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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #231077
Title: Experts stress both wellness and amenity aspects of food and nutrition services in assisted living facilities for older adults

Author
item CHAO, SHIRLEY - FRIEDMAN SCHOOL
item DWYER, JOHANNA - FRANCES STERN CTR, TNEMC
item HOUSER, ROBERT - FRIEDMAN SCHOOL
item Jacques, Paul
item TENNSTEDT, SHARON - NEW ENGLAND RESEARCH INST

Submitted to: Journal Of The American Dietetic Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/7/2008
Publication Date: 10/1/2008
Citation: Chao, S.Y., Dwyer, J.T., Houser, R.F., Jacques, P., Tennstedt, S. 2008. Experts stress both wellness and amenity aspects of food and nutrition services in assisted living facilities for older adults. Journal Of The American Dietetic Association. 108:1654-1661.

Interpretive Summary: Assisted living facilities (ALFs) are popular housing alternatives that provide a supportive environment for older Americans who can no longer live independently and who often have low mobility levels. According to the National Center for Assisted Living Facilities, ALF residents needed assistance with 2.3 out of 5 activities of daily living (ADLs) on average, compared to 3.8 ADLs for nursing home residents and 1.6 ADLs among those receiving home health services. Optimal food and nutrition care can help to maintain or improve mobility, delay the onset of frailty, and further promote the quality of life of older Americans. The older adults who reside in ALFs are heterogeneous, and therefore it is not surprising that operators of these facilities differ markedly in their views about optimal care relating to food and nutrition services in these settings. The conceptual components of these views can be grouped into four descriptive food and nutrition service emphases: homestyle, restaurant/hotel, health/medical, and a combination of these three. Each reflects a different perspective toward food and nutrition services in ALFs. Both the “homestyle” with its free choice of food, informality, and independence, and the “restaurant/hotel” style, which features attractively prepared foods, personalized service, and a congenial dining environment, emphasize amenities. In contrast, the health/medical style focused services emphasize menus that are tailored to older adults’ preventive or therapeutic nutritional needs, other health issues and dining safety. To ensure that residents in ALFs are adequately nourished, many external standards have been proposed and some regulations have been mandated. Although many stakeholders agree that ALFs should promote good nutrition as well as residents’ choices, independence, autonomy, and dignity, it is unclear whether such concepts are widespread and are operationalized in planning food and nutrition services for older adults. This is an important matter because ALF meals are often their only source of food intakes. The objective of this study was to assess the degree of consensus among a panel of 135 national experts on food and nutrition services emphases covering six key food and nutrition service areas for ALFs. We also examined the association between the experts’ responses to questions regarding the importance of food choice autonomy of residents, their ability to make wise dietary choices, and the experts’ favored role for ALFs. Sixty-three percent of the experts favored the combination scenario. Significant predictors of emphases including “wellness” considerations were experts’ education as dietitians and experts’ beliefs that ALFs should be health promotion and maintenance facilities. Experts chose food and nutrition service quality indicators that emphasized a focus on both wellness and amenities, and stressed both in their ideal scenarios for overall emphases on optimal food and nutrition services in ALFs.

Technical Abstract: There has been no consensus on best practices in food and nutrition services in assisted living facilities (ALFs) for older adults. We documented experts’ views on optimal food and nutrition services emphases in ALFs, and factors affecting their views. One hundred thirty-five national experts specializing in health, aging, nutrition and ALFs completed a survey consisting of four scenarios (homestyle, restaurant/hotel, health/medical, and a combination of these three) in 6 food and nutrition services areas: dining room environment, meal services, meal quality, nutrition services, employee’s qualifications, and therapeutic nutrition services. Sixty-three percent of the experts favored the combination scenario. Significant predictors of emphases including “wellness” considerations were experts’ education as dietitians and experts’ beliefs that ALFs should be health promotion and maintenance facilities. Experts’ personal views exerted a powerful influence. Experts chose food and nutrition service quality indicators that emphasized a focus on both wellness and amenities, and stressed both in their ideal scenarios for overall emphases on optimal food and nutrition services in ALFs.