspects of meals, especially for people who require assistance to eat. Relevance to clinical practice. The findings indicate that the institutional conditions for meals need to be reconsidered. For instance caregivers could be exempted from other responsibilities during mealtimes. More flexible time-limits for meals depending on the number of patients with extensive assistance needs is another possibility. [ABSTRACT FROM AUTHOR]

An abstract of the study "Caregiver-Resident Interaction With Barnard's Feeding Scale," by Cynthia Beel-Bates and colleagues is presented.

Background: Gastrostomy feeding is superior to long-term nasogastric (NG) feeding in patients with dysphagic stroke, but this practice remains uncommon in Asia. We sought to examine the nutritional adequacy of patients on long term NG feeding and identify barriers to gastrostomy feeding in these patients. Methodology: A prospective comparison of Subjective Global Assessment (SGA), and anthropometry (mid-arm muscle circumference, MAMC; triceps skinfold thickness, TST) between elderly stroke patients on long-term NG feeding and matched controls was performed. Selected clinicians and carers of patients were interviewed to assess their knowledge and attitudes to gastrostomy feeding. Results: 140 patients (70 NG, 70 oral) were recruited between September 2010 and February 2011. Nutritional status was poorer in the NG compared to the oral group (SGA grade C 38.6% NG vs 0% oral, p<0.001; TST males 10.7 + 3.7 mm NG vs 15.4 + 4.6 mm oral, p<0.001; MAMCmales 187.9 + 40.4 mm NG vs 228.7 + 31.8 mm oral, p<0.001). 45 (64.3%) patients on long-term NG feeding reported complications, mainly consisting of dislodgement (50.5%), aspiration of feed content (8.6%) and trauma from insertion (4.3%). Among 20 clinicians from relevant speciliaties who were interviewed, only 11 (55%) clinicians would routinely recommend a PEG. All neurologists (100%) would recommend a PEG, whilst the response was mixed among non-neurologists. Among carers, lack of information (47.1%) was the commonest reason stated for not choosing a PEG. Conclusion: Elderly patients with stroke on long term NG feeding have a poor nutritional status. Lack of recommendation by clinicians appears to be a major barrier to PEG feeding in these patients. [ABSTRACT FROM AUTHOR]

Previous studies on autism have shown a lack of motor anticipation in children and adults with autism. As part of a programme of research into early detection of autism, we focussed on an everyday situation: spoon-feeding. We hypothesize that an anticipation deficit may be found very early on by observing whether the baby opens his or her mouth in anticipation of the spoon’s approach. The study is based on a retrospective analysis from family home movies. Observation of infants later diagnosed with autism or an autism spectrum disorder (ASD) (n = 13) and infants with typical development (n = 14) between 4 and 6 months old show that the autism/ASD group has an early anticipation deficit. [ABSTRACT FROM PUBLISHER]

Aim: The study aims to highlight barriers and feasible opportunities to enhance nutrition support of elderly, long-stay patients in Australian hospitals. Methods: A total of 218 dietitians, nurse unit managers and food service managers from medical and rehabilitation wards of 184 hospitals completed a web-based survey about current practices, perceived barriers and priority opportunities to enhance nutrition support in their context. Results: Cook-fresh food was the most commonly reported food-service system (50%). Eighty-eight percent still used paper menus and one- or two-week cycles were the most common menu cycle lengths. Lack of choice due to special diet, boredom arising from the length of stay, a lack of feeding assistance, limited variety and inadequate flexibility of food service were the key barriers identified. Food fortification, assistance with packaging, additional feeding assistance by nurses, non-nursing feeding assistance and further nutrition assessment were key priorities for improvement. Conclusion: A 'toolbox' of strategies is needed as no one intervention will improve nutrition support of all patients. Further practice-based outcomes and cost-benefit studies are needed to enhance support and advocacy for feasible food service interventions in the future. [ABSTRACT FROM AUTHOR]

