An investigation of main meal preferences in nursing home residents

Identifying desirable attributes in dairy-rich breakfast and desserts for older adults

In the next decade, the US anticipates a rapid increase in the older adult population, who also face an increased risk for disease. To reduce this risk, research should explore increasing intake of nutrient-dense foods and prepared meals that include dairy foods and utilize novel food processing that better retain nutrients. This study identified attributes that older adults (age = 65+) desire in dairy-rich ready-to-eat breakfasts and desserts, two meals important in healthy aging. Two online choice-based conjoint analysis surveys were fielded (one for breakfast and one for dessert) to determine desirable attributes amongst respondents (breakfast n = 211; dessert n = 300). Breakfast concepts included protein source, primary ingredient, type of dairy, and health claim. Dessert concepts included primary flavor, primary sweetener, type of inclusion, and health claim. Breakfast results revealed the desirable attributes included "no meat" (utility value [UV] = 0.138), "eggs" (UV = 0.384), "cheese" (UV = 0.034), and "good source of fiber" (UV = 0.163). Two consumer clusters were identified with cluster 1 (n = 151) desiring "red meat" as the protein source and cluster 2 (n = 60) preferring "no meat." The majority of respondents (86%) indicated a willingness to consume foods processed with a novel technique. For the dessert meals, desirable attributes were "chocolate flavor" (UV = 0.638), "sugar" (UV = 0.859), "fruit inclusions" (UV = 0.522), and "heart-healthy" (UV = 0.453). Dessert consumer cluster 1 (n = 145) desired chocolate desserts sweetened with sugar, whereas cluster 2 (n = 155) desired vanilla desserts sweetened with honey. Participants who preferred oral manipulation of food via "smooshing" expressed a higher liking for desserts with no inclusions. These results provide insight for future product development for older adults involving dairy products or novel processing techniques. PRACTICAL APPLICATIONS: This study shows that both sensory attributes and health claims are important considerations when developing ready to eat meals for older adults. For breakfast, providing a vegetarian option is important while for desserts, both chocolate and vanilla remain popular options.

Predictors of incident malnutrition-a nutritionDay analysis in 11,923 nursing home residents

Background/Objectives

Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents.

Subjects/Methods

NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m²) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals.

Results

Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model.

Conclusion

10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.

Dysphagia-Related Health Information Improved Consumer Acceptability of Thickened Beverages

Most people tend to think that healthy foods do not taste good. This view could have a negative impact on the taste of the food that people eat for health. However, if health-related information is provided to avoid negative aspects, acceptability may improve. Thus, this study investigated changes in consumers’ sensory perception of thickened beverages before and after the provision of dysphagia-related health information. Sixty young (19–39 years old) and middle-aged (40–64 years old) consumers participated in two experiment sessions conducted one week apart. The first session proceeded without any information and the second provided information about dysphagia and the need for dietary modification before evaluation. Three beverages (orange juice, red bean water, and sports drink) were used in nectar-like (51–350 cP) and honey-like (351–1750 cP) forms; original beverage samples (0%) were used as the control. Consumers were asked about acceptability, liking the flavor, intensity, and general health interest (GHI). An analysis of variance was performed to show the change in flavor rating and acceptability between the two sessions. Although there were age-related differences in response to the samples, thickened beverages were rated as more acceptable, in terms of their characteristics (swallowing, viscosity, and mouthfeel) after the information was provided. There were no significant differences for the 0% samples. The mean GHI values were 3.97 ± 0.85 and 4.81 ± 0.68 for the young and middle-aged groups, respectively. High and low GHI groups were analyzed. The high GHI group showed significant differences in acceptability in the informed evaluation, whereas the low GHI group was not influenced by the information.

Effect of nutritional interventions on discharged older patients: study protocol for a randomized controlled trial

Background

During hospitalization, many older patients are at nutritional risk or malnourished, and their nutritional condition is often further impaired during hospitalization. After discharge, a “nutrition gap” often occurs in which the patient does not receive enough nutrition to ensure an optimal recovery.

Methods

The study is a randomized controlled study ongoing over 112 days. At discharge, the intervention group receives guidance from a clinical dietitian, and an individualized nutrition plan is made. The dietitian will perform telephone follow-up after 4 and 30 days. It will also be possible for the participant, the participant’s relatives, or the participant’s municipality to contact the dietitian if nutritional questions arise. At the time of discharge, the intervention group will receive a package containing foods and drinks that will cover their nutritional needs on the first day after discharge. They will also receive a goodie bag containing samples of protein-rich, milk-based drinks. Data are collected on quality of life, appetite, physical function, dietary intake, weight, height, energy and protein needs, and experience of discharge and cooperation with the municipality. Information about nutrition status will be sent to the municipality so that the municipality can take over nutritional treatment. The control group receives a standard treatment.

Discussion

This study is the first to combine previously successful single nutritional interventions into a multimodal intervention whose aim is to obtain an effect on patient-related outcomes. We hope that the results will prove beneficial and help to ensure the cross-sector quality of nutritional support to older patients.

Trial registration

ClinicalTrials.gov, NCT03488329. April 5, 2018.