Application and Effect Evaluation of an NDB Theory-Guided Stepwise Feeding Strategy in Patients With Dementia-Related Feeding Difficulties

Abstract

Background: Dementia is a common neurocognitive disorder in older adults and is often accompanied by feeding difficulties, which pose significant challenges for caregivers. According to the Need-Driven Dementia-Compromised Behavior (NDB) theory, such behaviors can be understood as expressions of unmet needs influenced by individual and environmental factors. Stepwise feeding strategies have been proposed as a practical approach to support feeding in patients with dementia. This study aims to evaluate the associations between an NDB theory-guided stepwise feeding strategy and clinical outcomes in patients with dementia-related feeding difficulties.

Methods: This retrospective study included 96 patients with dementia-related feeding difficulties secondary to dementia who were treated at our hospital between July 2019 and December 2021. Based on the nursing care documented in medical records, patients were divided into a conventional care group (n = 58) and an NDB theory-guided stepwise feeding group (n = 38). The primary outcome was the Edinburgh Feeding Evaluation in Dementia (EdFED) score. Secondary outcomes included nutritional status[body mass index (BMI), hemoglobin (Hb), and albumin (ALB)], immune indicators [immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), and cluster of differentiation 4 (CD4)/cluster of differentiation 8 (CD8) ratio], and adverse events (coughing, aspiration, and aspiration pneumonia). All data were extracted from medical records before and after the 10-week observation period.

Results: Baseline characteristics were comparable between the two groups (p > 0.05). Compared with baseline, BMI, Hb, and ALB levels increased in both groups after the 10-week observation period (all p < 0.05). Higher posttreatment values were observed in the NDB theory-guided stepwise feeding group than in the conventional care group (all p < 0.05). Similarly, lower post-treatment EdFED scores and a lower documented incidence of feeding-related adverse events were observed in the NDB theory-guided stepwise feeding group than in the conventional care group (all p < 0.05). Post-treatment immune indicator levels were also higher in the NDB theory-guided stepwise feeding group than in the conventional care group (all p < 0.05).

Conclusions: The NDB theory-guided stepwise feeding strategy was associated with more favorable posttreatment nutritional indicators, exploratory immunerelated laboratory indicators, lower EdFED scores, and improved exploratory immune-related laboratory indicators in patients with dementia-related feeding difficulties. Further prospective studies are needed to confirm these observations.