Background For many adults with an intellectual disability (ID), mealtimes carry significant health risks. While research and allied clinical guidance has focused mainly on dysphagia, adults with a range of physical and behavioural difficulties require mealtime support to ensure safety and adequate nutrition. The extent of need for and nature of such support within the wider ID population has yet to be reported. Methods In this study, we have estimated the prevalence of need for mealtime support among people with ID in the UK, using a population of 2230 adults known to specialist ID services (in Cambridgeshire, UK, total population 586 900). In a sample ( n = 69, aged 19 to 79 years, with mild to profound ID), we characterised the support provided, using a structured proforma to consult support workers and carers providing mealtime support, and health and social care records. Results Mealtime support was found to be required by a significant minority of people with ID for complex and varied reasons. Prevalence of need for such support was estimated at 15% of adults known to specialist ID services or 56 per 100 000 total population. Within a sample, support required was found to vary widely in nature (from texture modification or environmental adaptation to enteral feeding) and in overall level (from minimal to full support, dependent on functional skills). Needs had increased over time in almost half ( n = 34, 49.3%). Reasons for support included difficulties getting food into the body ( n = 56, 82.2%), risky eating and drinking behaviours ( n = 31, 44.9%) and slow eating or food refusal ( n = 30, 43.5%). These proportions translate into crude estimates of the prevalence of these difficulties within the known ID population of 11.9%, 6.6% and 6.4% respectively. Within the sample of those requiring mealtime support, need for support was reported to be contributed to by the presence of additional disability or illness (e.g. visual impairment, poor dentition and dementia; n = 45, 65.2%) and by psychological or behavioural issues (e.g. challenging behaviour, emotional disturbance; n = 36, 52.2%). Conclusions These findings not only highlight the need for a multidisciplinary approach to mealtime interventions (paying particular attention to psychological and environmental as well as physical issues), but also signal the daily difficulties faced by carers and paid support workers providing such support and illustrate their potentially crucial role in managing the serious health risks associated with eating and drinking difficulties in this population. [ABSTRACT FROM AUTHOR]

Objectives To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia. Design Cluster randomized controlled trial. Setting Twenty-four nursing homes in North Carolina. Participants Residents with advanced dementia and feeding problems and their surrogates. Intervention Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care. Measurements Primary outcome was the Decisional Conflict Scale (range: 1-5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use. Results Two hundred fifty-six residents and surrogate decision-makers were recruited. Residents' average age was 85; 67% were Caucasian, and 79% were women. Surrogates' average age was 59; 67% were Caucasian, and 70% were residents' children. The intervention improved knowledge scores (16.8 vs 15.1, P < .001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs 1.90, P < .001) and more often discussed feeding options with a healthcare provider (46% vs 33%, P = .04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs 76%, P = .04) and showed a trend toward greater staff eating assistance (20% vs 10%, P = .08). Tube feeding was rare in both groups even after 9 months (1 intervention vs 3 control, P = .34). Conclusion A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers. [ABSTRACT FROM AUTHOR]

Objective: To examine differences in feeding among children with cerebral palsy (CP) who varied in the severity of their oral motor involvement; to examine longitudinal change in feeding behaviours for different severity groups. Method: Twenty-three children with CP participated (mean age = 4.53 years at the first time point). Feeding data were collected from parent questionnaires at 6 month intervals over 30 months. Results: Significant differences were observed among severity groups for all feeding variables except coughing and choking during meals. Only one variable, coughing, showed significant change over time. Conclusions: Children with CP who had severe oral-motor involvement had marked and pervasive feeding difficulties which showed some fluctuation with time, but generally were stable. Children with CP who did not have oral motor involvement and those who had mild--moderate involvement also showed little-to-no change over time and had fewer problems than those in the severe group. [ABSTRACT FROM AUTHOR]

The objective of this review was to locate and assess the evidence obtained from articles reporting empirical research that volunteers improve mealtime care of adults in institutional settings. Malnutrition in adult patients or residents in institutional care settings is common. Poor standards of mealtime care have been suggested to contribute to the development of malnutrition. A systematic review of the literature was undertaken. Key words were identified and used separately and in combination to search the electronic databases MEDLINE, CINHAL, BNI and EMBASE and the internet for relevant articles. Searches were undertaken in August 2008, April 2009 and July 1010. Ten studies fulfilled the criteria for inclusion. The methodologies of five of the 10 studies were unclear due to the brevity of the reports. The validity of the design of the other five studies varied. Generally the results suggested the use of volunteers in mealtime care increased satisfaction of patients, relatives, volunteers and staff concerning meal-time assistance (assessed using methods such as questionnaires and focus groups) and three studies found increased nutritional intake in groups assisted by volunteers. However, few well designed and reported studies were identified. There is some evidence that volunteers can improve mealtime care of adult patients or residents in institutional settings, however few well designed studies are reported. This review demonstrates that there is limited evidence that the use of volunteers improves mealtime care of adult patients or relatives in institutional settings. [ABSTRACT FROM AUTHOR]

To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services. We used a chi-squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers. Demographic information, assessments of the statuses and service needs of elders. We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night. Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources. [ABSTRACT FROM AUTHOR]

