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Sossen L, Bonham M, Porter J. Can fortified, nutrient-dense and enriched foods and drink-based nutrition interventions increase energy and protein intake in residential aged care residents? A systematic review with meta-analyses. Int J Nurs Stud 2021; 124:104088. [PMID: 34717275 DOI: 10.1016/j.ijnurstu.2021.104088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/26/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Food fortification as part of the food-first approach in nursing homes is a strategy that may increase energy and protein intake. OBJECTIVES This review aimed to determine the effect of nutrition interventions using fortification, nutrient-dense or enriched food and/or drinks on energy and protein intake in residents living in nursing homes, compared to the standard menu with or without oral nutritional support products. The secondary aim was to identify and synthesise outcomes of these interventions on weight change, nutritional status, acceptability, cost-effectiveness, and cost-benefit. METHODS A systematic search of seven databases was undertaken. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesised narratively and through meta-analysis. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research. RESULTS Of 3,098 articles retrieved, 16 were included, 13 in the meta-analysis. There were 891 participants, with the study duration ranging from four to 26 weeks. The groups receiving the fortified diet had a significantly higher energy intake (Hedges' g = 0.69 (CI 0.36-1.03), p < 0.0001) and protein intake (Hedges' g = 0.46 (CI 0.17-0.74), p = 0.003) compared with the groups receiving the standard menu +/- ONS. The meta-analysis revealed I2 values of 77% for energy (p < 0.0001) and 60% for protein (p = 0.003), indicating considerable statistical heterogeneity across included studies. Benefits to weight and nutritional status of residents were recorded in some studies. Where reported, cost-effectiveness and cost-benefit of menu fortification/supplementation were variable. CONCLUSIONS This systematic review with meta-analyses has shown that fortified menus may significantly increase energy and protein intakes compared with standard menus in nursing homes. As such, the findings of this review support further use of fortified diets in this setting. Further research is warranted comparing food fortification to standard menus, with a particular focus on evaluating the effect on weight, nutritional status and cost-effectiveness of the intervention. STUDY REGISTRATION PROSPERO no. CRD42020162796.
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Affiliation(s)
- Lisa Sossen
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia.
| | - Maxine Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia.
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill VIC 3168, Australia; Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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Sorensen J, Fletcher H, Macdonald B, Whittington-Carter L, Nasser R, Gramlich L. Canadian Hospital Food Service Practices to Prevent Malnutrition. CAN J DIET PRACT RES 2021; 82:167-175. [PMID: 34286621 DOI: 10.3148/cjdpr-2021-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The study aimed to determine current practice, barriers, and enablers of foodservices in Canadian hospitals relative to guiding principles for best practice to prevent malnutrition.Methods: Foodservice managers completed a 55-item cross-sectional, online survey (closed- and open-ended questions).Results: Survey responses (n = 286) were from diverse hospitals in all Canadian regions; 56% acute care; 13% had foodservices contracted out; and 60% had a reporting structure combined with clinical nutrition. Predominantly, foodservice systems were 43% in-house versus 41% pre-prepared, 46% cook-serve food production, 64% meals assembled centrally (on-site), and 40% non-selective menus with limited opportunities for patient choice in advance or at meals. The "regular menu" (44%) was most commonly served as 3 meals, no snacks at specific times. Energy and protein-dense menus were available, but not widespread (9%). Daily energy targets ranged from 1200 to 2400 kcal and 32% of respondents viewed protein targets as important. The number of therapeutic diets varied from 2 to 150.Conclusions: Although hospital foodservice practices vary across Canada, the survey results demonstrate gaps in national evidence-based practices and an opportunity to formalize guiding principles. This work highlights the need for standards to improve practice through patient-centered, foodservice practices focused on addressing malnutrition.
