New roads to commensality in widowhood

The association between loneliness or social isolation and food and eating behaviours: A scoping review

Loneliness or social isolation and food/eating behaviours have important health consequences and there are rationales for why they could interact. Loneliness and dietary behaviours are recognised as health determinants and targets for interventions at individual, group and population levels. However, there are currently no research reviews investigating associations between these areas. This scoping review synthesized evidence investigating loneliness or social isolation and food/eating behaviours in people aged over 16 years in high-income countries. A systematic search of five databases from 2000 was conducted using predetermined search terms. Dissertation database and backwards citation searches were also conducted. Full text screening of 254 articles/theses resulted in inclusion of three qualitative and 26 quantitative studies, with eight conducted in COVID-19 lockdowns. Almost all studies reported a relationship between loneliness/social isolation and eating behaviours usually considered harmful such as low fruit and vegetable intake and lower diet quality. Qualitative research also supports the detrimental influence of loneliness or social isolation on eating. Study quality was considered, and interpretation and comparison of results was complicated by use of varying methods. Better awareness and understanding of the relationship between these complex aspects of health is needed to inform the development of interventions and practice of nutrition and mental health practitioners, policymakers, researchers and end-users.

Perceptions and experiences of eating alone among community-living retired Swedes: Loss, routine and independence

The practice of eating together, commensality, is often considered as something positive in later life, particularly regarding peoples' nutritional status and psychosocial well-being. Eating alone, in contrast, is treated as a risk factor, although literature indicates that it is not necessarily something negative. Still, analyses that specifically target older peoples' varied experiences and notions of eating alone are scarce. This study has explored perceptions and experiences of eating alone among older people in Sweden, a country considered highly individualistic, yet with relatively low levels of loneliness in the older population. Semi-structured interviews were conducted with 20 community-living and retired Swedes, 70-90 years of age. A thematic analysis identified three themes: i) 'Eating alone as a manifestation of loss'; ii) 'Eating alone as an everyday routine'; and iii) 'Eating alone as independence and contentment'. General perceptions of eating alone were often related to the current living situation (e.g., cohabiting or single-living). One key finding was an identified tension between the idea of eating alone as something problematic among those living and eating with a partner and the practical experience of an uncomplicated routine among those living and eating alone. Eating together is discussed as a possible social need for many, but perhaps not for all. Some can feel content with eating alone or even enjoy it. Future studies should approach potential disadvantages of eating alone among older people as an open empirical question that is likely to depend on both the individual and the cultural context.

"It's part of our life now": a qualitative exploration of the social eating experiences of family members of patients living with head and neck cancer

Purpose

Family members (FMs) of patients with head and neck cancer (HNC) report a change in their social eating experience. They miss out on the opportunities and benefits that eating with others provides. However, few studies investigate FM’s social eating experiences, with existing research primarily focusing on the patient experience. Therefore, the aim of this study was to explore the social eating experiences of FMs of patients who have had treatment for HNC.

Methods

A qualitative research design using semi-structured interviews was used to understand FM’s social eating experiences. Key themes were inductively developed from the data using reflexive thematic analysis.

Results

Twelve interviews were conducted with FMs, and three key themes were identified: (1) changes and challenges experienced by FMs due to HNC patients’ social eating difficulties, (2) living with social eating changes is a balancing act, and (3) FMs’ efforts to promote social eating for a patient with HNC. FMs expressed significant changes to their social eating habits within and outside the home, indicating the need for support to meet their own emotional, psychological and social needs.

Conclusion

FMs experience many demands and tensions, having to balance the psychological impact they experience, which are often minimised, whilst attempting to find the best ways to support, protect and encourage their loved ones to adjust and adapt to social eating changes. Therefore, interventions need to support FMs’ challenges and equip them to know how to best support patients living with HNC and themselves.

The Health and Well-being Impacts of Community Shared Meal Programs for Older Populations: A Scoping Review

Background and Objectives

There are social and economic benefits to supporting individuals to live independently for as long as possible. Structured shared meal programs provide opportunities for older individuals to connect in their communities and likely impact their health and well-being. Research in this area has not been summarized in recent years. This scoping review was undertaken to explore the impact shared meal programs may have for older community-dwelling adults.

Research Design and Methods

Nine databases were systematically searched in 2020, and 5,996 unique studies were identified. Two independent reviewers screened titles, abstracts, and full text for inclusion. Reference lists of included papers were hand searched, and the search was updated in 2021. Eighteen studies were included in the final review.

Results

Studies were published between 1980 and 2021 and most were published in the United States. Most studies were cross-sectional, two adopted a qualitative design, one a cohort design. Significant associations were reported between shared meal programs and improved dietary intake; however, minimal improvements were reported for physical health measures. The programs had a positive impact on attendees' social networks and perceived well-being.

Discussion and Implications

Structured shared meal programs show promise in supporting the health and well-being of older adults in the community. They provide additional nutrition, opportunities for social connection, and are perceived to contribute to perceived well-being. More investigation is required to understand how these programs work to facilitate health and well-being, and how they can best be used to improve health outcomes for older populations.

