AIMS AND OBJECTIVES To understand the nutritional status, observing eating difficulties during mealtimes for people living with dementia in acute care settings. BACKGROUND Changed eating behaviours caused by declining cognitive function is common in people living with dementia which can lead to malnutrition. Malnutrition is associated with prolonged hospitalisation and increased mortality. People living with dementia in acute care settings are at high risk of malnutrition. This highlights the importance of better understanding the nutritional intake and eating behaviours of people living with dementia in acute care settings. DESIGN This study is a cross-sectional, observational study. METHODS Data of mealtime difficulties and nutritional status of people living with dementia were collected in four geriatric care wards (in acute or sub-acute hospitals) by using Feeding Difficulty Index and Mini Nutritional Assessment Short-Form. The STROBE checklist was used throughout this study. RESULTS The study included 94 people living with dementia. The median age of the participants was 85.86 years old, with a Feeding Difficulty Index of 8.27 and had stayed in hospitals for average 14.46 days, with an average total feeding time of 24.61 min. Only 1.2% of participants were considered to be in normal nutritional status, whereas 72.1% were malnourished. All participants required partial or full assistance during mealtime. Participants with higher scores on the Feeding Difficulty Index have longer total feeding times, compared to those with lower scores. CONCLUSIONS Malnutrition is prevalent in people living with dementia. People living with dementia demonstrate varying mealtime difficulties depending on the level of dependence. Mealtime assistance training programs are warranted and are beneficial for nursing staff and family members to improve their feeding skills and knowledge. NO PATIENT OR PUBLIC CONTRIBUTION This study did not involve patients, service users, caregivers or members of the public. RELEVANCE TO CLINICAL PRACTICE The study is relevant to clinical practice by identifying changed eating behaviours or mealtime difficulties in people living with dementia in acute care settings can significantly decrease the risk of malnutrition.

Background: Mealtime difficulties are exacerbated in acute care settings, which further complicate health issues in people with dementia (PWD). Understanding staff knowledge and attitudes is crucial for providing better care for PWD in nursing home settings. However, little is known about the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.Aim: To explore the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.Methods: We conducted a cross-sectional study between August and December 2020 at three acute care hospitals in Illawarra region, New South Wales, Australia. Surveys were distributed to nursing staff including registered nurses, enrolled nurses, and nurse assistants, who worked in geriatric wards. Medical practitioners and casual staff were excluded from the survey. Demographics, knowledge, attitudes, and intentions toward mealtime assistance of PWD were included in the survey.Findings: A higher level of knowledge in mealtime assistance of PWD was found to be associated with positive attitudes toward mealtime assistance of PWD ( r = 0.464, p < 0.001). No differences were found between educational levels and knowledge and attitudes of mealtime assistance for PWD. Discussion: The need for mealtime assistance training to enhance knowledge of and attitudes toward assisting PWD during mealtimes is highlighted and needs more attention. Future studies could consider including a simulation training program and adopting a mealtime engagement scale to provide training and assess changes in nursing staff knowledge of and attitudes toward mealtime assistance for PWD in acute care settings.Conclusions: The study findings can inform future research in raising awareness of the need for and developing mealtime assistance training programs for nursing staff in acute care settings.