Abstract
Objectives
To develop a content validated set of indicators to evaluate the quality of meals and meal service in residential facilities for elderly. Inadequate food intake is an important risk factor for malnutrition in residential facilities for elderly. Through better meeting the needs and preferences of residents and optimization of meals and meal service, residents’ food intake can improve. No indicators were available which could help to guide strategies to improve the quality of meals and meal service.
Design
The indicator set was developed according to the Indicator Development Manual of the Dutch Institute for Health Care Improvement (CBO). The working group consisted of three nurse researchers and one expert in gastrology and had expertise in elderly care, malnutrition, indicator development, and food quality. A preliminary list of potential indicators was compiled using the literature and the working group’s expertise. Criteria necessary to measure the indicator in practice were developed for each potential indicator. In a double Delphi procedure, the list of potential indicators and respective criteria were analyzed for content validity, using a multidisciplinary expert panel of 11 experts in elderly meal care.
Results
A preliminary list of 20 quality indicators, including 45 criteria, was submitted to the expert panel in a double Delphi procedure. After the second Delphi round, 13 indicators and 25 criteria were accepted as having content validity. The content validity index (CVI) ranged from 0.83 to 1. The indicator set consisted of six structural, four result, and three outcome indicators covering the quality domains food, service and choice, as well as nutritional screening. The criteria measure diverse aspects of meal care which are part of the responsibility of kitchen staff and health care professionals.
Conclusion
The ‘quality of meals and meal service’ set of indicators is a resource to map meal quality in residential facilities for elderly. As soon as feasibility tests in practice are completed, the indicator set can be used to guide meal and meal service quality improvement projects in collaboration with kitchen staff and health care professionals. These improvement projects will help to improve food intake and reduce the risk of malnutrition among elders living in residential facilities.
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References
Jesus P, Desport JC, Massoulard A et al. Nutritional assessment and follow-up of residents with and without dementia in nursing homes in the Limousin region of France: a health network initiative. J Nutr Health Aging 2012;16:504–8.
Papparotto C, Bidoli E, Palese A. Risk factors associated with malnutrition in older adults living in Italian nursing homes: a cross-sectional study. Res Gerontol Nurs, 2013;6:187–97.
Verbrugghe M, Beeckman D, Van Hecke A et al. Malnutrition and associated factors in nursing home residents: a cross-sectional, multi-centre study. Clin Nutr 2013;32:438–43.
Suominen M, Muurinen S, Roautasalo P et al. Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur J Clin Nutr 2005;54:578–83.
Crogan NL, Pasvogel, A. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol Nurs 2003;58A:159–64.
Reed PS, Zimmerman S, Sloane PD, Williams CS, Boustani MB. Characteristics associated with low food and fluid intake in long-term care residents with dementia. Gerontologist 2006;45:74–80.
Paquet C, St.-Arnaud-McKenzie D, Ferland G, Dube L. A blue print-based case study analysis of nutrition services provided in a midterm care facility for the elderly. J Am Diet Assoc 2003;103:363–8.
Allisson SP, Rawlings J, Field J, Bean, N, Stephen AD. Nutrition in the elderly hospital patient-Nottingham studies. J Nutr Health Aging 2000;4:54–7.
Aoyama L, Weintraub N, Reuben DB. Is weight loss in the nursing home a reversible problem? J Am Med Dir Assoc 2006;7:S66–S72.
Morley JE. Malnutrition: a major problem in nursing homes. J Am Med Dir Assoc 2011;12:243–6.
Barnes S, Wasielewska A, Raiswell C, Drummond B. Exploring the mealtime experience in residential care settings for older people: an observational study. Health Soc Care Community 2013;21:442–50.
Merrell J, Philipin S, Warring J, Hobby D. Addressing the nutritional needs of older people in residential care homes. Health Soc Care Community 2012;20:208–15.
Nijs K, de Graaf C, van Staveren WA. Malnutrition and mealtime ambiance in nursing homes. J Am Med Dir Assoc 2009;10:226–9.
Federal Public Service Health, Food Chain and Environment (FOD). Advies aangaande integrale kwaliteit en veiligheid van de ziekenhuiszorg. FOD Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu, Brussel, 2011.
Crogan NL, Dupler AE, Short R, Heaton G. Food choice can improve nursing home resident meal service satisfaction and nutritional status. J Gerontol Nurs 2013;39:38–45.
Palacios-Ceña D, Losa-Iglesias ME, Cachón-Pérez JM et al. Is the mealtime experience in nursing homes understood? A qualitative study. Geriatr Gerontol Int 2013;13:482–9.
Beersen N, Kallewaard M, van Croonenborg J, Everdingen J, Barneveld T. Handleiding indicatorenontwikkeling. Dutch Institute for Health Care Improvement, Den Haag, 2007.
De Koning JS, Kallewaard M, Klazinga NS. Prestatie-indicatoren langs de meetlat–Het AIRE-instrument. Tijdschrift voor Gezondheidswetenschappen 2007;85:261–4.
