Mealtime Assistance by Family and Professional Caregivers: An Observational Study of Cognitively Impaired Older Adults in Hospital and Nursing Homes

Background: Malnutrition is highly prevalent among older adults with cognitive impairment, contributing to frailty, reduced immunity, and poorer health outcomes. The majority of people with dementia require eating assistance during mealtime to maintain adequate nutritional intake (Tang, et al., 2025). While the role of professional caregivers in nursing homes is well documented, the contribution of family caregivers in hospital settings remains underexplored. Aim: To explore the distinct mealtime assistance practices provided by family caregivers in hospitals and professional caregivers in nursing homes for cognitively impaired older adults. Methods: A cross-sectional observational study was conducted in New South Wales, Australia, including 82 older adults (≥65 years) with cognitive impairment: 31 hospital patients assisted by family caregivers and 51 nursing home residents assisted by professional caregivers. Nutritional status was assessed using the Mini Nutritional Assessment–Short Form (MNA-SF), feeding difficulties with the Feeding Difficulty Index (FDI), and caregiver practices with observational checklists of encouragement and technical skills. Independent t-tests were performed, with significance set at p< 0.05. Results: Nursing home residents consumed a greater proportion of meals (76% vs. 56%) and displayed fewer feeding difficulties than hospital patients. Professional caregivers demonstrated broader technical skills, such as mouth opening (27.5% vs. 0%, p< 0.001), lip-opening techniques (31.4% vs. 0%, p< 0.001) and choking management (78.4% vs. 25.8%, p=0.004). In contrast, family caregivers provided stronger relational support, including sitting facing the patient (90.3% vs. 31.4%, p< 0.001), using verbal cueing (100% vs. 68.6%, p=0.001), and engaging in conversation (100% vs. 64.7%, p=0.003). Consequently, the mean nutritional status (MNA-SF score) was significantly poorer in the hospital group (6.03 vs. 10.24, p< 0.001). Conclusion: Family and professional caregivers demonstrate complementary strengths in mealtime care. Integrating the relational engagement of family caregivers with the technical expertise of staff through targeted training and policy initiatives may improve nutritional outcomes and reduce malnutrition in cognitively impaired older adults across hospital and nursing home settings.