Ask an answerable question (PICO)：
The elderly population is rapidly growing worldwide, and Taiwan entered an aging society in 2018. Dementia patients often develop eating disorders due to cognitive decline, elevating risks like respiratory issues, malnutrition, and improper food intake. Improper eating behavior can easily lead to risks such as upper respiratory tract obstruction, malnutrition, or poisoning due to incorrect food intake. Therefore, how to improve the eating behavior of patients with dementia has become a crucial issue. In previous literature, many studies have found that intervention using spaced retrieval training can improve cognitive function and memory. However, there is little consensus on whether it can improve eating behavior. Therefore, the authors were guided by the question of "Can spaced retrieval training improve the eating behavior of patients with dementia?" and hoped to gain a better understanding of the effectiveness through empirical literature exploration.
The Method and Analysis of Literature Review：
According to the three steps of evidence-based practice (asking, acquire, appraisal), the present study formed a PICO question: "Can spaced retrieval training improve the eating behavior of elderly patients with dementia?" The keywords were set as follows: P: elderly patients with dementia; I: spaced retrieval training; C: standard care; O: eating behavior. Five databases, including the China Academic Journals Full-text Database, PubMed/MEDLINE, Cochrane Library, Embase, and CINAHL, were searched using MeSH terms, natural language, and synonyms in both Chinese and English. The Boolean logic of AND and OR was used to combine the keywords. The inclusion criteria were from April 2016 to November 2022, no language restrictions, and the study types were systematic reviews (SR) and meta-analyses (MA) as a priority, followed by randomized controlled trials (RCT). A total of 26 articles were initially identified, and duplicates and irrelevant results were removed. Finally, one SR and two RCTs were selected for critical appraisal.
Critical Appraisal：
Using the 2018 Chinese version and 2020 English version of the Critical Appraisal Skills Programme (CASP) as tools, we conducted an appraisal of effectiveness, importance, and applicability. According to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence classification of clinical research evidence, all three studies investigated the use of spaced retrieval training for mild to moderate cognitive impairment, and the participants were all community-dwelling individuals with dementia, consistent with the PICO research question and target population. The three appraisals belong to Level 1 and Level 2, and the study results support the effectiveness of spaced retrieval cognitive training in improving the eating behavior and meal etiquette of people with dementia. All three articles are of high quaility research and can be applied for clinical reference.
Results, Conclusions and Recommendations：
This study's methodology was comprehensive, and past research has shown that intervention using spaced retrieval cognitive training does not result in adverse events and is a safe intervention. In clinical practice, using spaced retrieval training to teach memory and eating learning can promote the use of non-pharmacological behavior training instead of medication, control the eating behavior of patients with dementia, and learn to develop good daily habits, which can improve dining etiquette indirectly. Therefore, spaced retrieval training program should be applied for clinical reference. However, when implementing spaced retrieval training, the severity of cognitive impairment in patients with dementia should be considered for appropriate clinical application.