The legacy of marriage: Using food to challenge traditional gender norms in widowhood

Studies on aging tend to apply a traditional approach to gender roles. This is especially evident in studies of widowhood, as responses to this life transition tend to be shaped by gender. Studies on food and widowhood in old age suggest that men and women differ when it comes to food related life after the loss of a spouse. As the traditionalist story goes, men face practical challenges because they lack cooking skills whereas women face emotional challenges because they are no longer the food provider. However, this research often overlooks that married couples may have had non-traditional ways of dividing domestic household tasks, and that this division of labor is likely to have affected the way in which widows and widowers experience and handle food related challenges. Applying a life course perspective to 31 qualitative interviews, I show that the way older men and women adjust to food activities in widowhood is shaped by the way these activities were shared in their marriage rather than by gender per se.

Biological mechanisms underlying widowhood's health consequences: Does diet play a role?

The loss of a spouse is a highly stressful event that puts older adults at increased risk for morbidity and mortality. The risk is highest in the first year to 18 months post-loss; nevertheless, widow(er)s, in general, are at heightened risk of cardiovascular disease (CVD) related morbidity and mortality, and to a lesser extent, non-CVD related morbidity and mortality. The primary goal of this article is to argue for a perspective that considers diet and emotion-induced autonomic, neuroendocrine, and immune dysregulation, in unison, to understand the mechanisms underlying morbidity and mortality in early widowhood. Toward this end, we first summarize our previously published work, as well as work from other investigatory teams, showing that compared with those who were not bereaved, widow(er)s have higher levels of pro-inflammatory cytokine production and more dysregulated autonomic and neuroendocrine activity than non-widow(er)s, independent of health behaviors such as diet. We highlight that a major gap in our current understanding of the biobehavioral mechanisms that underlie the widowhood effect is the role of diet and hypothesize that the adverse health impact of grief and associated negative emotions and diet may be more than additive. Therefore, we propose that diet may be a pathway by which widow(er)s are at higher CVD risk requiring further investigation.

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Losing a spouse is highly stressful event; it increases one’s risk for morbidity and mortality, especially within the first 18 months post-loss.

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Widow(er)s are at risk of cardiovascular disease (CVD)- and non-CVD related morbidity and mortality.

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The role of diet is a major gap in our understanding of the biobehavioral mechanisms that underlie the widowhood effect.

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Diet clearly impacts CVD, and widow(er)s' eating habits are altered for at least the first two years post-loss.

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The adverse health impact of stress and diet may be more than additive; it may be synergistic.

What Is Commensality? A Critical Discussion of an Expanding Research Field

Commensality (the act of eating together) is studied in a range of disciplines and often considered important for social communion, order, health and well-being, while simultaneously being understood as in decline (especially the family meal). However, such claims are also contested in various ways. In this paper, we discuss the expanding field of commensality research and critically reflect on the debates surrounding its social functions, including its role in public health. We illuminate the deep social and cultural significance of commensality, through time and space, and conclude that whether or not commensality is the preferred social form of eating for any given individual, it is difficult to escape its sociocultural desirability and idealization. As a cross-cultural phenomenon in both past, present, and future, we suggest that commensality deserves further research. This includes commensality as a research topic in itself and as an entry point to unveil different dimensions of social relations between people, as well as interactions between humans and material objects.

‘I'm old, but I'm not old-fashioned’: mealtimes and cooking practices among Danish widows and widowers

Existing research on how older adults handle challenges associated with domestic housework, and in particular food work, almost invariably assumes that older adults are traditionalist, and that this affects the way they adjust to widowhood. This assumption is problematic, as decades of research have emphasised increasing gender equality in food work. In this paper, I explore how older adult men and women adjust to food preparation after the loss of a spouse. Interviews with 31 Danish widows and widowers aged between 67 and 86 years old suggest that the men have made culinary progress. However, I also show that the narratives around domestic food work among the older generations remain gendered: both men and women identify widowed men's domestic food work as something meriting acknowledgement, and men and women draw on traditional masculine and feminine ways of approaching domestic food work.

Food Habits of Older Australians Living Alone in the Australian Capital Territory

The link between adequate nutrition and quality of life for older persons is well established. With the proportion of older adults increasing, policy regarding support and care for the ageing has shifted emphasis to keeping older adults in their homes for as long as possible. Risk of malnutrition is an issue of importance for this population and, while this risk is well researched within the hospital setting, it is still relatively under-researched within the community-dwelling elderly, particularly with respect to the lived experience. This qualitative study (underpinned by interpretative phenomenology philosophy) explores how the lived experiences of community-dwelling older people living in one-person households in the Australian Capital Territory (ACT) influences dietary patterns, food choices and perceptions about food availability. Using purposeful and snowballing sampling, older people (65 years and over) living alone in the community participated in focus group discussions triangulated with their family/carers. Data were thematically analysed using a previously established approach. Participants (n = 22) were interviewed in three focus groups. Three themes were identified: active and meaningful community connectedness; eating well and behaviours to promote dietary resilience. Of these, community connectedness was pivotal in driving food patterns and choices and was a central component influencing behaviours to eating well and maintaining dietary resilience.