Journal of Gerontological Nursing

Feature Article 

Food Choice Can Improve Nursing Home Resident Meal Service Satisfaction and Nutritional Status

Neva L. Crogan, PhD, GCNS-BC, GNP-BC, FNGNA, FAAN; Alice E. Dupler, JD, APRN-BC; Robert Short, PhD; Grace Heaton, RD

Abstract

The purpose of this study was to test the feasibility of implementing the Eat Right food delivery system and measure its impact on residents’ food satisfaction, food intake, and subsequent nutritional status, including serum prealbumin levels and changes in body weight. Two eastern Washington State nursing homes (NHs) were recruited based on a similar case mix, the number of beds, and management’s willingness to participate in the study. A total of 61 residents (NH A = 33, NH B = 28) participated. Intervention group residents (NH A) reported significant overall improvement in food service satisfaction and significant improvement in serum prealbumin levels after the intervention (p = 0.001). Changes in intervention group body weight improved after the intervention (p = 0.029). Use of nutritional interventions such as the multidimensional Eat Right system encourages resident decision making and facilitates overall satisfaction with care and improved health.

Dr. Crogan is Professor, Department of Nursing, Gonzaga University; and Ms. Dupler is Clinical Associate Professor, Dr. Short is Research Professor/Statistician, and Ms. Heaton is Research Associate, Washington State University College of Nursing, Spokane, Washington.

The authors have disclosed no conflicts of interest, financial or otherwise. Funding was provided by the Alzheimer’s Association Foundation.

Address correspondence to Neva L. Crogan, PhD, GCNS-BC, GNP-BC, FNGNA, FAAN, Professor, Department of Nursing, Gonzaga University, 502 East Boone Avenue, Spokane, WA 99258; e-mail: crogan@gonzaga.edu.

Received: April 04, 2012
Accepted: August 22, 2012
Posted Online: March 22, 2013

Abstract

The purpose of this study was to test the feasibility of implementing the Eat Right food delivery system and measure its impact on residents’ food satisfaction, food intake, and subsequent nutritional status, including serum prealbumin levels and changes in body weight. Two eastern Washington State nursing homes (NHs) were recruited based on a similar case mix, the number of beds, and management’s willingness to participate in the study. A total of 61 residents (NH A = 33, NH B = 28) participated. Intervention group residents (NH A) reported significant overall improvement in food service satisfaction and significant improvement in serum prealbumin levels after the intervention (p = 0.001). Changes in intervention group body weight improved after the intervention (p = 0.029). Use of nutritional interventions such as the multidimensional Eat Right system encourages resident decision making and facilitates overall satisfaction with care and improved health.

Dr. Crogan is Professor, Department of Nursing, Gonzaga University; and Ms. Dupler is Clinical Associate Professor, Dr. Short is Research Professor/Statistician, and Ms. Heaton is Research Associate, Washington State University College of Nursing, Spokane, Washington.

The authors have disclosed no conflicts of interest, financial or otherwise. Funding was provided by the Alzheimer’s Association Foundation.

Address correspondence to Neva L. Crogan, PhD, GCNS-BC, GNP-BC, FNGNA, FAAN, Professor, Department of Nursing, Gonzaga University, 502 East Boone Avenue, Spokane, WA 99258; e-mail: crogan@gonzaga.edu.

Received: April 04, 2012
Accepted: August 22, 2012
Posted Online: March 22, 2013

 

Quality of life and “culture change” are fast becoming a national focus as nursing homes (NHs) embrace evolution from institution-like models of care to nurturing environments that are person directed and person centered (Koren, 2010). Quality of life is defined as the result of combining control of the environment, personal values and resources, and actual living conditions (Hoffman, 2008). For older adults in NHs, food and meal service are important features of life, thus impacting their overall quality of life.

