Mealtimes in Nursing Homes: Striving for Person-Centered Care

Abstract

Malnutrition is a common and serious problem in nursing homes. Dietary strategies need to be augmented by person-centered mealtime care practices to address this complex issue. This review will focus on literature from the past two decades on mealtime experiences and feeding assistance in nursing homes. The purpose is to examine how mealtime care practices can be made more person-centered. It will first look at several issues that appear to underlie quality of care at mealtimes. Then four themes or elements related to person-centered care principles that emerge within the mealtime literature will be considered: providing choices and preferences, supporting independence, showing respect, and promoting social interactions. A few examples of multifaceted mealtime interventions that illustrate person-centered approaches will be described. Finally, ways to support nursing home staff to provide person-centered mealtime care will be discussed. Education and training interventions for direct care workers should be developed and evaluated to improve implementation of person-centered mealtime care practices. Appropriate staffing levels and supervision are also needed to support staff, and this may require creative solutions in the face of current constraints in health care.

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

“…Social models of care that recognize and encourage staff-resident relationships and resident-centered care are seen as the preferred approach to promote residents quality of life in LTC [49, 50]. To date, the relational and resident-centeredness of mealtimes has been qualitatively explored [43, 47, 51, 52], but has yet to be quantitatively assessed to determine its association with food intake. The physical environment can also influence eating [41, 53] and ‘homelike’ environments with music, decorations, and table dressings have been shown to improve residents’ food intake [46, 54].…”

Perspectives on Mealtime Management in Residential Aged Care: Insights From a Cross-Disciplinary Investigation

“…Key barriers identified relate to time and funding constraints, restricted scope of service provision, insufficient clarification of service provider roles, poor interprofessional communication, deficits in education and training, and limited policy guidance pertaining to mealtime management. These findings suggest that despite alignment between past research recommendations, aged care policy, and an international health focus on multidisciplinary care, personcentered care and quality of life (7,8,10,11,(13)(14)(15), these premises and philosophies are yet to be effectively translated to daily care.…”

“…Speech-language pathologists explicitly stated that current service provision was inconsistent with profession-specific advancements, clinical guidelines, and research recommendations for best practice (7,8,(10)(11)(12). It was also evident that limitations in education relating to mealtime management raised in past studies remain (11,21,33,34). Participants in this study emphasized the need for interprofessional education to facilitate cross-discipline communication and to clarify service provider roles and responsibilities for mealtime management, again illustrating the negative impact of poor communication and collaboration.…”

“…Although financing, organization, and accreditation differences exist across residential aged care settings in an international context, the importance of mealtimes and the need for individualized management of mealtime difficulties is well recognized and has been emphasized in the literature (5)(6)(7)(8)(9)(10)(11)(12). To align service provision with local and international aging policy, mealtime management must be both multidisciplinary and consistent with a person-centered care approach (13)(14)(15).…”

Making the Most of Mealtimes (M3): Grounding Mealtime Interventions With a Conceptual Model

“…31 This association may be linked to greater individualization of care including food preferences. Use of person-centred strategies such as accommodating individualized needs and preferences during mealtimes has been qualitatively explored 32,33 but has yet to be quantitatively assessed with respect to improved outcomes.…”