The effect of the presence of others on caloric intake in homebound older adults

Prevention, Assessment, and Management of Malnutrition in Older Adults with Early Stages of Cognitive Disorders

Malnutrition is common in older adults, and its risk is greater in those living with dementia. Relative to cognitively healthy peers, the prevalence of malnutrition is also increased in individuals with early stages of cognitive disorders owing to pathophysiological, cognitive, and psychosocial changes related to cognitive impairment. Malnutrition is associated with adverse health outcomes, including faster cognitive and functional decline. Here, we provide an overview of the prevention, assessment, and management of malnutrition in older adults, with a special focus on the aspects that are important to consider in individuals with early stages of cognitive disorders. Strategies to prevent malnutrition include systematic screening for malnourishment using validated tools to detect those at risk. If the screening reveals an increased risk of malnutrition, a detailed assessment including the individual's nutritional, medical, and functional status as well as dietary intake should be performed. The management of malnutrition in the early stages of cognitive disorders should be based on the findings of a comprehensive assessment and be personalized according to the individual's specific characteristics. In the article, we also provide an overview of the evidence on vitamin supplements and specific dietary patterns to prevent cognitive decline or attenuate its progression.

Risk of Social Isolation as a Contributing Factor to Diet Quality in Community-Dwelling Older Persons Living in the Australian Capital Territory-A Pilot Study

OBJECTIVES

Social isolation is recognised as a risk factor in the inflammatory process. This study explored the association between social isolation and the Dietary Inflammatory Index (DII) in community-dwelling older persons.

METHODS

This cross-sectional pilot study recruited 107 community-dwelling people aged over 55 years living in the Australian Capital Territory. Participants completed an extensive food frequency questionnaire and provided anthropometric and sociodemographic data. Social isolation was evaluated using the Lubben Social Network Scale (LSNS). Diet quality was assessed using DII.

RESULTS

Average age was 70.1 (±8.61) years and 62.8% were female. The average DII score was -1.10 (±1.21), indicating an anti-inflammatory diet. Higher LSNS was associated with lower DII (b (95% CI) = -0.041 (-0.066, -0.17); p < 0.01) and was positively influenced by the number of people in household (b (95% CI) = 5.731 (2.336, 9.127); p = 0.001).

CONCLUSION

Increased risk of social isolation was associated with an increased tendency towards a more inflammatory diet. Reducing social isolation may decrease the inflammatory component of dietary intake for older persons living independently in the community.

Perceptions and experiences of eating alone among community-living retired Swedes: Loss, routine and independence

The practice of eating together, commensality, is often considered as something positive in later life, particularly regarding peoples' nutritional status and psychosocial well-being. Eating alone, in contrast, is treated as a risk factor, although literature indicates that it is not necessarily something negative. Still, analyses that specifically target older peoples' varied experiences and notions of eating alone are scarce. This study has explored perceptions and experiences of eating alone among older people in Sweden, a country considered highly individualistic, yet with relatively low levels of loneliness in the older population. Semi-structured interviews were conducted with 20 community-living and retired Swedes, 70-90 years of age. A thematic analysis identified three themes: i) 'Eating alone as a manifestation of loss'; ii) 'Eating alone as an everyday routine'; and iii) 'Eating alone as independence and contentment'. General perceptions of eating alone were often related to the current living situation (e.g., cohabiting or single-living). One key finding was an identified tension between the idea of eating alone as something problematic among those living and eating with a partner and the practical experience of an uncomplicated routine among those living and eating alone. Eating together is discussed as a possible social need for many, but perhaps not for all. Some can feel content with eating alone or even enjoy it. Future studies should approach potential disadvantages of eating alone among older people as an open empirical question that is likely to depend on both the individual and the cultural context.

Factors Associated With Dietary Risks in Older Korean Americans

Given the importance of healthy eating in the later years of life, the present study examined factors associated with dietary risks in older Korean Americans. We hypothesized that dietary risks would be associated with sociodemographic disadvantages, adverse health conditions, and limited sociocultural resources. Dietary risks were assessed with a scale covering five behavioral and situational risk factors (eating alone, skipping meals, functional challenges, oral health problems, and financial difficulties). Analyses of the data from the Study of Older Korean Americans (N = 2,150) showed that the sample on average had 1.13 risks (SD = 1.31), eating alone having the highest frequency (35.6%). Supporting the hypothesis, higher levels of dietary risks were found in individuals with sociodemographic disadvantages, poorer physical and mental health status, smaller social networks, and lower acculturation. Findings suggest concerted efforts to promote dietary behaviors and call attention to older immigrants who are socially and culturally isolated.

Longitudinal association between eating alone and deterioration in frailty status: The Korean Frailty and Aging Cohort Study

BACKGROUND

Among risk factors of developing frailty, dietary factor played an important role as a potentially modifiable risk factor. Eating alone is associated with malnutrition, depression, and social isolation, which are risk factors of frailty. We evaluated the longitudinal association between a change to eating alone and deterioration in frailty status in a cohort of community-dwelling elderly persons.

METHODS

The study subjects were 2072 non-frail Korean elderly persons aged 70-84 years who were recruited for the Korean Frailty and Aging Cohort Study (KFACS). The subjects were divided into 4 groups based on changes in eating with others or alone between the baseline survey (2016-2017) and the follow-up survey (2018-2019): group I (ate with others consistently), group II (ate with others at baseline but ate alone at follow-up), group III (ate alone at baseline but ate with others at follow-up), group IV (ate alone consistently). We assessed physical frailty using the Cardiovascular Health Study (CHS) frailty phenotype. The association between changes in eating with others or alone and frailty progression was assessed by multiple logistic regression analysis after adjusting for covariates.

