Mealtime assistance by family and professional caregivers: an observational study of cognitively impaired older adults in hospitals and nursing homes

Background: Malnutrition is common among older adults with cognitive impairment and contributes to frailty and poorer health outcomes. Many individuals with dementia require mealtime assistance, yet differences in caregiving practices across hospital and nursing home settings remain underexplored. Aim: The aim of this study was to compare eating encouragement practices, feeding skills, feeding difficulties, and nutritional status between family caregivers in hospitals and professional caregivers in nursing homes. Methods: A cross-sectional observational study was conducted between June 2020 and December 2023 in New South Wales, Australia. The study included 82 older adults (≥65 years) with cognitive impairment: 31 hospital patients supported by family caregivers and 51 nursing home residents supported by assistant nurses. Eating encouragement, feeding skills, and feeding difficulties were assessed using structured observation tools, and nutritional status was evaluated using the Mini Nutritional Assessment–Short Form (MNA-SF). Group differences were analysed using chi-square tests and independent t-tests (p < 0.05). Results: Family caregivers in hospitals demonstrated stronger relational and engagement-based practices, including consistent handwashing (χ² = 31.945, p < 0.001), encouraging self-feeding (χ² = 21.678, p < 0.001), verbal cueing (χ² = 12.083, p = 0.002), touch prompting (χ² = 51.817, p < 0.001), and sitting face to face (χ² = 38.697, p < 0.001). Nursing home caregivers showed more advanced technical skills, such as task simplification (χ² = 54.135, p < 0.001), mirroring (χ² = 78.456, p < 0.001), hand-over-hand guidance (χ² = 73.076, p < 0.001), mouth- and lip-opening techniques (both χ² = 81.000, p < 0.001), and stronger choking management (p < 0.001). Feeding difficulties also differed: refusal behaviours were more common in nursing homes, while distraction and oral–motor issues were more frequent in hospitals. Overall, nursing home residents had significantly poorer nutritional status (t = −12.592, p < 0.001). Conclusions: Family caregivers provide stronger relational support, whereas professional caregivers demonstrate superior technical competence. Integrating these complementary strengths may enhance mealtime care and reduce malnutrition among cognitively impaired older adults.