Institutional feeding of the elderly

Changes in type of foodservice and dining room environment preferentially benefit institutionalized seniors with low body mass indexes

OBJECTIVE

To compare energy intakes in seniors with cognitive impairment residing in long-term care and receiving meals by bulk (cafeteria style with waitress service) vs traditional tray delivery systems and determine subject characteristics that identify responsiveness to type of foodservice provided. DESIGN AND SUBJECTS/SETTING: Usual energy intakes were compared in subjects residing in cognitive impairment units in either the old (tray delivery, n=23) or new (bulk delivery, n=26) nursing home at Baycrest, a teaching facility associated with University of Toronto Medical School.

INTERVENTION

Changes to foodservice and physical environment (from institutional to more home-like environment).

MAIN OUTCOME MEASURES

Twenty-one consecutive day investigator-weighed energy and macronutrient intakes and behavioral function (London Psychogeriatric Rating Scale).

STATISTICAL ANALYSES PERFORMED

Analysis of variance determined mean differences in intake and regression analyses identified predictors of sensitivity to type of food delivery systems.

RESULTS

Higher 24-hour total (P<0.001) and dinner (P<0.001) energy intakes in subjects receiving bulk compared to tray delivery were predominantly associated with greater carbohydrate intakes (P<0.001). Higher energy, carbohydrate, and protein, but not fat intakes, with bulk delivery were more apparent in individuals with lower body mass indexes (BMIs) (food delivery by BMI interaction, all P values <0.05).

CONCLUSIONS

High-risk, cognitively impaired individuals with low BMI benefited the most from the changed foodservice and physical environment, whereas individuals with higher BMIs did not show substantive changes in intake. Bulk foodservice and a home-like dining environment optimize energy intake in individuals at high risk for malnutrition, particularly those with low BMIs and cognitive impairment.

Life enrichment programme; enhanced dining experience, a pilot project

PURPOSE

The purpose of this pilot project is to highlight how food intake, nutrition status and quality of life could be improved for long stay residents of a community nursing unit and demonstrate that assisted feeding can be a more dignified experience for them.

DESIGN/METHODOLOGY/APPROACH

A good dining experience involves not just the food, but also its presentation and the environment in which it is served. A review of the literature identified projects with similar objectives but differing approaches. A survey of residents informed the planning phase. A home style dining room was created with a more traditional ambiance and decoration. The pace of dining was leisurely. Personal choice and independence in eating were supported. A schedule of dining activities was delivered by two staff facilitators.

FINDINGS

Eight dining sessions facilitated 23 residents over three months. "Minced" meals were not served, help was given to cut up meat and cues or prompts offered to maximize independence and demonstrate the value of this approach to care staff.

ORIGINALITY/VALUE

The project illustrated the advantages of stepping outside the purely clinical framework in addressing issues around poor food intake. It highlighted and how small but valuable changes can be implemented even where resources and space is limited. Involvement with the project allowed staff to observe and reflect on the benefits of enhancing the social and aesthetic aspects of dining.

Nutrition in Older Adults

Both physiologic and psychosocial changes affect the nutritional status of adults over the age of 65. Malnutrition is, in fact, a greater threat to this population than obesity. This article reviews the intake requirements of older adults and discusses the risk factors that can lead to malnutrition, including diet, limited income, isolation, chronic illness, and physiologic changes. Assessment and nursing interventions are also addressed.

Food provision and the meal situation in elderly care - outcomes in different social contexts

BACKGROUND

Nutritional problems concerning older people in care can be affected both by their illness and by the standard procedures surrounding food provision, for example rigid routines of food supply and ritualized mealtime situations.

METHOD

The aim was to study how organizational structure and staff members' routines and actions influence activities related to food and meals in different caring context in Sweden. The qualitative methodology chosen for this study was participant observation.

RESULT

Care recipients were given different opportunities concerning what, how, when and with whom to eat, depending on where their meals were served. In restaurants, older people could choose from several foods and they could also choose the time of and company for the meal. At care units with 'part-of-day' care or 'around-the-clock' care, food choices, time and company were limited, especially at the units with 'around-the-clock' care, where the most ailing older people lived.

CONCLUSIONS

Food provision and the mealtime situation for the elderly are shaped by the individual's living arrangements, and the social organization surrounding it, not determined by the individual's needs and wishes, including social and cultural meanings of food and meals, which could, thereby, affect nutritional intake.

Nutritional issues in the care of the elderly patient

Aging is associated with a progressive decline in the function of many organs and apparatus. In a medical context, depletion of lean body mass and muscle mass in particular, and alteration of the immune system are of utmost importance. A defective immune response is associated with an increased incidence of inflammatory, infective and neoplastic diseases in the elderly as well as with a slow and sluggish recovery after illness or other injury. Depletion of muscle mass, the so-called sarcopenia, is responsible for the typical frailty of the elderly. Moreover, since muscle represents the protein reserve of the body, its progressive erosion not only results in a poor mobility and disability of these subjects, with associated complications, but with a diminished capacity to meet the extra demand of protein synthesis associated with disease and injury. In cancer patients, as in other elderly patients with different pathologies, it is important to evaluate the nutritional status, since frailty of these individuals recognizes as a relevant etiopathogenetic cofactor, a defective food intake. Nutritional support should aim at meeting the requirements in macronutrients, in water and in micronutrients. Requirements are not so different from those of adult subjects, since the decrease in energy expenditure due to a lower physical activity is compensated by the increase due to the disease. Particular attention must be given to fluid administration, since the elderly tolerate fluid overload less than hypohydration. Elderly patients quite frequently suffer from long-standing undernutrition; this means that nutritional repletion will take more time than is usually expected with use of medication. If a correct feeding program is performed for a few weeks, a benefit can be observed not only on the nutritional status but also in the clinical outcome. In fact nutritional support may have a permissive role in the administration of aggressive (oncologic) treatment than may be otherwise denied to elderly patients.