RESULTS

The mean age of the study subjects was 76.2 (SD: 3.8) years old and 50.8 % were female. At follow-up, 364 new cases (34.5 %) of pre-frailty (n = 348) and frailty (n = 16) were identified among those who were robust at baseline (n = 1056), while 88 new cases (8.7 %) of frailty were identified among those who were pre-frail at baseline (n = 1016). Compared to group I, group II showed an increased risk of deterioration in frailty status after adjustments with multivariables including social isolation and malnutrition (adjusted odds ratio [aOR] = 1.61, 95 % confidence interval [CI]: 1.03-2.50). However, the association disappeared after further adjustment for depression. When we examined the longitudinal association between changes in eating with others or alone and changes in each frailty domain, group II showed an increased risk for the weight loss (aOR = 3.07, 95 % CI: 1.39-6.76) compared to group I. Group IV showed an increased risk for the weight loss (aOR = 2.39, 95 % CI: 0.95-6.00) and weakness (aOR = 2.07, 95 % CI: 1.16-3.68).

CONCLUSIONS

A change from eating with others to eating alone was found to significantly increase the risk of deterioration in frailty status in elderly people, and the association seemed to be mediated by depression. These findings suggest that interventions to maintain eating partners and manage depression are needed to prevent frailty progression in elderly people.

Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018

This study aimed to determine four-year outcomes of community-living older adults identified at ‘nutrition risk’ in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49–87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.

Differentiation of Nutritional Risk among Polish Seniors Based on Selected Lifestyle Characteristics

Elderly people living in the community are a population group at high nutritional risk. The aim of this study was to assess the nutritional risk of Polish seniors in relation to the region of residence and selected lifestyle characteristics (alcohol consumption, smoking, sleep, physical activity). The SCREEN-14 (Seniors in the Community: Risk Evaluation for Eating and Nutrition) questionnaire was used to assess nutritional risk. The questionnaire was conducted among 320 Polish adults aged 60 and older. The snowball method was used to select the sample. The study was conducted from May to July 2021 in two regions. Cluster analysis with agglomeration technique was used to identify the association between categories of variables describing nutritional risk level, demographic characteristics, and lifestyle characteristics. Logistic regression analysis was used to assess the association between identified nutritional risk levels and selected lifestyle characteristics. Men over 75 and seniors living in smaller towns have been shown to be at higher nutritional risk. High nutritional risk was significantly more common among those who consumed alcohol, smoked tobacco, and had less than six hours or more than nine hours of sleep per day. In addition, low to moderate physical activity was associated with higher nutritional risk. The identification of factors that increase nutritional risk among seniors can support the planning of ways to prevent nutritional problems in this age group.

Loneliness: An Overlooked Contributing Factor in Anorexia of Older Patients With End-Stage Renal Disease and Focal Point for Interventions to Enhance Nutritional Status-An Overview of Evidence and Areas of Suggested Research

Although research has shown that loneliness can contribute to anorexia in older non-ESRD (end-stage renal disease) populations, and the benefits of its mitigation with improving appetite, nutrient, and caloric intake, its implications for older patients with ESRD have been overlooked. This article provides an overview of evidence on the potential contributing role of loneliness in anorexia of older patients with ESRD, and loneliness as a focal point for interventions to help improve nutritional status. Areas of needed research are suggested in the course of the analysis. With a 41%-83% projected rise in the prevalence of patients in the United States with ESRD by 2030, and demographic population trends showing that an ever-increasing number will be living alone, there is a long overdue need to better understand the implications of loneliness for this nutritionally vulnerable population. KEYWORDS: Chronic kidney disease; loneliness; anorexia; malnutrition; protein energy wasting.

Factors associated with nutrition risk among community-dwelling older adults in Thailand

This study was to investigate socio-demographic, chronic conditions and health factors associated with nutrition risk among Thai community-dwelling older adults. This was a cross-sectional study, involving 330 participants aged ≥ 60 years living in low-income suburban Chiang Mai, Northern Thailand. Of the 330 participants, 54.8% were at nutritional risk based on the Mini Nutritional Assessment. Multivariate analysis indicated factors significantly associated with nutritional risk were: aged ≥80 years (OR:8.59, 95% CI = 2.94-25.11), low income (OR: 2.35, 95% CI = 1.15-4.78), living alone (OR: 2.02, 95% CI = 0.20-0.78), moderate to severe pain (OR: 5.88, 95% CI = 2.30-15.02), dyslipidemia (OR: 5.12, 95% CI = 2.23-11.77), osteoarthritis (OR: 2.49, 95% CI = 1.14-5.48), poor physical performance (OR: 1.49, 95% CI = 1.70-3.15), and ≥1 fall in the previous year (OR: 2.22, 95% CI = 1.21-4.07). Results point to the need for multifactorial interventions to reduce risk for geriatric nutrition problems. Further studies are needed to determine effective solutions to the problem of malnutrition among older adults.

Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries

Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants’ health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70–97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.

Association of Eating Alone with Depressive Symptoms and Suicidal Ideation among Korean Adults

BACKGROUND

In recent years, eating dinner alone has become a rising social issue in Korea. Depression is one of the primary health problems that can lead to numerous negative consequences. However, few studies have focused on people who eat alone and the effect of eating alone on depression. We investigated the association between eating dinner alone and depression.

METHODS

Our cross-sectional study included data from 14,093 Korean adults aged above 19 years old; data were sourced from the Korea National Health and Nutrition Examination Survey in 2014, 2016, and 2018, when the Patient Health Questionnaire (PHQ-9) was used. We classified participants based on their dinner habits: eating alone or social eating. Depression and suicidal ideation among participants were measured using the PHQ-9. Multivariate logistic regression analysis was used to investigate whether eating alone was related to depression or suicidal ideation after adjusting for age, sex, household income, education, alcohol, smoking, exercise, frequency of eating out, and living arrangement.