Purpose: Children with special health care needs (CSHCN) are most in need of anticipatory guidance and prevention. Achieving and maintaining optimal oral health is challenging, due to the many challenges this group faces both in medical and dental care. The purpose of this pilot project was to identify the educational needs of health professionals on a feeding team to prepare them to provide anticipatory guidance to special needs children, along with preliminary investigation into the role of the dental hygienist in improving the oral health of the CSHCN served by the feeding team. Methods: Small focus groups were used to determine educational needs of the feeding team and provide initial identification of the role of the dental hygienist on the feeding team. Results: The needs assessment indicated interest in an in-service to address connections between oral health and feeding issues, i.e.problems related to tube feeding and oral hypo- and hypersensitivities of the CSHCN. Conclusion: This project suggests there is a role for the dental hygienist on the feeding team to provide preventive dental care and referral as well as education for caregivers and therapists. Future research is needed to further delineate the role of the dental hygienist on the feeding team as well as implementation of a model for integrating them into this multidisciplinary team. [ABSTRACT FROM AUTHOR]

The article presents an overview of the challenges in feeding patients with dementia in the U.S., and offers strategies to be taken by caregivers to overcome those difficulties. It states several factors that contribute to such challenges including impaired cognitive function, environmental factors and cultural considerations. It suggests playing relaxing music if a patient reacted violently when being fed. Health care settings are urged to supply enough number of trained personnel to help in feeding such patients.

Dysphagia, or swallowing difficulties, is a common problem in patients affected by stroke and its management is an important aspect of stroke rehabilitation and reducing the risk of aspiration pneumonia. Adequate nutrition and oral hygiene are also important aspects of dysphagia management. Nurses are well informed about the needs of patients and there is a consensus within the profession that they should undergo training to allow them to assess patients' swallow before formal assessments by speech and language therapists. This can ensure patients have adequate fluid and diet intake. [ABSTRACT FROM AUTHOR]

As the population ages, the number of patients with dementia will increase rapidly. Nurses caring for patients with dementia will need knowledge of interventions for communicating; managing agitation, nutrition, hygiene, and pain; providing spiritual care; and determining decision-making capacity. [ABSTRACT FROM AUTHOR]

The article discusses the management of dysphagia or impaired swallowing through different types and levels of diet modifications. It discusses the components of normal swallowing, signs of impaired swallowing and detection of dysphagia. It discusses food textures affecting dysphagia management and the effects of different types of thickeners on the texture and flavor of drinks.

To study the outcomes from initiation of percutaneous endoscopic gastrostomy (PEG) feeding in young people with profound multiple disabilities. Observations were made on 40 adults with lifelong intellectual disability (mental retardation) and quadriplegia, in whom PEG feeding was initiated during 1990-2008. There were 20 men and 20 women aged 15-40 years at the time of the audit, living in settings with 24 h registered nurse staffing. Undernutrition and recurrent aspiration with frequent infections were cited as reasons for PEG feeding. The positive outcomes were that some were said to be more alert for a time following the procedure; and these young adults lived with PEG feeding for an average of 8.5 years, some up to 18 years. In that time, however, they all experienced complications of the PEG insertion, and of the PEG feeding process. There were no measurable improvements in cognition. There were no reductions in prescription of medications. They all required frequent daily interventions by nurses to maintain medical stability. Ten people died during this review period, from continued deterioration in neurological status, with pneumonia cited as the terminal event. Unlike other people with neurological deterioration, young adults with lifelong multiple disabilities may live for many years with PEG feeding. There is little gain in quality of life. [ABSTRACT FROM AUTHOR]

OBJECTIVE- To examine the relationship of diabetes and functional disability in older adults and the possible mediating roles of comorbidities and A1C. RESEARCH DESIGN AND METHODS-- We analyzed data from a nationally representative sample of 6,097 participants aged ≥60 years in the National Health and Nutrition Examination Survey, 1999-2006. Diabetes was defined by self-report. Disability was defined as difficulty performing a physical task. We evaluated disability by grouping 19 physical tasks into five functional groups: lower-extremity mobility (LEM) general physical activities (GPA) activities of daily living (ADL), instrumental activities of daily living (IADL), and leisure and social activities (LSA). RESULTS-- Older U.S. adults with diabetes had the greatest disability in GPA (prevalence 73.6% [95% CI 70.2-76.9]), followed by LEM (52.2% [48.5-55.9]), IADL (43.6% [40.147.2]), ADL (37.2% [33.1-41.3]), and LSA groups (33.8% [30.8-36.9]). Diabetes was associated with two to three times increased odds of disability across functional groups (all P < 0.05). Comorbidities, mostly cardiovascular disease and obesity, and poor glycemic control (A1C ≥ 8%) together explained up to 85% of the excess odds of disability associated with diabetes whereas poor glycemic control alone explained only ∼10% of the excess odds. Adjustment for comorbidities, A1C, and diabetes duration fully attenuated the associations of diabetes with disability in all functional groups (all P > 0.05). CONCLUSIONS -- Older adults with diabetes have a high prevalence of disabilities with variable associations attributable to comorbidities and A1C. Aggressive management of cardiovascular risk factors and obesity may significantly reduce the burden of disability in this population. [ABSTRACT FROM AUTHOR]