The AGREE collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care, 2003;12:18–23.
Crogan, NL, Evans B, Velasquez D. Measuring nursing home resident satisfaction with food and food service: initial testing of the FoodEx-LTC. J Gerontol A Biol Sci Med Sci 2004;59:370–7.
Rand Health (S.a.). Assessing care of vulnerable elders (ACOVE). http://www.rand.org/health/projects/acove.html. Accessed 15 July 2014
Center for Medicare & Medicaid Services (S.a.) Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html. Accessed 16 July 2014
Van Eenoo L, Spruytte N, Van Audenhove C. Referentiekader integrale kwaliteit van wonen en zorg in de woonzorgcentra: handleiding kwaliteitsindicatoren over kwaliteit van zorg en veiligheid en over kwaliteit van zorgverleners en zorgorganisatie. Flemish Agency Care and Health, Brussels, 2012.
Health Care Inspectorate (S.a.) Ouderenzorg. http://www.igz.nl/onderwerpen/verpleging-en-langdurige-zorg/ouderenzorg/ Accessed 5 August 2014
Levitt CA, Nair K, Dolovich L, Price D, Hilts L. Refinement of indicators and criteria in a quality tool for assessing quality in primary care in Canada: a Delphi panel study. Fam Pract, 2014. doi: 10.1093/fampra/cmu021
Lynn MR. Determination and quantification of content validity. Nurs Res 1986;35:382–6.
Wollersheim H, Hermens R, Hulscher M et al. Clinical indicators: development and applications. Neth J Med 2007;65:15–22.
Fitch K, Bernstein S, Aguilar M et al. The RAND/UCLA Appropriateness Method User’s Manual, RAND Corporation, Santa Monica, 2001, CA. http://www.rand.org/pubs/monograph_reports/MR1269 Accessed 11 May 2015.
American Dietetic Association (ADA). Unintended weight loss (UWL) in older adults: evidence-based nutrition practice guideline. ADA, Chicago (IL), 2009.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2002;22:415–21.
Mueller C, Compher S, Ellen DM, et al. A.S.P.E.N. clinical guidelines: nutrition screening, assessment and intervention in adults. J Parenter Enteral Nutr 2011;35:16–24.
Simmons SF, Peterson, EN, You C. The accuracy of monthly weight assessments in nursing homes: implications for the identification of weight loss. J Nutr Health Aging 2009;13:284–8.
Kruizenga HM, Van Tulder MW, Seidell JC. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 2005;82:1082–9.
Crogan NL, Evans B, Severtsen B, Shultz JA. Improving nursing home food service: uncovering the meaning of food through residents’ stories. J Gerontol Nurs 2004;30:29–36.
Wright ORL, Capra S, Connelly LB. Foodservice satisfaction domains in geriatrics, rehabilitation and aged care. J Nutr Health Aging, 2010;14 (9), 775–780.
Wright L, Cotter D, Hickson M, Frost G. Comparison of energy and protein intakes of older people consuming a texture modified diet with normal hospital diet. J Hum Nutr Diet, 2005;18:213–9
Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake. Clin Nutr 2010;29:160–9.
Huang CS1, Dutkowski K, Fuller A, Walton K. Evaluation of a pilot volunteer feeding assistance program: influences on the dietary intakes of elderly hospitalized patients and lessons learnt. J Nutr Health Aging 2015;19:206–10.
Simmons S, Keeler E, Zhuo X, Hickey KA, Sato H, Schnelle JF. Prevention of unintentional weight loss in nursing home residents: a controlled trial of feeding assistance. J Am Getriatric Soc 2008;56:1466–73.
Kröger E, Tourigny A, Morin D, et al. Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia. BMC Health Serv Res, 2007. doi:10.1186/1472-6963-7-195
Van Nie NC, Meijers JMM, Schols JMGA et al. Do structural quality indicators of nutritional care influence malnutrition prevalence in Dutch, German, and Austrian nursing homes? Nutrition 2014;30:1384–90.
Donabedian A. The quality of care. How can it be assessed? JAMA, 1988;260:1743–8.
Arvanitakis M, Cappoens P, Doughan L, Van Gossum A. Nutrition in care homes and home care: recommendations–a summary based on the report approved by the Council of Europe. Clin Nutr 2009;28:492–96.
Chao SY, Houser RF, Tennstedt S, Jacques P, Dwyer JT. Food and nutrition care indicators: experts’ views on quality indicators for food and nutrition services in assisted-living facilities for older adults. J Am Diet Assoc 2007;107:1590–8.
Zanandrea V, Barreto de Souto Ph, Cesari M, Vellas B, Rolland Y. Obesity and nursing home: a review and an update. Clin Nutr 2013;32:679–85.
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Van Damme, N., Buijck, B., Van Hecke, A. et al. Development of a quality of meals and meal service set of indicators for residential facilities for elderly. J Nutr Health Aging 20, 471–477 (2016). https://doi.org/10.1007/s12603-015-0627-4
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DOI: https://doi.org/10.1007/s12603-015-0627-4