RESULTS

Individuals who ate dinner alone (22.9%) had higher depression and suicidal ideation rates than those who ate with others. Those who ate alone had greater odds ratios (ORs) of depressive symptoms (depression: OR, 1.42; 95% confidence interval [CI], 1.27-1.58; suicidal ideation: OR, 1.49; 95% CI, 1.25-1.78) after adjustment for covariates. The subgroup analysis shows that the odds of suicidal ideation among individuals who eat alone were nonexistent among those who performed regular aerobic exercise.

CONCLUSION

Eating dinner alone is closely associated with depressive symptoms, particularly suicidal ideation. Therefore, providing opportunities to eat with others may be effective for maintaining the mental health of adults.

Nutrition risk prevalence and associated health and social risk factors in Māori and non-Māori: Results from the New Zealand Health, Work and Retirement Study

OBJECTIVE

To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Māori and non-Māori older adults in New Zealand.

METHODS

As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Māori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures.

RESULTS

Half (50.2%) of Māori and 32.7% of non-Māori were at nutrition risk. Independent risk factors were as follows: for Māori, being unpartnered and rating general health as fair, and for non-Māori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness.

CONCLUSIONS

Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.

Managing malnutrition in older adults in the community during the COVID-19 pandemic

The COVID-19 pandemic has resulted in an increase in the number of older adults in the community who are at risk of malnutrition. Vulnerable groups include people recovering at home from mild-to-moderate COVID-19, those discharged from hospital after severe infection and those who have undergone extended periods of social isolation as a result of the public health measures in place to reduce the spread of infection. Various COVID-19-specific malnutrition care pathways and resources are available, and this article details practical interventions that can assist nurses caring for older adults in the community to identify and manage malnutrition risk.

Eating Alone or Together among Community-Living Older People-A Scoping Review

Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples' life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative methods adding complexity.

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review

Background: Setting up a home-delivered meal service often allows older people suffering from physical and/or cognitive disabilities to stay at home. However, older people who delegate their food activities (food purchasing, cooking…) have been reported to have a worse nutritional status than people who take care of their food activities. In this context, we will conduct a systematic review of all studies related to the nutritional issue in home-delivered meal older recipients. Methods: In June 2020, we searched 3 databases (Pubmed, Web of Science, EMBASE) to identify studies from all years on older adults at home and receiving home-delivered meal services (population). The following outcomes were considered: nutritional status (Body Mass Index, weight, undernutrition) and nutritional intake. Any nutritional intervention, comparator, and study design were relevant for inclusion. Results: Forty-eight original studies met the inclusion criteria, most of them being published after the year 2000 (n = 34) and undertaken in the USA (n = 32). The selection includes 30 cross-sectional and 18 longitudinal studies. The main findings of this review are the following: (1) home-delivery meal older recipients are at high risk of undernutrition; (2) providing home-delivery meals may improve the nutritional status and nutrient intake; (3) this improvement is even higher when the home-delivery meal service is improved, for instance by providing dietetic counseling or adding supplementary snacks/meals or enriched food. However, even an improved service does not allow all the older recipients meeting their recommended nutritional allowance. Conclusion: This review reveals a need to further develop strategies allowing home-delivery meal older recipients to fulfill their nutritional needs. From a methodological point of view, there is a need to describe in more detail the home-delivered services provided to studies' participants to better consider meal frequency and meal content in the results.

Managing malnutrition in the community during the COVID-19 pandemic

The prevalence of risk factors for malnutrition has increased during the coronavirus disease 2019 (COVID-19) pandemic. These risk factors include various symptoms and effects of COVID-19, such as breathlessness, coughing, inflammation, sarcopenia, anorexia and loss of taste or smell, as well as the side effects of treatment. In addition, public health infection prevention and control measures can inadvertently reduce access to food and increase social isolation, thus adversely affecting people's nutritional status. This article outlines practical interventions for preventing and managing malnutrition in the community, particularly where it is exacerbated by the social restrictions in place to contain the COVID-19 pandemic.

Eating Alone and Cognitive Decline in Korean Older Adults: A 3-Year Prospective Study

BACKGROUND

Eating alone is a critical factor in nutritional risk screening among older adults. We investigated whether changes in eating status (eating alone or with others) in late-life affected cognitive decline in community-dwelling older adults.

METHODS

We used data from the Survey of the Living Conditions and Welfare Needs of Korean Older Persons. Nutritional risk, including eating status, was assessed using seven questions from the Nutrition Screening Initiative checklist, and cognitive function was measured using the Mini-Mental State Examination (MMSE). On the basis of changes in eating status between baseline (2008) and the 3-year follow-up (2011), the subjects were divided into four groups: group 1 (eating with others at both visits), group 2 (eating alone in 2008 and eating with others in 2011), group 3 (eating with others in 2008 and eating alone in 2011), and group 4 (eating alone at both visits). Generalized linear models were used to compare the changes in MMSE scores over the 3-year period among the four groups.

RESULTS

Among older women, group 2 had the least decline in MMSE scores (-0.55±0.46), whereas group 3 had the greatest decline (-1.76±0.37) (p=0.034). We observed no difference in the change in MMSE scores among the four eating groups in older men.

CONCLUSION

Deprivation of mealtime partners in late life enhanced cognitive decline compared with gaining mealtime partners. Eating alone may be a risk factor for cognitive impairment; thus, meal programs reinforcing social integration might help preserve cognitive function.

Ethnic Differences in Loneliness, Depression, and Malnutrition Among Older Adults During COVID-19 Quarantine

BACKGROUND

Depression in older adults may result from a variety of reasons such as loneliness feelings and malnutrition.

OBJECTIVE

To examine the direct and indirect effect of loneliness feelings on depressive symptoms, mediated by malnutrition, among older adults from different cultures during the Coronavirus disease 2019 (Covid-19) pandemic quarantine.