Consuming adequate amounts of food is important for older adults living in NHs. Inadequate food intake can lead to weight loss and malnutrition. In fact, up to 85% of residents have this condition (Suominen et al., 2005). The Centers for Medicare & Medicaid Services (2012) defines weight loss as “a weight loss of 5% or more in the last month or 10% or more in the last two quarters who were not on a physician prescribed weight-loss regimen” (p. 36). Malnutrition compromises quality of life and can lead to chronic disability, functional decline, increased health care use and health care costs, and death (Reed et al., 2005). A multifaceted problem, malnutrition can be caused by poor appetite, chronic disease, sensory loss, poor oral/dental health, polypharmacy, depression, chronic inflammation, catabolism due to severe illness, and environmental factors (Morley, 2011). For the typical NH resident, malnutrition is ultimately due to inadequate food intake (Aoyama, Weintraub, & Reuben, 2006).

Prevention of malnutrition due to inadequate food intake is important because weight loss and low body weight are predictors of morbidity, mortality (Reed et al., 2005), and poor quality of life (Crogan & Pasvogel, 2003). Although there are many reasons for a decline in food intake, food choice and satisfaction have not been studied adequately in controlled empirical investigations. Unlike those in acute care, NH residents are seldom given a choice of food at mealtime, although state and federal regulators require that an alternative food item be available. Facility or corporate dietitians develop menus, providing little opportunity for resident input. NH residents want to choose the foods they eat and want a voice in menu development (Crogan, Evans, Severtsen, & Shultz, 2004). The Eat Right food delivery system addresses these concerns.

Eat Right is a resident-centered, multi-level, two-component delivery system. Component 1 is designed to systematically change and update menus to include foods residents like to eat; whereas Component 2 supports resident food choice using a select menu and a buffet-style dining program in the dining room. Although many NHs have tried practical approaches to meal service (meal carts, spoken menus, “fresh” menus), none have tested these approaches in controlled empirical investigations. The purpose of this article is to describe the testing of the Eat Right food delivery system and report subsequent resident outcome measures (i.e., changes in meal service satisfaction, food intake, serum prealbumin levels, and body weight).

Method

Setting and Design

Using a two-group, repeated measures design, two eastern Washington State NHs were recruited to participate in a 6-month study to test the effects of a new food delivery system. NHs were chosen based on similar case mix (sub-acute, skilled, custodial care), number of beds, and management’s willingness to participate in the study. NH A was chosen as the intervention site using a random process (coin flip). NH B acted as a comparison site.

Unbeknownst to the principal investigator (N.L.C.), and prior to the beginning of the study, the control site began serving food from a steam table in the dining room. Rather than search for another comparable NH, it was determined that the intervention was the Rate the Food process itself and resulting food choice, not simply the use of a steam table in the dining room.

Participants

All residents meeting inclusion/exclusion criteria were invited to participate in the study. A total of 61 residents (NH A = 33, NH B = 28) were recruited to participate. Of those, 51 (83.6%) were women (NH A = 30, NH B = 21). Mean age of the residents from NH A was 84.7 (SD = 9.6 years), similar to residents from NH B (85.6, SD = 7.6 years). Both groups had similar Mini Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) scores: NH A = 21 (SD = 5); NH B = 20 (SD = 5). A power analysis was completed based on an N of 60 and an alpha of 0.05. The study was determined to have a power greater than 0.80 to detect an effect size of 0.30 for both main effects and the interaction. The participating university’s Institutional Review Board approved the study procedures.

Inclusion and Exclusion Criteria

Inclusion criteria were age 65 or older, residents who consume all meals in the dining room, and residents who feed themselves or require minimal cueing to eat. Exclusion criteria were residents who were “actively” dying or receiving palliative/hospice care; residents on a planned weight reduction diet; short-stay residents (expected stay < 6 to 9 months); residents receiving tube feedings as their primary source of nourishment; residents with high nutrition risk; and very low functioning residents.

Eat Right Food Delivery System

The Eat Right food delivery system is a resident-centered, multi-level, two-component delivery system requiring completion of the following steps.

Component 1: Rate the Food and Update Facility Menus.

Step 1. Administer the Rate the Food pictorial tool (Heaton, Crogan, Dupler, & Short, 2011) (intervention and comparison sites).

