Best intentions or best practice? A case study of the nutritional needs and outcomes of a person with dementia living in a residential aged care home.

Aims: To evaluate the nutritional status and needs of a person with dementia living in an aged care home, including identification of barriers to, and effective strategies for, the provision of person‐centred care. Background: Nutrition and hydration care are integral to quality of life for adults with dementia, but there is little research on whether staff knowledge around effective care strategies for residents is translated into optimal care. Design Focused ethnographic single‐case design. Methods: The perspectives of the resident, her prime family member, and six care staff were triangulated through interviews, observation, document audit, and medical file review to investigate the resident's nutrition and hydration status and needs (October 2014‐April 2015). Results: During 3 years in care, this resident had lost weight steadily. Staff appeared attentive but did not maintain a systematic record of body mass index. At meals, staff encouraged eating but used ineffective strategies. Food was not served in ways that facilitated active participation. Eating and drinking were structured as tasks to be completed rather than activities to be enjoyed. Conclusion: This instrumental case study identified a task‐oriented, rather than person‐centred, approach to nutrition and hydration care, adversely affecting the resident's nutritional health and capability to participate actively. SUMMARY STATEMENT: What is already known about this topic? Nutrition and hydration care are integral to quality of life for adults with dementia.Data are limited, but studies document that many point‐of‐care staff in aged care homes have limited knowledge of residents' nutrition and hydration needs and that evidence‐based and person‐centred care practices are not being followed in mealtime management.There is little research on whether staff knowledge around nutrition and hydration care strategies for residents is translated into optimal daily care.What this paper adds? It adds to the limited ethnographic research on nutrition care practices for aged care residents with dementia.This focused ethnographic single‐case description provides insight into key systematic barriers to person‐centred care and effective nutritional management that have wider relevance to the nutritional health of all residents.The case study identifies a task‐oriented, rather than person‐centred, approach to nutrition and hydration care, which adversely affects the resident's nutritional health and capability to participate actively.The implications of this paper: There are many opportunities for improved nutrition and hydration care practices in aged care homes, such as documentation of body mass index and facilitation of social engagement.While cachexia inevitably occurs in advanced dementia, it is important that nutritional status should not be further compromised by ineffective or inadequate care practices.The findings may be used as a basis for further research and to tailor education for aged care home staff to enhance nutrition and hydration care practices. [ABSTRACT FROM AUTHOR]