METHOD

A convenience sample of 101 Arabs and 100 Jewish older adults aged 65 and over was interviewed. Using bootstrapping, we tested the strength and significance of the conditional indirect effect of malnutrition (mediator) on the relationship between loneliness feelings and depressive symptoms.

RESULTS

The relationship between loneliness feelings and depressive symptoms was mediated by malnutrition and Arab older adults reported a higher level than Jewish older adults of loneliness, depression, and malnutrition during the Covid-19 pandemic quarantine.

CONCLUSIONS AND IMPLICATIONS

To reduce loneliness feelings, depressive symptoms, and malnutrition in times of crisis like the Covid-19 pandemic, it is essential to develop new communication methods for and with older adults in general, with particular attention paid to ethnic differences, that will be effective in reducing loneliness and in promoting nutrition intervention. Possible solutions include new social network technologies for reducing loneliness, with continued reliance on phone communication for combined intervention that includes psychological support accompanied by instructions for a healthy lifestyle and malnutrition prevention.

Loneliness, Malnutrition and Change in Subjective Age among Older Adults during COVID-19 Pandemic

Objectives: We examined the effect of loneliness and the role of two mediating factors, depressive symptoms and malnutrition on subjective age among older adults during the 2020 COVID-19 pandemic, and explored how the pandemic is affecting subjective age. Design: A convenience sample of 201 older adults aged 65 and over was interviewed. Using bootstrapping, we tested the strength and significance of the indirect effect of depressive symptoms and malnutrition (mediators) on the relationship between feelings of loneliness and subjective age. Results: The relationship between feelings of loneliness and subjective age during the COVID-19 pandemic was mediated by malnutrition, but not by depressive symptoms. In addition, the participants felt older during the COVID-19 pandemic compared with the preceding period. Conclusions: An association was found among feelings of loneliness, malnutrition, and subjective age. To overcome these feelings in times of crisis like the pandemic, it is essential to develop new communication methods (technologies for managing and addressing the needs of the older population; technologies to encourage social engagement, and technologies for managing and providing remote medical services) for and with older adults that are effective in reducing loneliness, and to promote good nutrition. Possible practical solutions include new social network technologies for reducing loneliness combined with continued reliance on phone communication as an intervention of psychological support to promote a healthy lifestyle and prevent malnutrition.

Living alone, social networks in neighbourhoods, and daily fruit and vegetable consumption among middle-aged and older adults in the USA

OBJECTIVE

A social network is a valuable resource in later life. Therefore, the current study aims to investigate whether social networks within homes and neighbourhoods are associated with older adults' daily fruit and vegetable consumption.

DESIGN

Cross-sectional secondary data analysis.

SETTING

USA.

PARTICIPANTS

A nationally representative sample of 6865 community-dwelling older adults over age 53 in the Health and Retirement Study - Health Care and Nutrition Survey.

RESULTS

Older adults who lived alone with no children or friends nearby had the lowest fruit and vegetable consumption. However, the daily fruit and vegetable consumption of respondents who lived alone and had children or friends nearby or those who lived with someone and had no children or friends nearby was not statistically different from those who lived with someone and had children or friends nearby. This suggests that having a social network either at home or in the neighbourhood complements the absence of living with someone or having children or friends nearby and attenuates the negative association between limited social networks and daily fruit and vegetable consumption. A greater decrease in the number of fruits and vegetables consumed was observed among men when they lived alone with no children or friends nearby.

CONCLUSIONS

Special attention should be given to older adults with limited social networks, especially older adults living alone with no children or friends nearby. Provision of help with grocery shopping and meal preparation as well as social support networks and more opportunities that can improve social engagement appear to be necessary.

Gender and age group differences in nutrition intake and dietary quality of Korean adults eating alone: based on Korean National Health and Nutrition Examination Survey Data, 2013-2016

BACKGROUND/OBJECTIVES

This study investigated gender and age differences in nutrient intake and dietary quality of people eating alone.

SUBJECTS/METHODS

From Korean National Health and Nutrition Examination Survey 2013–2016 data, 2,305 adults aged 20 years and older that ate meals alone were included in this study. Their energy and nutrients intakes, as well as their nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and index of nutritional quality (INQ) were analyzed. Food group consumption pattern, dietary variety score (DVS), dietary diversity score (DDS) were also analyzed. All data were compared among gender and age groups.

RESULTS

Men consumed more energy and nutrients than women, except for vitamin C, and the NARs showed similar gender differences. The INQs of 4 nutrients (calcium, vitamin A, vitamin C, and riboflavin) were lower than 1.0 in men, whereas only the calcium INQ was lower than 1.0 in women. Men had a lower DDS (3.6) than women (3.9) (P < 0.001) and had more ‘undesirable’ food group consumption patterns than women (P < 0.001). The intakes of calcium, vitamin A, and vitamin C were relatively low in the young-aged group (INQs less than 1.0). In the old-aged group, the MAR level was relatively low, and the INQs of calcium, riboflavin, and niacin were below 1.0. The old-aged group consumed more menu items, but their DVS was the lowest.

CONCLUSIONS

Compared to women, the dietary quality and food diversity among men were poorer. There were poorer quality and diversity patterns in the young-aged group compared to those of the older groups. An overall low intake of nutrients and the low nutrient density of meals were the main dietary problems among the old-aged group who eat alone. Therefore, men, particularly young- and old-aged, need to be prioritized in nutritional policies directed toward those who eat alone.

Aging and nutrition. Paving the way to better health

Sufficient caloric intake is important to maintain the balanced health status, especially during the period of aging, as aging and sickness share paths. Maintaining adequate nutritional balance is the best preventive measure to counteract the risk of malnutrition. There are several causes for malnutrition in elderly people, and some techniques such as anthropometric measurements, laboratory and clinical parameters could help to diagnose malnutrition in these patients. The use of a simple validated questionnaire called the 'Mini Nutritional Assessment' measures the nutritional status of elderly patients. In this review, we discuss about the malnutrition in elderly people with and without a known cause and we present some of nutritional intervention. There are promising strategies that help overcoming malnutrition.

