Co-designing a mealtime intervention integrating Spaced Retrieval and montessori-based activities for people with dementia living in nursing homes

Introduction: Eating difficulties significantly impact the nutrition, health, and well-being of people with dementia worldwide. Training strategies, such as Spaced Retrieval and Montessori-based activities, have the potential to enhance the self-eating ability of people with dementia but have not been widely tested. This paper reports the co-design and preliminary testing of the SPREMON (Spaced Retrieval and Montessori-based activities) intervention to enhance mealtime independence and experiences for people with dementia living in nursing homes. Methods: Informed by experience-based co-design methodology, this study used a three-phase approach to intervention development. Three initial sessions were conducted with aged care professionals to develop and refine the intervention. Four pilot sessions were conducted with people with dementia to assess the feasibility and suitability of intervention elements. A final consultation session explored the data and identified barriers and facilitators to successful implementation. While field notes were kept in early sessions, the final session was audio-recorded and transcribed for analysis. Thematic analysis was undertaken with all qualitative data, while observational data are reported using descriptive statistics. Findings: Six aged-care professionals, 3 researchers, and 9 people with dementia participated in the intervention development. The intervention approach was positively appraised for its potential to enhance self-feeding abilities in people with dementia while saving staff time. Participants suggested improvements to the Spaced Retrieval approach by incorporating visual and verbal cues to make it less confrontational. However, challenges regarding the lack of detail and guidance for implementing Montessori-based activities made them difficult to apply without clarification. Additional barriers included staff shortages, engagement difficulties, and scheduling conflicts. Pilot activities highlighted practical considerations for intervention implementation and patient engagement. Discussion and Implications: This study demonstrates that the SPREMON intervention holds significant potential to enhance the self-eating ability of people with dementia living in nursing homes. However, the paper also highlights potential challenges in the implementation.