  • A research assistant (RA) helps participants mark the “facial expression” that most closely matches their own opinion of each food item (main entree, vegetable, starch, and dessert). Breakfast items are assessed during Week 1, lunch items Week 2, and dinner items Week 3. To fully refine menu selections, food items are evaluated again at midpoint and postintervention by treatment group participants.

Step 2. Update the nursing home menu (intervention site only).

  • Menu items with a median score of 3.5 or higher (on a scale from 1 to 5) remain on the menu.
  • Deleted items are replaced with favorite items gathered from Resident Council (comprised of elected residents who meet monthly to discuss issues specific to facility life and resident concerns) and study participants.

Component 2: Menu Selection Process (Intervention Site Only) and Steam Table Usage.

Step 3. Menu Selection Process.

  • Principal investigator coordinates printing of NH menus.
  • Resident makes food choice by marking menu (prior day) with help from the RA.
  • RA gives food selections to dietary staff to prepare correct amount of food.

Step 4. Steam Table Usage.

  • Steam table is placed immediately inside the dining room (both intervention and control sites).
  • Nursing assistant brings residents by a filled steam table to view food.
  • Staff asks residents if their prior choice has changed.

Step 5. Meal Service.

  • Dietary staff serves the food from the steam table. Food serving is moved from the kitchen to the dining room. By regulation, only dietary staff can serve food.
  • Staff delivers individual plates to dining tables or, on rare occasions, to resident rooms during periods of illness.
  • Staff offers dessert via a traveling cart after the meal.

Measurements

Study measures included meal service satisfaction, food intake, serum prealbumin level, and body weight.

The FoodEx-LTC is a research-based, 28-item, four-domain instrument developed and pilot tested by the principal investigator (and others) to measure resident satisfaction with food and meal service (Crogan, Evans, & Velasquez, 2004; Evans & Crogan, 2005; Crogan & Evans, 2006). The four domains include enjoying food and food service (8 items); exercising choice (6 items); cooking good food (5 items); and providing food service (9 items). Responses are scored on a 4-point Likert scale (1 = true, 2 = somewhat true, 3 = somewhat false, 4 = false). During development and pilot testing of the FoodEx-LTC, internal consistency reliability (Cronbach’s alpha) estimates ranged from 0.65 (exercising choice) to 0.82 (providing food service). All alpha coefficients were above the 0.50 criterion suggested by Nunnally and Bernstein (1994) for a new scale, and three of four scales met the more stringent criterion of 0.70. Two-week test-retest coefficients ranged from 0.79 (enjoying food and food service) to 0.88 (providing food service and exercising choice). None fell below 0.70. An RA administered and scored the FoodEx-LTC at baseline and postintervention.

Food intake was measured for 21 consecutive days (1 week breakfast, 1 week lunch, and 1 week dinner) at baseline, midpoint, and during the last 3 weeks of the intervention using a plate waste protocol that uses a gram food scale to weigh and compare weights of original food servings to weights of the same foods left “on the plate” after meals (Hayes & Kendrick, 1995). The amount of fluids (in milliliters) of each beverage consumed during each meal also was documented.

The MMSE was administered to all participants and subsequently categorized into three mental status groupings: 12 to 18, 19 to 23, and 24 to 30. Mental status and the interaction between mental status and time were used as covariates in the statistical analysis.

A local laboratory company collected, transported, and analyzed blood samples from participating older adults to determine serum pre-albumin levels at baseline and postintervention. An RA obtained baseline and monthly body weight from each participating resident using a calibrated scale.

Statistical tests of main effects and interactions for each outcome variable were completed using generalized estimating equations using the hierarchy of person-time. The complete model equations included factors for time, facility, sex, age, mental status, the facility by time interaction, and the time by mental status interaction. The analyses were repeated for each facility using time, sex, age, mental status, and the time by mental status interaction. Tabulated means and standard deviations were calculated from the raw data and do not represent estimated marginal means. Type 1 error occurrence was controlled at p = 0.05.