Optimizing sensory quality and variety: An effective strategy for increasing meal enjoyment and food intake in older nursing home residents

A decline in appetite and consequently in food intake is often observed with ageing, particularly in older adults living in nursing homes. Several strategies have been tested in nursing homes to counter this phenomenon. However, the approaches have rarely focused on food improvement, and most studies have assessed the impact of flavor enhancement on eating behavior. The present experiment aimed to assess the impact of improving sensory quality versus increasing sensory variety on food intake and meal enjoyment in elderly individuals living in a nursing home. Four conditions were compared: control condition, a Quality+ condition (recipes were improved according to sensory preference of the target population), a Variety+ condition (participants were offered a variety of main dishes and several condiments throughout the meal) and a Quality&Variety+ condition combining the two previous conditions. Eighty-two residents (age range: 71-101 years) participated in eight lunchtime sessions (2 replicates × 4 conditions). Compared to control condition, our results showed that improving the sensory quality of the dishes and/or providing variety led to increased meal enjoyment and food intake (energy intake: +5% for Quality+; +7% for Variety+). No additional effect was observed when the two factors were combined (+7% for Quality&Variety+). These results suggest that meal improvement strategies can be used to increase food intake in order to prevent and treat malnutrition in dependent older adults.

Comparison of the eating behaviour and dietary consumption in older adults with and without visual impairment

Globally, a high prevalence of obesity and undernutrition has been reported in people with visual impairment (VI) who have reported multi-factorial obstacles that prevent them from achieving a healthy diet, such as having restricted shopping and cooking abilities. The present study is the first to investigate the relationship between VI and dietary consumption using a representative sample size, standardised methods to categorise VI and a detailed analysis of dietary consumption. Ninety-six participants with VI and an age-matched control group of fifty participants were recruited from across the UK. All participants were aged 50 years or over. The participants completed a 24-h food recall for a period of 3 d. The participants also answered questions about their abilities to shop for and cook food as well as their knowledge of healthy eating. The participants with VI in this sample consumed significantly fewer energy content and other nutrients than is recommended for their age group and when compared with an age-matched control group. The participants with VI mainly made food choices irrespective of nutritional value. The results of the present study highlight for the first time that a large proportion of older adults with VI in the UK are undernourished. These results suggest local and government-led initiatives should be implemented to support the diets of older adults in the UK, and these initiatives could include healthy eating workshops, café clubs or skills training and rehabilitation.

Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies

Malnutrition in the elderly could be tackled by addressing socioeconomic factors. This study aimed to determine the magnitude of the relationship between socioeconomic factors and the malnutrition or malnutrition risk (MR) in the elderly. The PubMed and SCOPUS databases were searched for observational studies that included assessment of malnutrition or/and MR and socioeconomic variables (educational level, living alone, marital status, income and occupational level, feeling of loneliness, place of residence, and food expenditure) in ≥60-year-old subjects, published in English among 2000–2018 (PROSPERO: CRD42019137097). The systematic review included 40 observational studies (34 cross-sectional and 4 cohort studies) and 16 cross-sectional studies in the meta-analysis (34,703 individuals) of malnutrition and MR in relation to low educational level (Odds Ratio (OR): 1.48; 95% Confidence Interval (CI): 1.33–1.64; p < 0.001), living alone (OR: 1.92; 95% CI: 1.73–2.14; p < 0.001), being single, widowed, or divorced (OR: 1.73; 95% CI: 1.57–1.90; p < 0.001), and low income level (OR: 2.69; 95% CI: 2.35–3.08; p < 0.001), and considering these four socioeconomic factors, malnutrition and MR is associated with them (OR: 1.83; 95% CI: 1.73–1.93; p < 0.001). Malnutrition and MR could be reduced by increasing economic level, supporting people living alone or being single, widowed, and divorced, and improving lifelong learning.

Prevalence and Determinants of Undernutrition in A Sample of Dutch Community-Dwelling Older Adults: Results from Two Online Screening Tools

To stimulate undernutrition screening among Dutch community-dwelling adults, a website was developed with general information on healthy eating for healthy aging and self-tests. Based on cross-sectional data obtained from the self-tests, we studied nutritional risk factors (early determinants) as well as risk of undernutrition (late symptoms). SCREEN II (n = 2470) was used to asses nutritional risk factors. This tool consists of 16 items regarding nutritional intake, perception of body weight, appetite, oral health and meal preparation. An adjusted SNAQ65+ (n = 687) was used to assess risk of undernutrition. This four-item tool contains questions on weight loss, appetite, walking stairs and body mass index. Differences between age-groups (65-74, 75-84, ≥85) were tested by logistic regression. Overall prevalence of nutritional risk factors was 84.1%, and increased risk of undernutrition was 56.8%. Participants aged ≥85 scored worst on almost all items of the SCREEN II and the SNAQ65+. In conclusion: A large proportion of older adults reported early determinants for increased nutrition risk, while a smaller, yet remarkable proportion scored positive on undernutrition risk. Internet screening may be a useful, contemporary, and easy, accessible way to reach older adults who are at nutritional risk and may thus contribute to early identification and prevention of undernutrition.

ESPEN guideline on clinical nutrition and hydration in geriatrics

BACKGROUND

Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats.

AIM

To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons.

METHODS

This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process.

RESULTS

We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach.

