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Quality indicators of nutritional care practice in elderly care
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.ORCID iD: 0000-0002-5423-4262
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
2017 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 9, p. 1057-1064Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. Design: Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. Measurements: Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents’ age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. Results: Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, foodservice dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and ‘meal councils’. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. Conclusion: Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.

Place, publisher, year, edition, pages
2017. Vol. 21, no 9, p. 1057-1064
Keywords [en]
nutritional care practice, meal satisfaction, nutritional status, older adults, residential care homes
National Category
Nutrition and Dietetics Social Work
Research subject
Food, Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-330114DOI: 10.1007/s12603-017-0970-8ISI: 000414338800017PubMedID: 29083448OAI: oai:DiVA.org:uu-330114DiVA, id: diva2:1144310
Available from: 2017-09-26 Created: 2017-09-26 Last updated: 2018-04-13Bibliographically approved
In thesis
1. Food Service and Nutritional Care in Swedish Elderly Care: The Progress of National Actions and their Local Interpretations
Open this publication in new window or tab >>Food Service and Nutritional Care in Swedish Elderly Care: The Progress of National Actions and their Local Interpretations
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main aim of this thesis is to study local level outcomes regarding food service and nutritional care in Swedish elderly care in relation to the progress of national actions. Study I compared results from a repeated national survey using a questionnaire investigating the general structure and organisation of food service in elderly care. Study II built on data merged from a questionnaire, open comparison survey data and records from the quality registry Senior Alert to investigate nutritional care practice, focusing on quality indicators related to food service. Study III was a web-based questionnaire that described perceived facilitators in the process of adopting a national regulation that aims to prevent and treat malnutrition. Study IV explored associations between the level of adoption of the regulation and registrations in Senior Alert using registry data and results from a questionnaire.

       Differences were found primarily between rural and city municipality groups. The predominant food service organisation was public, but city municipalities reported a higher and increased use of private providers, chilled production and meal choices. The number of clinical/community dietitians had declined significantly between the surveys. Access to this profession was associated with being well-nourished. Food service dietitians and private providers were positively associated with meal satisfaction, while the food production system cook-chill was negatively associated. One year after the launch of the regulation, 50% of municipalities had adopted new routines. The odds for adoption were higher in municipalities where preventive work was already in progress, the regulation was considered helpful, and where facilitators had long experience of working in elderly care. The most important support factors for the adoption of new routines were cooperation between professions and well-defined goals. There was no significant difference in nutritional screening scores associated with adoption rate, but, in general, the number of individuals registered in Senior Alert increased after the entry into force of the regulation.

     In conclusion, this thesis contributes increased knowledge about the different outcomes in local level practices in relation to central actions. The results indicate a strong local autonomy and the importance of local access to sufficient capacity and knowledge.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 153
Keywords
food service, nutritional care, elderly care, national actions, municipality, questionnaire, registry data
National Category
Social Sciences
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-348484 (URN)978-91-513-0337-6 (ISBN)
Public defence
2018-06-08, sal A1:111a, Biomedicinskt centrum, Husargatan 3, (ingång A11), Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2018-05-16 Created: 2018-04-13 Last updated: 2018-10-08

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Skinnars Josefsson, MalinNydahl, MargarethaPersson, IngerMattsson Sydner, Ylva

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