Results

Across-Group Findings

The main effects of time, sex, and age on serum prealbumin levels, body weight, and food intake (Table 1) were not unexpected. For example, sex had an effect on body weight and food intake; age had a significant effect on all three primary outcomes. Changes from baseline to postintervention were observed for serum prealbumin level as well as body weight. The effect of the intervention on study outcome measures across groups in the full model was not significant (Table 2). However, statistically significant and clinically important differences in the primary outcome measures were found within groups. Most notably, changes in serum prealbumin level and body weight were observed in the intervention group. As expected, group-by-time interaction effects for the FoodEx-LTC (Table 3) were reflective of the significant within group results.

Main Effects of Time, Sex, and Age on Study Outcome Measurements

Table 1: Main Effects of Time, Sex, and Age on Study Outcome Measurements

Primary Outcome Measures at Baseline and Postintervention

Table 2: Primary Outcome Measures at Baseline and Postintervention

Meal Service Satisfaction at Baseline and Postintervention (PI)Meal Service Satisfaction at Baseline and Postintervention (PI)

Table 3: Meal Service Satisfaction at Baseline and Postintervention (PI)

Within-Group Findings

Because the comparison facility installed a steam table prior to the beginning of the study, thereby introducing some cross-over effects to the planned intervention, within-group changes from baseline to postintervention were closely examined. Resident satisfaction with meal service changed significantly over the 6-month period for several variables and for both groups. Table 3 describes within-group meal service satisfaction differences from baseline to postintervention. Postintervention, NH A evidenced significant improvement in two FoodEx-LTC domains: enjoying food and food service and providing food service. NH B improved in one domain: cooking good food. Unlike control participants, residents from NH A reported significant overall improvement in food service satisfaction (item 28) after the intervention in comparison to baseline.

Discussion

This article describes the testing of the Eat Right food delivery system and reports subsequent resident outcome measures including meal service satisfaction, food intake, serum prealbumin levels, and changes in body weight. An innovative and one-of-kind intervention, Eat Right is resident centered, resident focused, and supports resident food choice and quality of life. In an extensive review of the literature (using Medline, CINAHL, and the Cochrane databases), no other clinical studies were found that address food choice and satisfaction from the perspective of the resident. Most important, none have tested the feasibility of a select menu or buffet-style dining program with cognitively impaired older adults (Crogan, Evans, & Velasquez, 2004).

Intervention group participants experienced increased body weight and significant improvements in serum prealbumin levels postintervention. Although total food intake did not change, undoubtedly the quality of food consumed improved as evidenced by these clinically significant changes. Of perhaps greater importance was the increased autonomy exercised by residents when choosing their food preferences and subsequent increased enjoyment of their dining experience. Residents were more complimentary of staff who cooked their meals and also felt more engaged in making decisions that positively affected their health through choices in menu development and steam table entrees. Subsequently, intervention participants’ overall perceptions of their dining experience were more positive than those in the control group.

Although the intervention was confounded by the initiation of a steam table by NH B and the use of multiple inferential tests increasing the chance of observing a Type I error, within-group results were encouraging. Other limitations included the potential confounding of events or variables that could influence food intake such as illness, condition change, refusing to participate, or changes in NH staffing. Strengths of the study include its longitudinal (> 6 months) and repeated-measures design. Subsequently, this study contributes to the overall body of knowledge related to this complex nutritional issue when caring for older adults.

Implications for Practice

As with any organizational change, teamwork and coordination of tasks are critical for success. The intervention NH for this study proactively embraced the Eat Right food delivery system with the development of a Dining Model Task Group. Members of this group included nurses, nursing assistants, dietary staff, and key informal front-line leaders. The group met daily at first, then weekly, and finally monthly to refine the system. The group found that the meal “seems to go smoother on evenings” and that “the steam table model on a whole is more efficient than meal service delivery from trays” (Dining Model Task Group meeting minutes, February 13, 2012). Specific recommendations included:

