Assessment of food service delivery to elderly residents in long term care facilities

The purpose of this study was to assess food service delivery provided to elderly long term care (LTC) residents. The sample was drawn from the 18 LTC facilities located in Saskatoon District Health, Saskatoon, Saskatchewan. The study was conducted in four phases: 1) Menu Analysis; 2) Resident Food Service Satisfaction; 3) Food Service Practices; and 4) Dietary Intakes of the Elderly. The study methodology included a 7-day nutrient analysis of cycle menus of 11 LTC facilities, a food service satisfaction survey (n=205 elderly residents), a LTC survey examining menu planning practices (n=11 LTC facilities), and a 3-day dietary intake analysis (n=48 elderly residents) using weighed and observation dietary assessment methods. LTC facility menus did not meet the recommended levels

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

Background: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro-and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. Methods: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. Discussion: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.Canadian Institutes of Health Research (CIHR) , The PI is an endowed research chair with the Schlegel-University of Waterloo Research Institute for Aging; half of her salary is provided by this non-profit organizatio

Navigating Mealtimes to Meet Public Health Mandates in Long-Term Care During COVID-19: Staff Perspectives

Context: Mealtimes in long-term care (LTC) settings play a pivotal role in the daily lives of residents. The COVID-19 pandemic and the required precautionary infection control mandates influenced many aspects of resident care within LTC homes, including mealtimes. Limited research has been conducted on how mealtimes in LTC were affected during the pandemic from staff perspectives. Objective: To understand the experiences of LTC staff on providing mealtimes during the pandemic. Methods: Semi-structured telephone interviews were conducted with 22 staff involved with mealtimes between February and April 2021. Transcripts were analysed using interpretive description. Findings: Three themes emerged from the analysis: (1) recognizing the influence of homes’ contextual factors. Home size, availability of resources, staffing levels and resident care needs influenced mealtime practices during the pandemic; (2) perceiving a compromised mealtime experience for residents and staff. Staff were frustrated and described residents as being dissatisfied with mealtime and pandemic-initiated practices as they were task-focused and socially isolating and (3) prioritizing mealtimes while trying to stay afloat. An ‘all hands-on deck’ approach, maintaining connections and being adaptive were strategies identified to mitigate the negative impact of the mandates on mealtimes during the pandemic. Limitations: Perspectives were primarily from nutrition and food service personnel. Implications: Overly restrictive public health measures resulted in mealtime practices that prioritized tasks and safety over residents’ quality of life. Learning from this pandemic experience, homes can protect the relational mealtime experience for residents by fostering teamwork, open and frequent communication and being flexible and adaptive

Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.jamda.2017.05.003 © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake. Multisite cross-sectional study. Thirty-two nursing homes from 4 provinces in Canada. From a sample of 639 residents (20 randomly selected per home), 628 with complete data were included in analyses. Three days of weighed food intake (main plate, estimated beverages and side dishes, snacks) were completed to measure energy and protein intake. Health records were reviewed for diagnoses, medications, and diet prescription. Mini-Nutritional Assessment-SF was used to determine nutritional risk. Oral health and dysphagia risk were assessed with standardized protocols. The Edinburgh-Feeding Questionnaire (Ed-FED) was used to identify eating challenges; mealtime interactions with staff were assessed with the Mealtime Relational Care Checklist. Mealtime observations recorded duration of meals and assistance received. Dining environments were assessed for physical features using the Dining Environment Audit Protocol, and the Mealtime Scan was used to record mealtime experience and ambiance. Staff completed the Person Directed Care questionnaire, and managers completed a survey describing features of the home and food services. Hierarchical multivariate regression determined predictors of energy and protein intake adjusted for other covariates. Average age of participants was 86.3 ± 7.8 years and 69% were female. Median energy intake was 1571.9 ± 411.93 kcal and protein 58.4 ± 18.02 g/d. There was a significant interaction between being prescribed a pureed/liquidized diet and eating challenges for energy intake. Age, number of eating challenges, pureed/liquidized diet, and sometimes requiring eating assistance were negatively associated with energy and protein intake. Being male, a higher Mini-Nutritional Assessment–Short Form score, often requiring eating assistance, and being on a dementia care unit were positively associated with energy and protein intake. Energy intake alone was negatively associated with homelikeness scores but positively associated with person-centered care practices, whereas protein intake was positively associated with more dietitian time. This is the first study to consider resident, unit, staff, and home variables that are associated with food intake. Findings indicate that interventions focused on pureed food, restorative dining, eating assistance, and person-centered care practices may support improved food intake and should be the target for further research.Canadian Institutes for Health Research || 201403MOP-326892-NUT-CENA-2546

Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future

Purpose Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future. Design Meta-analysis of prevalence data. Participants A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe. Methods AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV). Main Outcome Measures Prevalence of early and late AMD, BCVA, and number of AMD cases. Results Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95%

Diagram safari:a visualization literacy game for young children

Data literacy has become a critical skill to deal with the complexities of the information-driven society of the 21st century. At the same time, data visualization has long escaped the boundaries of science and has become a pervasive - often unrecognized - part of our everyday lives. In this paper, we introduce Diagram Safari, an educational game to foster data literacy among children 9 to 11 years old by teaching about diagrams and charts in a playful manner. We report on the iterative design process and on a preliminary evaluation with 23 children showing that the game was well received and that the difficulty was appropriate for the target audience

Diagram safari: a visualization literacy game for young children

Data literacy has become a critical skill to deal with the complexities of the information-driven society of the 21st century. At the same time, data visualization has long escaped the boundaries of science and has become a pervasive - often unrecognized - part of our everyday lives. In this paper, we introduce Diagram Safari, an educational game to foster data literacy among children 9 to 11 years old by teaching about diagrams and charts in a playful manner. We report on the iterative design process and on a preliminary evaluation with 23 children showing that the game was well received and that the difficulty was appropriate for the target audience

Construct validity of the Dining Environment Audit Protocol: a secondary data analysis of the Making Most of Mealtimes (M3) study

Abstract Background Research has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC). However, a lack of a standardized measurement to assess physical dining environments has resulted in inconsistent research with potentially invalid and unreliable conclusions. The development of a standardized, construct valid instrument that assesses dining rooms is imperative to systematically examine physical environments in LTC. The purpose of this study was to determine the construct validity of the new Dining Environment Audit Protocol (DEAP) tool. Methods Secondary data collected from the Making Most of Mealtimes (M3) study was used for this analysis. Data were collected in 32 long term care homes, which included 82 dining rooms and 639 residents. A variety of resident and dining room level constructs were compared to the summative scales found on the DEAP using Spearman correlations and Student t-tests. A regression analysis identified individual characteristics assessed with DEAP that were associated with the summative scales of homelikeness and functionality. Results Regression analysis (p < 0.05) identified that the DEAP homelikeness scale was positively associated with a view of the garden/green space, presence of a clock and a posted menu. The functionality scale was positively associated with number of chairs and lighting, while negatively associated with furniture with rounded edges and clutter. Additionally, the functionality scale was positively associated (p < 0.05) with the Mealtime Scan physical scale (ρ = 0.52), the dining room Mealtime-Relational Care Checklist (M-RCC) (ρ = 0.25), the DEAP total score (ρ = 0.56), and the Mini Nutritional Assessment- Short Form (ρ = 0.26). Homelikeness was positively associated (p < 0.05) with the DEAP total score (ρ = 0.53), staff Person Directed Care score (ρ = 0.49) and the resident Cognitive Performance Scale (t = 2.56), while negatively associated with energy (ρ = −0.26) and protein intake (ρ = −0.24). The homelikeness and functionality scales were also associated with one another (ρ = 0.26). Conclusion The construct validity of the DEAP was supported through significant correlations with a variety of measures that are theoretically related to the homelikeness and functionality of LTC dining rooms. This secondary analysis supports the use of the DEAP in future research to quantify the physical environment of LTC dining rooms. Protocol registered with ClinicalTrials.gov ID: NCT02800291; Registered retrospectively June 7, 2016