CONCLUSION

A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

Construct Validity of the Mealtime Scan: A Secondary Data Analysis of the Making Most of Mealtimes (M3) Study

Long-term care (LTC) physical and psychosocial mealtime environments have been inconsistently assessed due to the lack of a standardized measure. The purpose of this study was to examine the construct validity of a new standardized observational measure, the Mealtime Scan (MTS), using the Making Most of Mealtimes data collected on 639 residents in 82 dining rooms in 32 LTC homes. The MTS includes physical, social, and person-centered care summary scales scored from 1 to 8. Mean ratings on these summary scales were moderate for physical (5.6 SD 0.9), social (5.0 SD 0.9), and person-centered care (PCC; 5.5 SD 0.8). Regression analyses determined which items within the MTS were associated with these summary scales: physical - music (B = 0.27, p = 0.04), number of staff passing food (B = -0.11, p = 0.03), number of residents (B = -0.03, p = 0.01); social - social sound (B =  0.31 p < 0.0001), number of residents requiring eating assistance (B = 0.11, p = 0.02); PCC - lighting (B = 0.01 p = 0.04), and total excess noise (B = 0.05, p < 0.0001). The Mealtime Relational Care Checklist (M-RCC) was associated positively with ratings on all three summary scales. Correlations revealed that the MTS summary scales were associated with other constructs: Dining Environment Audit Protocol functionality scale, resident and dining room level M-RCC, Mini Nutritional Assessment- Short Form, and resident Cognitive Performance Scale. These results demonstrate that the MTS summary scales exhibit construct validity, as the ratings were associated with expected observed mealtime characteristics and correlated with dining room and resident level constructs in anticipated directions.

Optimizing nutrition in older people

Older adults are at increased risk of malnutrition, for a variety of physiological and psychological reasons. This has implications for health, quality of life, independence and economic circumstances. Improvements in nutrition are known to bring tangible benefits to older people and many age-related diseases and conditions can be prevented, modulated or ameliorated by good nutrition. However, practical and realistic approaches are required to optimize diet and food intake in older adults. One area where improvements can be made relates to appetite. Encouraging older adults to prepare meals can increase appetite and food intake, and providing opportunities for older adults to eat a wide variety of foods, in company, is a simple strategy to increase food intake. The protein requirement of older adults is subject to controversy and although considered the most satiating macronutrient, it appears that protein does not elicit as great a satiating effect in older adults as it does in younger individuals. This indicates that there is potential to increase protein intake without impacting on overall energy intake. Other areas where simple practical improvements can be made include both packaging of foods that are easy to prepare and the education of older adults on the safe storage and preparation of food. Research into improving the diets and nutritional status of older adults has indicated that many of the strategies can be easily and cost-effectively undertaken.

Nutritional Risk and Quality of Life in Community-Dwelling Elderly: A Cross-Sectional Study

OBJECTIVES

To evaluate the association between nutritional risk and quality of life in community-dwelling elderly.

METHOD

A cross-sectional study of individuals aged 60 years or older living in the Brazilian state of Minas Gerais was conducted. Nutritional status was evaluated using the Mini Nutritional Assessment, and quality of life was determined using the WHOQOL-bref and WHOQOL-old. The absolute and relative frequency distributions for each domain were calculated, and chi-square tests were used to examine the association between nutritional risk and quality of life (dichotomous variables). Poisson regression was used to perform univariate and multivariate analyses.

RESULTS

789 (27.9%) of the 2823 elderly patients in the sample were at nutritional risk. The risk of malnutrition was associated with the physical, environment, psychological, sensory abilities, social participation and intimacy domains of quality of life [(PR= 1.42, 95%CI 1.23-1.63); (PR= 1.28, 95%CI 1.12-1.47); (PR= 1.18, 95%CI 1.03-1.36); (PR= 1.36, 95%CI 1.20-1.54); (PR= 1.29, 95%CI 1.13-1.46); (PR= 1.14, 95%CI 1.01-1.29); respectively].

CONCLUSION

The present findings contribute to the understanding of nutritional risk, and support the association between quality of life and nutritional status. These factors should be considered in the diagnosis, monitoring and treatment of nutritional disorders, and may contribute to the prevention and reduction of nutritional risk in this especially vulnerable population.

Factors associated with risk of malnutrition in the elderly in south-eastern Brazil

ABSTRACT: Objective: The aim of this study was to evaluate the prevalence of malnutrition risk and its association with socioeconomic, behavioral, and health characteristics in the community-dwelling elderly. Methods: A cross-sectional study with individuals aged ≥ 60 years. Nutritional status was evaluated using the Mini Nutritional Assessment. Socioeconomic, behavioral, and health information was also collected from all participants. The association between each variable and the risk of malnutrition was calculated and adjusted using Poisson hierarchical regression. Results: The initial sample consisted of 3,101 elderly people, of whom 28.3% (95%CI 25.3 - 31.4%) were at risk of malnutrition. The multivariate analysis showed that the risk of malnutrition was significantly higher in women without formal education, who did not live with a partner, and identified as black-skinned. The risk of malnutrition was twice as high in individuals with no family income as compared to those who earned at least three minimum wages. Smokers were also more likely to be at risk of malnutrition than individuals who had never smoked. Participants suffering from kidney, respiratory or heart disease were at higher risk of malnutrition than those with no history of such illnesses. Conclusion: These findings could be used to help in the development of health policies and in the establishment of adequate programs aimed at reducing the risk of malnutrition in this population.

Gender differences in longevity in free-living older adults who eat-with-others: a prospective study in Taiwan

OBJECTIVES

Social activities such as 'eating-with-others' can positively affect the ageing process. We investigated the gender-specific association between eating arrangements and risk of all-cause mortality among free-living older adults.

SETTING

A representative sample from the Elderly Nutrition and Health Survey in Taiwan during 1999-2000.

PARTICIPANTS

Some 1894 participants (955 men and 939 women) who aged ≥65 and completed eating arrangement question as well as confirmed survivorship information.

PRIMARY AND SECONDARY OUTCOME MEASURES

Eating arrangements, health condition and 24-hour dietary recall information were collected at baseline. We classified eating arrangements as the daily frequency of eating-with-others (0-3). Survivorship was determined by the National Death Registry until the end of 2008. Cox proportional-hazards regression was used to assess the association between eating-with-others and mortality risk.

