Special Article
Malnutrition and Mealtime Ambiance in Nursing Homes

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Inadequate nutritional intake is the predominant cause of malnutrition in older persons. It is one of the most common and devastating conditions in nursing home residents. It is multifactorial and treatment or nutrition care plans should try to address the main causes. Such plans often include means to stimulate appetite to prevent or treat anorexia. One important stimulus, which can be modulated easily, is the meal ambiance. This article deals with the theory or mechanism behind this meal ambiance stimulus, discusses some study results, and makes practical recommendations.

Section snippets

The Concept of Mealtime Ambiance

To understand the concept of mealtime ambiance, Nijs et al7 selected, in 2001, 16 homes from a nationwide inventory study in The Netherlands conducting a project to improve mealtime ambiance. The common goals of the 16 projects were (1) to promote well-being of the clients, (2) to diminish the institutional character of the nursing home, and (3) to optimize the established care and treatment. Analyses of the projects revealed 3 strategies in improving meal ambiance :

  • 1.

    Restaurant (n = 6). The

Mealtime Ambiance as an External Appetite Stimulus

It is well known that food choice and therefore food intake is influenced by a large number of interrelated factors, which can be divided in internal signals (ie, hunger, thirst, satiety, appetite) and external signals (ie, social environment, economics).8 During the aging process the balance between the internal and the external signals seems to shift from predominantly stimulated by internal to external signals. Roberts et al9, 10 showed that in addition to this shift aging is also associated

Quality of Life, Food, and Meals

Quality of life is defined as the result of combining personal resources, control of the environment, personal values, and actual living conditions.17 Food is an integral part of our well-being and quality of life; it extends beyond simply satisfying hunger and providing nourishment.18 Good food is a sensory and psychological pleasure in its own right. Meals may also add a sense of security and meanings, and particular food habits are influenced by religious cultural, social, and emotional

Studies on Improving Mealtime Ambiance and Effects on Nutritional Status and Quality of Life

Only 4 trials on improving mealtime ambiance were detected, before Nijs et al20 started in 2002 with a larger cluster-randomized trial. The 4 previous trials in frail elderly were inconclusive owing to the small sample sizes, limited study duration, or lack of a control group.21, 22, 23, 24 The trial of Nijs et al20 was conducted among 178 residents, willing and able to answer questionnaires (mean age 77 years) in 5 Dutch nursing homes. Within each home, 2 wards were randomized into an

Discussion

Meals served to residents family style could encourage the feeling of having the meal in “normal” company and therefore these residents feel better and eat more compared with residents having their meals by pre-plating services. Thus, most likely an important factor to explain the observed positive effects of meals served family style is the process of social facilitation; the enhancement of behavior owing to the sheer presence of others: the sounds and sights of others doing the same thing.28

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