Graduate Thesis Or Dissertation
 

Strategies for enhancing food intake of the elderly in long-term care facilities

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  • With increasing numbers ofpeople entering the geriatric years, long-term care facilities need to maximize nutrition services with decreasing malnutrition problem due to poor food intake. This research determines extent ofuse and perceived effectiveness of food intake enhancement strategies in long-term care. Obstacles to implementing strategies and training to teach staff about the use of strategies are also explored. A total of 311 self-administered questionnaires listing seventeen strategies for enhancing food intake among the elderly were mailed out to two target populations of interest in this study: (1) Directors of Nursing Service (DONs) and (2) Consultant Dietitians (CDs) in the pacific region including Oregon, Washington, and California. The most frequently cited strategies used for enhancing food intake were: providing a neat and comfortable dining room from DONs (μ=3.880); offering snacks and adding nutrients to food from RDs (μ=3.614). The most effective strategies for enhancing food intake according to respondents include providing assistance for positioning from DONs (μ=3.185) and providing tube feeding from RDs (μ=3.339) indicating "usually effective". Comparing the results of the frequency of use and the perceived effectiveness, they often use most strategies, but they do not think that those strategies are very effective. The obstacles were dietary labor cost and/or product cost to implementing strategies of: adding additional nutrients to foods; providing small, frequent meals; offering snacks between meals; and providing liquid supplements (51-61 %). Additional nursing labor cost was an obstacle to tube feeding (52 %). CNA training, in-house inservice, verbal or written instruction (50-73 %) were provided to teach staff about feeding strategies including: providing liquid supplements, providing assistance for optimal positioning; and providing praise or positive reinforcement for eating. DONs and RDs in this study have a significant difference in the use of strategies including: providing liquid supplements (p=0.0003); providing specialized utensils (p=0.0004), and using simple verbal prompts to eat (p<0.0001). DONs more frequently use those strategies than RDs do with the exception of tube feeding. The results also revealed statistically significant associations between: 1) providing several meals rather than three large meals and the obstacle of product or supply cost (p=0.0310); 2) providing praise or positive reinforcement for eating and the obstacle of additional nursing labor cost (p=0.0035); 3) providing praise or positive reinforcement for eating and the obstacle of difficulty of implementation or maintenance (p=0.0280). The majority ofDONs and RDs had Skilled Nursing Facility licenses (93%). In addition, volunteers' participation in feeding activities was inactive. RDs acquired skills in feeding enhancement techniques mainly from RD-HCF manuals or newsletters. The majority ofRDs (96.2%) believed that resident behavior problems interfering with eating was an obstacle to adequate food intake among the elderly. Further research should be performed to explore the reasons of the difference in the frequency ofthe use and its perceived effectiveness between DONs and RDs. Also, the cost effectiveness on the input of strategies and its outcome should be performed to surpass the expenses for practicing those strategies.
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