RESULTS

Overall, 63.1% of men and 56.4% of women ate with others three times a day. Both men and women who ate with others were more likely to have higher meat and vegetable intakes and greater dietary quality than those who ate alone. The HRs (95% CI) for all-cause mortality when eating-with-others two and three times per day were 0.42 (0.28 to 0.61), 0.67 (0.52 to 0.88) in men and 0.68 (0.42 to 1.11), 0.86 (0.64 to 1.16) in women, compared with those who ate alone. Multivariable HRs (95% CI) adjusted for sociodemographic, nutritional and 'activities of daily living' covariates were 0.43 (0.25 to 0.73), 0.63 (0.41 to 0.98) in men and 0.68 (0.35 to 1.30), 0.69 (0.39 to 1.21) in women. With further adjustment for financial status, HR was reduced by 54% in men who ate with others two times a day. Pathway analysis shows this to be dependent on improved dietary quality by eating-with-others.

CONCLUSIONS

Eating-with-others is an independent survival factor in older men. Providing a social environment which encourages eating-with-others may benefit survival of older people, especially for men.

Alone at the Table: Food Behavior and the Loss of Commensality in Widowhood

OBJECTIVES

Eating alone is a known risk factor for nutritional vulnerability in later life. Widowhood often entails loss of commensality (shared meals). This article explores this experience among older widowed women in relation to food behavior.

METHOD

Qualitative methods based on constructivist grounded theory were used. Interviews were conducted with 15 women living alone in the community, aged 71 to 86 years, and widowed 6 months to 15 years.

RESULTS

Widowhood meant having significantly fewer opportunities for commensality. Participants attributed changes to their food behaviors to the loss of commensality, including food choice, fewer regular meals, and reduced work of meal preparation. These changes were attributed to the experienced difference between shared meals and meals eaten alone, no longer having the commitment of commensality, and having less interest in meal preparation in the absence of obligation or reward of commensality.

DISCUSSION

Eating alone symbolized loss and was less enjoyable, yet the pleasure experienced with food was intact. Focusing on the pleasure of eating may help support women when they lose regular commensality late in life. Free from the commitment of commensality, some shifted away from regular meals and simplified their meal preparation strategies. This has implications for clinical and research endeavors.

RelAte: pilot study of the effects of a mealtime intervention on social cognitive factors and energy intake among older adults living alone

Mealtime interventions typically focus on institutionalised older adults, but we wanted to investigate whether they may also be effective among those living independently. Using a randomised controlled trial design, we assessed the effects of a novel mealtime intervention on self-efficacy, food enjoyment and energy intake. A total of 100 adults living alone aged over 60 years were randomised to the treatment or control conditions: all received a guidebook on nutrition and culinary skills. Treatment group participants received a weekly visit from a trained volunteer who prepared and shared a meal with them. Participants in the treatment group showed improvements relative to those in the control group at borderline significance (P=0·054) for self-efficacy and at significance for food enjoyment. Significant improvements were observed in female participants in the treatment but not in the control group in energy intake (although following corrections for multiple comparisons, only the effect on food enjoyment remained significant). These findings will inform the design of future complex interventions. For this type of intervention to be successful, more focus has to be placed on making interventions more personalised, potentially according to sex. Findings are important for nutritional sciences as they indicate that, in order to improve energy intake and food enjoyment among older adults, multimodal nutritional interventions including social components may be successful.

Nutrition in Older Adults on Peritoneal Dialysis

Nutrition in older adults on peritoneal dialysis is an important aspect of a patient's clinical management as well as being influenced by their overall well-being, both mental and physical. This is especially pertinent as individuals age, since the potential impact of life changes and physical changes contribute to the development of protein-energy wasting and potentially exacerbating sarcopenia and wasting. This article provides an outline of the nutritional issues to consider in older adults on peritoneal dialysis (PD).

Macronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ)

As part of the 12-month follow-up of the longitudinal cohort study, Life and Living in Advanced Age: A Cohort Study in New Zealand, dietary intake was assessed in 216 Māori and 362 non-Māori octogenarians using repeat 24-h multiple pass recalls. Energy and macronutrient intakes were calculated, and food items reported were allocated to food groups used in the New Zealand Adult Nutrition Survey (NZANS). Intakes were compared with the nutrient reference values (NRV) for Australia and New Zealand. The median BMI was higher for Māori (28·3 kg/m2) than for non-Māori (26·2 kg/m2) P=0·007. For Māori, median energy intake was 7·44 MJ/d for men and 6·06 MJ/d for women with 16·3 % energy derived from protein, 43·3 % from carbohydrate and 38·5 % from fat. Median energy intake was 7·91 and 6·26 MJ/d for non-Māori men and women, respectively, with 15·4 % of energy derived from protein, 45 % from carbohydrate and 36·7 % from fat. For both ethnic groups, bread was the top contributor to energy and carbohydrate intakes. Protein came from beef and veal, fish and seafood, bread, milk and poultry with the order differing by ethnic groups and sex. Fat came mainly from butter and margarine. Energy-adjusted protein was higher for Māori than non-Māori (P=0·049). For both ethnic groups, the median energy levels were similar, percent carbohydrate tended to be lower and percent fat higher compared with adults aged >70 years in NZANS. These unique cross-sectional data address an important gap in our understanding of dietary intake in this growing section of our population and highlight lack of age-appropriate NRV.

