An intervention to provide nutritional care for people living with dementia at home receiving home care (TOMATO): study protocol for a single-arm feasibility study

Background: In the UK, over 980,000 people are living with dementia, and two-thirds of them live in their own homes. Up to 60% of this population is estimated to be at risk of or already experiencing malnutrition, with 45% facing significant weight loss. As dementia progresses, ensuring that people eat and drink well becomes challenging. Many families affected by dementia access home care services, with home care professionals playing a vital role in supporting and enhancing overall quality of life. Training in identifying nutritional problems and supporting family carers to prevent malnutrition is an identified research need; however, research on the contribution of home care professionals in this area is limited. This study aims to assess the feasibility and acceptability of a nutritional intervention for people living with dementia receiving home care from the perspectives of people with dementia, family carers (dyads), and home care professionals (including home care managers). Method: This is a mixed-method single-arm feasibility study of a nutrition intervention with embedded process evaluation. Thirty-two participants living with dementia and their carers (dyads) will be recruited from home care organisations providing services for older adults across the South, Midlands, and North of England. The intervention comprises a nutritional awareness training session for home care workers, combined with educational resources for home care professionals, family carers, and friends. It is based on a model of person-centred nutritional care and will be delivered by trained home care professionals in the homes of participating dyads over 4 months. Outcome measures will be collected at baseline and at 4 months.Analyses will be descriptive and centred on the feasibility and acceptability of the interventions and study procedures. Key feasibility outcomes will include the rate of participant recruitment and dropout, and the percentage of home care staff who adhere to the intervention schedule (setting at least four actions in response to using the resources). Quantitative data analysis will primarily involve descriptive statistics. Acceptability of the intervention will be determined through in-depth semi-structured qualitative interviews conducted with a subsample of participants dyads and home care professionals. An embedded process evaluation will assess intervention implementation, capturing barriers and facilitators through participant interviews. Discussion: Findings from this study will help inform the development and implementation of a future RCT, should this nutrition intervention be feasible. Trial registration: NCT05866094.