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Affiliation(s)
- Janice Sorensen
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, BC
| | - Heather Fletcher
- Patient Food, Patient Transport and Environmental Services, Unity Health, Toronto, ON
| | - Brenda Macdonald
- Nutrition and Food Services, Nova Scotia Health Authority, Halifax, NS
| | | | - Roseann Nasser
- Department of Nutrition and Food Services, Pasqua Hospital, Saskatchewan Health Authority, Regina, SK
| | - Leah Gramlich
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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Sustainable Food Consumption in Nursing Homes: Less Food Waste with the Right Plate Color? SUSTAINABILITY 2020. [DOI: 10.3390/su12166525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of unsustainable food consumption among vulnerable residents of nursing homes who suffer from dementia is often multifaceted. From an individual perspective, people with dementia who do not finish their meals are likely to encounter serious health issues associated with malnutrition. Moreover, at the institutional level, nursing homes generate tons of nonrecoverable food waste each year, impairing not only their economic position but also the natural and social environment at large. The purpose of this study is to explore the possibility of reducing food waste in Norwegian nursing homes by appraising how large this reduction could be as one replaces traditional dining white porcelain with plates with diverse color combinations. A quasi-experimental method was adopted. The results of the pilot study were extrapolated to the annual amount of food wasted at the national level. The findings indicate that, on average, 26% of food was thrown away when served on white plates compared to only 9% when served on one of the colored plate options tested. Nationally, approximately 992.6 tons of food per year could potentially be saved with only a single change, ultimately ameliorating the unsustainable food consumption problem among residents of nursing homes.
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Mannan M, Chowdhury N, Sarker P, Amir R. Modeling customer satisfaction and revisit intention in Bangladeshi dining restaurants. JOURNAL OF MODELLING IN MANAGEMENT 2019. [DOI: 10.1108/jm2-12-2017-0135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to provide an insight into the crucial antecedents of customer satisfaction and revisit intention in the context of dining restaurants in a holistic approach, taking Bangladesh as a unit of analysis.Design/methodology/approachThe research design was cross-sectional. Data were collected from 30 dining restaurants in Dhaka city, Bangladesh. The proposed model was tested using partial least square structural equation modeling with a sample size of 600 respondents.FindingsThe antecedents of customer satisfaction (i.e. service quality, food quality, atmospherics, other customers and perceived value/price) were found to have significant positive effects on customer satisfaction. Customer satisfaction and restaurant reputation were found to have significant positive effects on revisit intention, while variety seeking tendency was found to have a significant negative effect on revisit intention. Trust was found to partially mediate the customer satisfaction-revisit intention and restaurant reputation-revisit intention relationships.Originality/valueThis study is among the first to provide a holistic approach toward the crucial antecedents of customer satisfaction (i.e. service quality, food quality, atmospherics, other customers and perceived value) and revisit intention (i.e. customer satisfaction, variety seeking tendency, trust and restaurant reputation) in one structural equation model, and investigated their interrelationships in the context of dining restaurants. To the authors’ knowledge, this is the first study that has investigated the mediating role of trust between the customer satisfaction-revisit intention and restaurant reputation-revisit intention relationships in the context of dining restaurants. From a market-specific context, this the first study to investigate and link the examined variables in the context of Bangladeshi dining restaurants.
