Absence of Nutritional or Clinical Consequences of Decentralized Bulk Food Portioning in Elderly Nursing Home Residents with Dementia in Montreal

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Abstract

Objectives To evaluate the nutritional and clinical consequences of changing from a centralized food delivery system to decentralized bulk food portioning; a system in which meal portioning occurs on residents’ floors of a nursing home.

Design A pilot study with a pre-post design

Subjects/setting The study took place on one floor of a home for elderly persons with dementia. Of the 34 residents, 22 (1 man) participated in this study. Average age was 82 years (range=55 to 94 years). Nutritional status was verified before introduction of the bulk food portioning system by 3 nonconsecutive days of observed food intakes, anthropometric measurements (height, weight, triceps skinfold thickness, mid-upper-arm circumference), and biochemical parameters (albumin, lymphocytes, glucose, sodium, potassium, transferrin, vitamin B-12, Mate, hemoglobin).Trained dietitians collected the dietary and anthropometric data and validated the food intake estimates and anthropometric measurements. Data were also collected 10 weeks after implementation of the new food distribution system.

Statistical analyses performed Paired t tests adjusted by a Bonferroni correction assessed differences between values measured before and after introduction of the new food distribution system.

Results Average food consumption increased substantially and significantly after introduction of the bulk food portioning system. Mean energy intakes rose from 1,555 to 1,924 kcal/day and most other nutrients also increased, many significantly, but there were no changes in anthropometric values or biochemical parameters, except for albumin level which decreased to the lower normal limit.

Applications Portioning of food in the residents’ dining room simulates a homelike atmosphere thereby encouraging increased food consumption. With well-trained and enthusiastic staff, this system could contribute to improved nutritional status in the very elderly, even those who have dementia. Dietitians have a key role to play in overseeing residents’ nutritional needs and in training, supervising, and motivating foodservice personnel. J Am DietAssoc. 2000;100:1354-1360.

Section snippets

Study Setting and Sample

The study took place in a 125-bed public nursing home attached to a university-affiliated geriatric hospital in Montreal. Average age of residents was 82 years, and 70% were cognitively impaired, most due to AD. All 34 residents living on one floor of the nursing home were invited to participate in the study. A nurse known to the residents and their families was responsible for recruitment and obtained informed consent from the residents’ families or other legal representative or from the

Results

Of the 34 residents on the study floor, 25 (or their legal representative) agreed to participate (74%). After the preintroduction data collection period, 2 residents were withdrawn because of illness and 1 person died; the final sample consisted of 22 persons (65% of the total population on the study floor). Participant characteristics are presented in Table 1. Data for the sole man are presented with those of the 21 women. Mean age was 82 years and more than 80% were older than 75 years

Discussion

To assess the impact of introducing a decentralized bulk food distribution system on indicators of nutritional status, anthropometric measurements were taken and biochemical analyses were conducted at 2 data collection periods in 22 elderly nursing home residents with dementia. Validated food consumption data were also obtained at both times, and nutrient values were calculated. Residents’ energy and nutrient intakes increased substantially, whereas, on average, anthropometric and clinical

Applications/Conclusions

A decentralized food portioning system in a nursing home led to greater food consumption by residents, but it had no impact on the nutritional status parameters evaluated.

■ Serving food from the bulk food cart in the dining room can offer elderly residents with dementia positive stimulation arising from the organoleptic properties of the foods themselves, such as enticing odor, or from being served foods at the appropriate temperature. The activity surrounding preparation of residents’ plates,

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