  • Duties/assignments for nursing assistants need to be clearly defined, especially hallway assignments.
  • Duties/assignments for food service workers need to be clearly defined (e.g., food service workers serve food from the steam table in the dining room).
  • Assign one nursing assistant to each table within the dining room.
  • Do not drag the garbage can from table to table when bussing tables.
  • All personal care of residents should be done before the beginning of the meal.
  • Recruit volunteers to assist with non-resident contact tasks (e.g., setting tables, prior day menu selection).
  • Frequent training is needed to ensure that staff know and understand their role in the new food delivery system. Training topics:
    • Deliver meals to residents who can feed themselves before attending to those needing assistance.
    • Time management skills.
    • Dos and don’ts specific to the food delivery system.
    • Table service—everyone at the table should be served before serving another table.
    • Guidelines for bussing tables.
    • Benefits of eating in the dining room.
    • Liberalized diets.

Most important, meet frequently with resident groups to ensure buy-in and willingness to participate. Listen to what residents want and include their suggestions in the new system.

Conclusion

Organizational change is needed in NHs. As Baby Boomers age and need NH care, they will demand systems that enhance their ability to make choices in their everyday lives. Weight loss and low body weight are predictors of morbidity, mortality, and poor quality of life; however, food choice and resident satisfaction have not been examined to determine their impact on nutritional decline. Findings from this study describe the potential relationship between food choice, meal service satisfaction, and nutritional status. Use of nutritional interventions, such as the multidimensional Eat Right system, encourages resident decision making and facilitates overall satisfaction with care and improved health. For older adults in NHs, food and meal service are important features of life, thus impacting their quality of life. Quality of life or “culture change” is fast becoming a national focus as NHs embrace organizational change and strive to provide person-directed or person-centered care in a noninstitutionalized setting (Koren, 2010). Empirically tested interventions such as Eat Right are needed to help NHs provide care that is both person centered and resident focused.

References

  • Aoyama, L., Weintraub, N. & Reuben, D.B. (2006). Is weight loss in the nursing home a reversible problem?Journal of the American Medical Directors Association, 7(3 Suppl.), S66–S72 doi:10.1016/j.jamda.2005.12.018 [CrossRef] .
  • Centers for Medicare & Medicaid Services (2012). MDS 3.0 quality measures user’s manual. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS30QM-Manual.pdf
  • Crogan, N.L. & Evans, B.C. (2006). The shortened food expectations—Long-term care questionnaire: Assessing nursing home residents’ satisfaction with food and food service. Journal of Gerontological Nursing, 32(11), 50–59.
  • Crogan, N.L., Evans, B., Severtsen, B. & Shultz, J.A. (2004). Improving nursing home food service: Uncovering the meaning of food through residents’ stories. Journal of Gerontological Nursing, 30(2), 29–36.
  • Crogan, N.L., Evans, B. & Velasquez, D. (2004). Measuring nursing home resident satisfaction with food and food service: Initial testing of the FoodEx-LTC. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59, 370–377 doi:10.1093/gerona/59.4.M370 [CrossRef] .
  • Crogan, N.L. & Pasvogel, A. (2003). The influence of protein-calorie malnutrition on quality of life in nursing homes. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56, B159–B164 doi:10.1093/gerona/58.2.M159 [CrossRef] .
  • Evans, B.C. & Crogan, N.L. (2005). Using the FoodEx-LTC to assess institutional food service practices through nursing home residents’ perspectives on nutrition care. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60, 125–128 doi:10.1093/gerona/60.1.125 [CrossRef] .
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  • Heaton, G., Crogan, N.L., Dupler, A.E. & Short, R. (2011). Resident choice: Improve the facility menu with a “Rate the Food” pictorial tool. Dietary Manager, 10, 30–34.
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  • Koren, M.M. (2010). Person-centered care for nursing home residents: The culture-change movement. Health Affairs, 29, 312–317. doi:10.1377/hlthaff.2009.0966 [CrossRef]
  • Morley, J.E. (2011). Undernutrition: A major problem in nursing homes. Journal of the American Medical Directors Association, 12, 243–246. doi:10.1016/j.jamda.2011.02.013 [CrossRef]
  • Nunnally, J.C. & Bernstein, I.H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.
  • Reed, P.S., Zimmerman, S., Sloane, P.D., Williams, C.S. & Boustani, M. (2005). Characteristics associated with low food and fluid intake in long-term care residents with dementia. The Gerontologist, 45, 74–80 doi:10.1093/geront/45.suppl_1.74 [CrossRef] .
  • Suominen, M., Muurinen, S., Roautasalo, P., Soini, H., Suur-Uski, I., Peiponen, A. & Pitkala, K.H. (2005). Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. European Journal of Clinical Nutrition, 54, 578–583 doi:10.1038/sj.ejcn.1602111 [CrossRef] .