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Törmä J, Winblad U, Saletti A, Cederholm T. The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial. Scand J Caring Sci 2017; 32:622-633. [PMID: 28851121 DOI: 10.1111/scs.12487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 04/26/2017] [Indexed: 01/15/2023]
Abstract
RATIONALE Suboptimal nutritional practices in elderly care settings may be resolved by an efficient introduction of nutritional guidelines. AIMS To compare two different implementation strategies, external facilitation (EF) and educational outreach visits (EOVs), when introducing nutritional guidelines in nursing homes (NHs), and study the impact on staff performance. METHODOLOGICAL DESIGN A quasi-experimental study with baseline and follow-up measurements. OUTCOME MEASURES The primary outcome was staff performance as a function of mealtime ambience and food service routines. INTERVENTIONS/RESEARCH METHODS The EF strategy was a 1-year, multifaceted intervention that included support, guidance, practice audit and feedback in two NH units. The EOV strategy comprised one-three-hour lecture about nutritional guidelines in two other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Mealtime ambience was evaluated by 47 observations using a structured mealtime instrument. Food service routines were evaluated by 109 food records performed by the staff. RESULTS Mealtime ambience was more strongly improved in the EF group than in the EOV group after the implementation. Factors improved were laying a table (p = 0.03), offering a choice of beverage (p = 0.02), the serving of the meal (p = 0.02), interactions between staff and residents (p = 0.02) and less noise from the kitchen (p = 0.01). Food service routines remained unchanged in both groups. CONCLUSIONS An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy.
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Affiliation(s)
- Johanna Törmä
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Clinical Nutrition and Metabolism, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Health Services Research, Uppsala, Sweden.,School of Public Health, Brown University, Providence, RI, USA
| | - Anja Saletti
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Clinical Nutrition and Metabolism, Uppsala, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Clinical Nutrition and Metabolism, Uppsala, Sweden
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Bannerman E, Cantwell L, Gaff L, Conroy A, Davidson I, Jones J. Dietary intakes in geriatric orthopaedic rehabilitation patients: Need to look at food consumption not just provision. Clin Nutr 2016; 35:892-9. [DOI: 10.1016/j.clnu.2015.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/18/2015] [Accepted: 06/10/2015] [Indexed: 01/03/2023]
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Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, Davidson B, Duerksen D, Jeejeebhoy K, Payette H. Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force. J Hum Nutr Diet 2015; 28:546-57. [DOI: 10.1111/jhn.12314] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H. Keller
- Schlegel-UW Research Institute for Aging; University of Waterloo; Waterloo ON Canada
| | - J. Allard
- Department of Medicine; University Hospital Network; University of Toronto; Toronto ON Canada
| | | | - M. Laporte
- Réseau de Santé Vitalité Health Network; Cambellton NB Canada
| | - L. Gramlich
- Department of Medicine; University of Alberta; Alberta Health Services; Edmonton AB Canada
| | - P. Bernier
- Jewish General Hospital; Montréal QC Canada
| | - B. Davidson
- Canadian Malnutrition Task Force; Canadian Nutrition Society; Toronto ON Canada
| | - D. Duerksen
- Department of Medicine St-Boniface Hospital; University of Manitoba; Winnipeg MB Canada
| | - K. Jeejeebhoy
- Department of Medicine St-Michael Hospital; University of Toronto; Toronto ON Canada
| | - H. Payette
- Centre de recherche sur le vieillissement; CSSS-IUGS; Faculté de Médecine et des Sciences de la Santé; Université de Sherbrooke; Sherbrooke QC Canada