Environmental Strategies to Promote Food Intake in Older Adults: A Narrative Review

Aging is often accompanied by lower intakes of food energy and consequent negative effects on health. To some extent this is due to declines in physiological ability, including the sensory responsiveness to regulate food intake. Fortunately, environmental factors may still influence food intake in older adults. Factors such as social facilitation, modeling, and nutrition knowledge and skills have been shown to stimulate their food intake. While environmental factors such as the eating location, portion size, food presentation, and labeling are known to influence eating behavior, their effectiveness in stimulating food intake in older persons is not well delineated. It is suggested that improving the environmental stimuli that promote food intake is a viable strategy to overcome age-related declines in nutrient intakes. This strategy is so promising that further research is warranted.

Differences in Medical and Life-style Risk Factors for Malnutrition in Limited-Resource Older Adults in a Rural U.S. State: A Descriptive Study

OBJECTIVES

Medical and life-style factors are associated with malnutrition in older adults. This study assessed the presence of these risk factors in limited-resource, community-dwelling older adults to inform the development of a nutrition education interventions.

DESIGN

Quantitative descriptive study.

SETTING

A total of 24 randomly selected congregate nutrition sites (where limited-resource older adults can receive one hot meal/day, five days/week) in the rural state of South Carolina, USA.

PARTICIPANTS

Data were collected from 477 older adults (of the 407 who reported race, 219 were African American and 171 were White).

MEASUREMENTS

Extension Educators who work for the Cooperative Extension Service (a formalized educational outreach system associated with some U.S. universities) read aloud a 27-item instrument designed to assess risk factors for malnutrition. Response frequencies were tabulated and chi-square tests were performed using SAS 9.3.

RESULTS

More African Americans reported having a chronic illness or condition (81.2 vs. 68.3%; p=0.003), eating alone (66.2 vs. 53.6%; p=0.012), having a refrigerator that sometimes did not keep food cold (31.8 vs. 8.4%; p<0.0001), and sometimes not having enough money to buy food (38.9 vs. 18.5%; p<0.0001) compared to White older adults.

CONCLUSION

Rural older adults who attend congregate nutrition sites, especially African Americans, could be at risk for malnutrition due to health status and food preparation-related factors. Evidence-based, tailored programs are needed to minimize malnutrition among limited-resource older adults living in rural areas in the U.S.

Association between eating alone and depressive symptom in elders: a cross-sectional study

Background

Depression is one of the main health concerns in elders which could lead to many negative outcomes. Eating alone is an emerging issue in elders in China and would become more serious along with the fast course of industrialization and urbanization, as well as population aging. However, their relationship was seldom researched.

Methods

Using a two-stage cluster sampling strategy, an investigation was conducted in 2014 among 9,361 permanent residents aged 60 years and above in Zhejiang Province, China. Totally, 7,968 cognitively normal elders were included in our analysis. Multilevel logistic regression was used to explore the association between eating arrangement (number of companions in mealtime) and depressive symptom as well as the association between eating alone and depressive symptom in relation to living alone.

Results

In our sample, 17.1 % of the elders ate alone and 8.7 % had depressive symptom. We observed a distinct inverse association between eating arrangement (number of companions in mealtime) and geriatric depressive symptom (female: OR = 1.12, P = 0.027; aged 60–74 years: OR = 1.16, P = 0.002), after adjustment for demography, socioeconomic status, social relation, health behaviors, underlying conditions and living alone. We then introduced a combined variable of eating alone and living alone and examined its relationship with depressive symptom. We found that compared with elders who ate and lived with others, those who ate alone but lived with others had a significant increased odds of depressive symptom (female: OR = 1.62, P = 0.027; aged 60–74 years: OR = 1.59, P = 0.025).

Conclusions

Our results suggested that a lack of companionship in mealtime might be independently associated with geriatric depressive symptom for females and those aged 60–74 years. What’s more, eating alone might be a stronger factor associated with depressive symptom than living alone. We recommend interventions to be performed in encouraging elders especially females and those aged 60–74 years to eat with others. Longitudinal studies in different populations which focus on this topic are required to better understand this issue.

Improving food intake in persons living with dementia

Persons living with dementia have many health concerns, including poor nutritional states. This narrative review provides an overview of the literature on nutritional status in persons diagnosed with a dementing illness or condition. Poor food intake is a primary mechanism for malnutrition, and there are many reasons why poor food intake occurs, especially in the middle and later stages of the dementing illness. Research suggests a variety of interventions to improve food intake, and thus nutritional status and quality of life, in persons with dementia. For family care partners, education programs have been the focus, while a range of intervention activities have been the focus in residential care, from tableware changes to retraining of self-feeding. It is likely that complex interventions are required to more fully address the issue of poor food intake, and future research needs to focus on diverse components. Specifically, modifying the psychosocial aspects of mealtimes is proposed as a means of improving food intake and quality of life and, to date, is a neglected area of intervention development and research.

Strategies to support engagement and continuity of activity during mealtimes for families living with dementia; a qualitative study

BACKGROUND

Mealtimes are an essential part of living and quality of life for everyone, including persons living with dementia. A longitudinal qualitative study provided understanding of the meaning of mealtimes for persons with dementia and their family care partners. Strategies were specifically described by families to support meaningful mealtimes. The purpose of this manuscript is to describe the strategies devised and used by these families living with dementia.

METHODS

A longitudinal qualitative study was undertaken to explore the meaning and experience of mealtimes for families living with dementia over a three-year period. 27 families [older person with dementia and at least one family care partner] were originally recruited from the community of South-Western Ontario. Individual and dyad interviews were conducted each year. Digitally recorded transcripts were analyzed using grounded theory methodology. Strategies were identified and categorized.

RESULTS

Strategies to support quality mealtimes were devised by families as they adapted to their evolving lives. General strategies such as living in the moment, as well as strategies specific to maintaining social engagement and continuity of mealtime activities were reported.

CONCLUSIONS

In addition to nutritional benefit, family mealtimes provide important opportunities for persons with dementia and their family care partners to socially engage and continue meaningful roles. Strategies identified by participants provide a basis for further education and support to families living with dementia.