Main Effects of Time, Sex, and Age on Study Outcome Measurements

p Value
Outcome Measure Nursing Home Time Sex Age
Serum prealbumin level 0.535 <0.001 0.445 0.002
Body weight 0.485 0.005 <0.001 0.036
Food intake 0.457 0.658 0.003 <0.001

Primary Outcome Measures at Baseline and Postintervention

Intervention Control
Outcome Measure Mean (SD) Mean (SD) Full Model
Baseline PI p Value Baseline PI p Value p Valuea
Serum prealbumin level (mg/dL) 18.6 (5.9) 22.0 (6.5) 0.001 20.2 (6.0) 21.7 (6.2) 0.288 0.140
Body weight (lbs) 163 (50) 174 (52) 0.029 170 (48) 173 (47) 0.053 0.579
Food intake during meals (g) 218 (97) 214 (107) 0.855 218 (90) 211 (60) 0.584 0.790

Meal Service Satisfaction at Baseline and Postintervention (PI)

Intervention Control Full Model
FoodEx-LTC item Baseline PI p Value Baseline PI p Value p Valuea
Domain: Enjoying Food and Food Service
Since I came to the nursing home:
1. I have lost my appetite 2.85 (1.25) 3.24 (1.05) 0.068 3.00 (1.33) 3.14 (1.21) 0.822 0.363
2. I am forced to eat with people I don’t know. 2.79 (1.34) 3.67 (0.86) <0.001 3.04 (1.25) 3.32 (1.13) 0.256 0.099
3. I have to eat things I just hate. 3.00 (1.22) 3.33 (1.11) 0.148 3.07 (1.09) 3.68 (0.84) 0.001 0.459
4. I am taken to the dining room too soon. 3.33 (1.22) 3.43 (1.03) 0.626 3.33 (1.07) 3.41 (1.10) 0.596 0.972
5. I have to wait to go back to my room. 3.42 (1.09) 3.57 (0.75) 0.426 3.07 (1.21) 3.52 (0.93) 0.149 0.497
6. I have food in front of me that I cannot get at. 3.58 (1.03) 3.71 (0.64) 0.435 3.54 (1.00) 3.59 (0.96) 0.566 0.819
Over the past week, during mealtime, I have received:
7. Food I dislike. 2.39 (1.41) 2.62 (1.32) 0.315 2.29 (1.30) 2.33 (1.32) 0.900 0.592
8. Food always cooked the same way. 2.32 (1.35) 2.33 (1.39) 0.958 2.38 (1.24) 2.65 (1.42) 0.571 0.727
Domain Total 2.97 (0.70) 3.24 (0.54) 0.027 2.97 (0.59) 3.20 (0.67) 0.143 0.712
Domain: Exercising Choice
Since I came to the nursing home:
9. I worry that I will not get the food I ask for. 3.45 (1.00) 3.76 (0.70) 0.186 3.64 (0.83) 3.57 (0.81) 0.706 0.255
10. I feel powerless to change the food or food service. 2.94 (1.17) 3.67 (0.73) 0.010 3.30 (1.14) 3.14 (1.21) 0.259 0.014
I enhance my satisfaction with the food and food service at the nursing home by:
11. Complaining about the food. 3.24 (1.23) 3.05 (1.24) 0.582 3.39 (1.13) 3.36 (1.05) 0.724 0.669
It is important to me to:
12. Choose what to eat. 1.91 (1.23) 1.86 (1.24) 0.948 1.86 (1.18) 1.64 (1.09) 0.474 0.717
13. Choose when to eat. 2.64 (1.32) 3.19 (1.21) 0.098 2.61 (1.26) 2.55 (1.37) 0.973 0.219
14. Send outside the nursing home for food. 3.44 (1.01) 2.95 (1.40) 0.103 3.33 (1.09) 3.55 (1.01) 0.108 0.037