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Adler-Nissen J, Akkerman R, Frosch S, Grunow M, Løje H, Risum J, Wang Y, Ørnholt-Johansson G. Improving the supply chain and food quality of professionally prepared meals. Trends Food Sci Technol 2013. [DOI: 10.1016/j.tifs.2012.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Leslie WS, Woodward M, Lean MEJ, Theobald H, Watson L, Hankey CR. Improving the dietary intake of under nourished older people in residential care homes using an energy-enriching food approach: a cluster randomised controlled study. J Hum Nutr Diet 2012; 26:387-94. [DOI: 10.1111/jhn.12020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- W. S. Leslie
- Life-course; Nutrition and Health; Centre for Population Health; University of Glasgow; Glasgow UK
| | - M. Woodward
- Epidemiology and Biostatistics; The George Institute for Global Health; The University of Sydney; Sydney Australia
| | - M. E. J. Lean
- Life-course; Nutrition and Health; Centre for Population Health; University of Glasgow; Glasgow UK
| | - H. Theobald
- GlaxoSmithKline; Nutritional Healthcare Future Group; GlaxoSmithKline; Brentford UK
| | - L. Watson
- Life-course; Nutrition and Health; Centre for Population Health; University of Glasgow; Glasgow UK
| | - C. R. Hankey
- Life-course; Nutrition and Health; Centre for Population Health; University of Glasgow; Glasgow UK
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Diez-Garcia RW, Padilha M, Sanches M. [Hospital food: proposals for qualification of the Food and Nutrition Service, evaluated by the scientific community]. CIENCIA & SAUDE COLETIVA 2012; 17:473-80. [PMID: 22267041 DOI: 10.1590/s1413-81232012000200020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 08/26/2010] [Indexed: 04/10/2023] Open
Abstract
The scope of this paper is to validate proposals used to qualify hospital food by the Brazilian scientific community. An electronic questionnaire was applied to clinical nutrition professionals registered on the Lattes Platform (Brazilian database of institutions and researchers' curricula in the areas of Science and Technology). The questionnaire incorporated a Likert scale and had spaces for comments. The themes dealt with patient participation, the nutritional and sensory quality of hospital diets, and planning and goals of the Hospital Food and Nutrition Service (HFNS). The questionnaire also asked for the top five priorities for a HFNS. Proposals with total or partial adherence equal to or greater than 70% were considered to be approved. All proposals had total adherence equal to or greater than 70%. The proposal that had minimal adherence (70%) was the one that proposed that nutritional intervention must be arranged by mutual agreement with the patient. The proposal that had maximal adherence (93%) was the one advocating that there must be statistical control on diets prescribed by the HFNS. The most cited priorities referred to infrastructure and training of human resources (40%), the quality of hospital food (27%) and the nutritional status of the patient.
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Affiliation(s)
- Rosa Wanda Diez-Garcia
- PrátiCA - Laboratório de Práticas e Comportamento Alimentares, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP.
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Abstract
PURPOSE OF REVIEW To highlight the losses in muscle mass, strength, power, and functional capacity incurred in older adults during bed rest-mediated inactivity and to provide practical recommendations for both the prevention and rehabilitation of these losses. RECENT FINDINGS In addition to sarcopenic muscle loss, older adults lose lean tissue more rapidly than the young during prolonged periods of physical inactivity. Amino acid or protein supplementation has the potential to maintain muscle protein synthesis and may reduce inactivity-induced muscle loss, but should ideally be part of an integrated countermeasure regimen consisting of nutrition, exercise, and, when appropriate, pharmacologic interventions. SUMMARY In accordance with recent mechanistic advances, we recommend an applied, broad-based two-phase approach to limit inactivity-mediated losses of muscle mass and function in older adults: (i) Lifestyle: consume a moderate amount (25-30 g) of high-quality protein with each meal and incorporate habitual exercise in close temporal proximity to protein-containing meals; (ii) Crises: react aggressively to combat the accelerated loss of muscle mass and function during acute catabolic crises and periods of reduced physical activity. As a base strategy, this should include nutritional support such as targeted protein or amino acid supplementation and integrated physical therapy.
