The effect of a mulit-component intervention on meal enjoyment, body weight and quality of life in older nursing home residents

The number of elderly poeple is rising in The Netherlands. The elderly
population faces various diseases and disabilities, which relates to high costs
for the health care system. Despite the effort put into reducing malnutrition,
still 20% of the Dutch elderly are malnourished and 50% is at risk for
malnutrition. Malnutrition results in numerous negative consequences regarding
to health and wellbeing of the individual, but results again in higher costs
for the health care system. The new finance regulation for the Dutch care
system asks for a new method of working in nusring homes. Due to the importance
of eating properly for health and quality of life, it is important to
investigate how an optimal eating experience for elderly can be achieved and
what the health consequences are of such an improved meal experience.

To investigate whether a multi-component intervention in institutional elderly
- which focuses on the product, the client, the social & physical environment
and the staff - leads to a higher meal enjoyment and a better nutritional
status (reducing undesirable body weight loss), thereby contributing to an
optimal quality of life .

250 elderly living in nursing will participate in a longitudinal intervention
with a duration of 6 months. A parallel design is applied, with 125 elderly in
the intervention group and 125 elderly as the control group.

During the intervention, changes will be implemented at four different levels:
product, environment, client (personal) and staff/ personnel. These changes aim
to optimize meal enjoyment (at a sensory, environmental and psychological
level) to improve nutritional status and quality of life. The pariticpants are
exposed to these changes around the meals for six months. At each level,
different strategies are applied to optimize meal experience. These strategies
form the scientific ground for the intervention; research has shown that these
strategies influence meal experience and food intake (evidence-based):

Product level
- increasing the perception of variety (optimal variety and amounts)
- encouraging sensory stimulation
- applying product marketing
- using good-quality and sustainable/ organic food products


Environmental level
- promoting an attractive physical environment
- promoting an attractive social environment
- promoting meal duration and a relaxed atmosphere during meal times

Client level:
- promoting autonomy & choice
- promoting participation
- applying a client-directed approach, tailored to the individual needs of the
elderly person

Personnel:
Personnel plays an important role at all three abovementioned levels. The
succes of the intervention depends for a large part on the personnel, and the
space and support they receive for implementing the changes. Therefore, we will
train and coach the personnel on meal enjoyment of elderly, with specific
attention for the barriers and facilitators that they experience. Therefor the
training will be focused on: awareness, knowledge, skills, attitude and
enabling factors.

The risks associated with participation can be considered negligible and the
burden can be considered minimal. There are no invasive measurements. The
intervention components that we apply are expected to be beneficial for the
residents, as it supports their feelings of self-determination, participation
and personal choice, their desire for aesthetics and purposeful living in order
to provide them with a pleasant meal experience. By encouraging meal enjoyment,
we strive to optimize the health status of the older and to contribute to their
quality of life.
In addition, normal food products are used that follow the regular
hygienic and food safety criteria that are valid in the nursing homes.
Furthermore, the researchers will not change any medicine prescriptions or use
of diet products; this is not our task; we will only monitor these
prescriptions. Body weight will be measured by the regular staff and the DEMMI
test will be done under supervision of a physiotherapist. So, there is no
additional risk than the normal risks that are present in a nursing home with
older people.
The burden is considered negligible, since we interview the clients
four times over a period of 10 months. By a respectful approach, the interview
may be perceived as a pleasant social activity. In addition, the body weight
measurements do not take much time, and are already part of the normal
procedure; except the intensity may be a bit higher. Also the DEMMI test will
take only 10 minutes at maximum. Also for these two measurements, a respectful
and client-centred approach will assist in minimizing the burden.
This study is group-related, since there is no use in doing the study
without participation of the somatic clients in nursing homes. This group is
very specific in the sense that they are not temporary guests of the nursing
home, but they stay there the rest of their life. We need to include their
experiences and thoughts in order to interpret the results in a valid way and
to use the respectful approach that we aim for in the study.