Domain Total 2.94 (0.72) 3.08 (0.63) 0.401 3.02 (0.64) 2.95 (0.67) 0.529 0.373
Domain: Cooking Good Food
The staff here at the nursing home:
15. Know how to prepare a meal. 1.91 (0.98) 1.76 (0.94) 0.441 1.35 (0.45) 1.00 (0.00) <0.001 0.476
16. Have experience in food service. 1.81 (1.09) 2.00 (1.17) 0.538 1.48 (0.59) 1.23 (0.43) 0.152 0.241
Here at the nursing home, I get:
17. A variety of foods. 1.76 (1.03) 1.14 (0.36) <0.001 1.52 (0.80) 1.41 (0.85) 0.805 0.038
18. Foods that are appetizing. 1.75 (0.95) 1.67 (0.80) 0.500 1.78 (1.05) 1.32 (0.48) 0.035 0.230
19. Plenty of fresh fruits and vegetables. 1.94 (1.17) 1.62 (1.12) 0.240 1.62 (1.06) 1.59 (0.73) 0.858 0.264
Domain Total 1.84 (0.68) 1.65 (0.61) 0.125 1.56 (0.46) 1.31 (0.29) 0.018 0.922
Domain: Providing Food Service
Over the past week, during mealtime, I have received:
20. Foods served at the proper temperature. 2.15 (1.25) 2.00 (1.18) 0.450 2.11 (1.23) 1.23 (0.43) <0.001 0.054
21. Food freshly cooked and served on time. 2.09 (1.18) 1.38 (0.59) 0.001 1.57 (0.92) 1.55 (0.91) 0.978 0.026
22. The right amount of food. 1.61 (1.17) 1.48 (0.81) 0.490 1.68 (1.12) 1.27 (0.63) 0.038 0.392
The staff here at the nursing home:
23. Keep a close eye on what I eat. 1.57 (1.07) 1.90 (1.29) 0.204 1.79 (1.10) 1.67 (0.91) 0.712 0.308
24. Get take-out food for me, if I want it. 3.04 (1.31) 3.65 (0.79) 0.197 2.43 (1.45) 3.10 (1.29) 0.114 0.845
25. Provide help in cutting up my food. 1.48 (1.09) 1.14 (0.36) 0.146 1.48 (1.01) 1.81 (1.29) 0.289 0.107
The kitchen staff here at the nursing home:
26. Work hard to serve food everyone likes. 1.81 (1.05) 1.15 (0.37) <0.001 1.29 (0.53) 1.00 (0.00) 0.003 0.110
27. Are friendly and courteous. 1.41 (0.87) 1.10 (0.44) 0.055 1.07 (0.26) 1.14 (0.36) 0.495 0.047
Since I came to the nursing home:
28. I have been satisfied with the food service. 2.06 (1.12) 1.24 (0.44) <0.001 1.61 (0.92) 1.36 (0.73) 0.183 0.014
Domain Total 1.90 (0.60) 1.62 (0.40) 0.014 1.63 (0.42) 1.55 (0.39) 0.480 0.143

Keypoints

Crogan, N.L., Dupler, A.E., Short, R. & Heaton, G. (2013). Food Choice Can Improve Resident Meal Service Satisfaction and Nutritional Status. Journal of Gerontological Nursing, 39(5), 38–45.

  1. Consuming adequate amounts of food is important for older adults living in nursing homes (NHs).

  2. Use of nutritional interventions such as the multidimensional Eat Right system encourages resident decision making and facilitates overall satisfaction with care and improved health.

  3. Empirically tested interventions such as Eat Right are needed to help NHs provide care that is both person centered and resident focused.

10.3928/00989134-20130313-02

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