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Affiliation(s)
- Kirk L English
- Department of Physical Therapy, Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, Texas 77555-1144, USA
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Kuosma K, Hjerrild J, Pedersen PU, Hundrup YA. Assessment of the nutritional status among residents in a Danish nursing home - health effects of a formulated food and meal policy. J Clin Nurs 2008; 17:2288-93. [DOI: 10.1111/j.1365-2702.2007.02203.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lassen KO, Grinderslev E, Nyholm R. Effect of changed organisation of nutritional care of Danish medical inpatients. BMC Health Serv Res 2008; 8:168. [PMID: 18687120 PMCID: PMC2531106 DOI: 10.1186/1472-6963-8-168] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Accepted: 08/07/2008] [Indexed: 11/24/2022] Open
Abstract
Background Many patients are undernourished during hospitalisation. The clinical consequences of this include lassitude, an increased risk of complications and prolonged convalescence. The aim of the study is 1) to implement a new organisation with a focus on improving the quality of the nutritional care of medical inpatients at risk of undernutrition, and 2) to investigate the effect of the intervention. Methods Social and healthcare assistants are educated to the higher level of nutritional and healthcare assistants to provide nutritional care in daily practice to undernourished medical inpatients. The effect of the intervention is investigated before and five months after the employment of the nutritional and healthcare assistants. Data are obtained from structured interviews with patients and staff, and the amount of ordered and wasted food is recorded. Results Patients regard the work of the nutritional and healthcare assistant as very important for their recovery and weight gain: the assistant takes care of the individual patient's nutritional requirements and wishes, and she imparts knowledge to the patient about optimum nutrition. Staff members benefit from the knowledge and dedication of the nutritional and healthcare assistant and from her work; the staff is often too busy with other nursing tasks to make it a priority to ensure that patients who are nibblers get sufficient nutrition. The choices of food from the production kitchen are utilised to a higher degree, and more of the food is eaten by the patients. Before the intervention, a 20% increase in ordered food in relation to the food budget is found. During the intervention a 20% decrease in ordered food in relation to the food budget is found, and food wastage decreases from 55% to 18% owing to the intervention. Conclusion The job function of the nutritional and healthcare assistants on the medical wards is of great value to patients, nursing staff members and the production kitchen. The quality of the nutritional care of undernourished patients increases significantly, and a considerable optimisation of resources in the production and ordering of food takes place. Hospitals can benefit from implementation of the present organisational model if they focus on improving the quality of the nutritional care of weak and elderly inpatients and on optimisating the use of resources.
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Affiliation(s)
- Karin O Lassen
- Department of Development and Training, Copenhagen Hospital Co-operation, Bispebjerg Hospital, Copenhagen, Denmark.
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Leydon N, Dahl W. Improving the nutritional status of elderly residents of long-term care homes. J Health Serv Res Policy 2008; 13 Suppl 1:25-9. [PMID: 18325165 DOI: 10.1258/jhsrp.2007.007017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION High rates of malnutrition exist in long-term care residents in Canada. Residents may be admitted in a malnourished state or may become malnourished while in care. Nutritional decline of residents may be due to medical conditions but may also result from the failure to provide for the unique nutritional needs of this population, through an inadequate menu, inadequate swallowing and functional assessments, and lack of assistance with dining. ASSESSMENT OF PROBLEM A project for the implementation of regional food services policies and practices was deployed with the ultimate goals to reduce nutritional risk and enhance the quality of life of the individuals residing in the 29 long-term care homes in the Saskatoon Health Region. The objectives were: to ensure that food and nutrition staff were competent; to provide adequate nutrition to residents; and to ensure nutrition screening, assessment and appropriate intervention, as approved by the resident or their relatives, was provided. Implementation consisted of: extensive communication of the problem; the development of draft Saskatchewan Food Services policies; planning regional goals, tasks, accountabilities and indicators; delivering meal assistance training to staff; and establishing a Regional Menu Advisory Committee. RESULTS Outcomes have been clearly articulated and methods to collect data clearly defined. Interventions in progress include: the development of key relationships among the health region's long-term care staff, managers and directors; communicating a clear understanding of resident-directed care; determining the baseline knowledge of food service staff; and assembling a project tool kit for implementing food and nutrition policies at each home. STRATEGIES FOR QUALITY IMPROVEMENT: Although the expectation was that food services policy implementation would be presented to all homes simultaneously, a more intensive pilot schedule has focussed on early-adopter sites. The three-year implementation plan is designed for sustainability. LESSONS AND MESSAGES Malnutrition is multifactorial and a concerted effort of all caregivers and service providers is important to address root causes.
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Affiliation(s)
- Noella Leydon
- Director of Food and Nutrition Services, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
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