“It could probably help someone else but not me”: A feasibility study of a snack programme offered to meals on wheels clients

Abstract

Objectives

Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia.

Participants

A convenience sample of 12 MOW clients.

Intervention

Participants received snacks five times a week, in addition to their usual MOW order, for four weeks.

Measurements

Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients’ homes were digitally recorded, transcribed verbatim, and themes identified.

Results

Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477)/day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as ‘malnourished’ or ‘at risk of malnutrition’ decreased from 17% to 8%, and 67% to 25%, respectively (P <0.05). Mean body weight increased from 67.1 (±14.3) to 67.8 (±14.8) (P= 0.008), while Body Mass Index (BMI) increased by a mean of 0.78 (±1.16) kg/m2 (P = 0.039). Only half of participants indicated interest in continuing with the program. Reasons included the role of snacks serving as a reminder to eat, as well as their perceived nutritional value. Identified barriers included perceived lack of need for additional food, ability to self-provide such items, and a perceived adequate health status.

Conclusion

Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.

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References

  1. 1.

    Inzitari M, Doets E, Bartali B, Benetou V, Di Bari M, Visser M, et al. Nutrition in the age-related disablement process. J Nutr Health Aging. 2011;15(8):599–604.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Frequency of Malnutrition in Older Adults: A Multinational Perspective Using the Mini Nutritional Assessment. J Am Geriatr Soc 2010;58(9):1734–1738.

    PubMed  Article  Google Scholar 

  3. 3.

    Visvanathan R, Macintosh C, Callary M, Penhall R, Horowitz M, Chapman I. The nutritional status of 250 older Australian recipients of domiciliary care services and its association with outcomes at 12 months. J Am Geriatr Soc. 2003;51(7):1007–1011.

    PubMed  Article  Google Scholar 

  4. 4.

    Rist G, Miles G, Karimi L. The presence of malnutrition in community-living older adults receiving home nursing services. Nutr Diet. 2012;69(1):46–50.

    Article  Google Scholar 

  5. 5.

    Barker LA, Gout BS, Crowe TC. Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514–527.

    PubMed  Article  Google Scholar 

  6. 6.

    Charlton K, Batterham M, Bowden S, Lambert K, Barone L, Mason M. Poor nutritional status of older sub-acute patients predicts clinical outcomes and mortality at 18 months of follow up. Eur J Clin Nutri. In review.

  7. 7.

    Charlton K, Batterham M, Bowden S, Ghosh A, K C, Potter J, et al. A high prevalence of malnutrition in acute geriatric patients predicts adverse clinical outcomes and mortality at 12 months Med J Aust 2012. In review.

    Google Scholar 

  8. 8.

    Roy MA, Payette H. Meals-on-wheels improves energy and nutrient intake in a frail free-living elderly population. J Nutr Health Aging. 2006;10(6):554–560.

    PubMed  CAS  Google Scholar 

  9. 9.

    O’Dwyer C, Corish CA, Timonen V. Nutritional status of Irish older people in receipt of meals-on-wheels and the nutritional content of meals provided. J Hum Nutr Diet. 2009;22(6):521–527.

    PubMed  Article  Google Scholar 

  10. 10.

    Coulston AM, Craig L, Voss AC. Meals-on-wheels applicants are a population at risk for poor nutritional status. J Am Diet Assoc. 1996;96(6):570–573.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Moran MB. Challenges in the meals on wheels program — Research editorial. J Am Diet Assoc. 2004;104(8):1219–1221.

    PubMed  Article  Google Scholar 

  12. 12.

    Charlton KE, Nichols C, Bowden S, Lambert K, Barone L, Mason M, et al. Older rehabilitation patients are at high risk of malnutrition: Evidence from a large Australian database. J Nutr Health Aging. 2010;14(8):622–628.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Fethke CC, Smith IM. The Critical Post-Discharge Period for Older Patients Leaving a Hospital. J Gerontol Soc Work. 1991;16(3–4):93–105.

    Article  Google Scholar 

  14. 14.

    Soini H, Routasalo P, Lauri S. Nutrition in patients receiving home care in Finland - Tackling the multifactorial problem. J Gerontol Nurs. 2006;32(4):12–17.

    PubMed  Google Scholar 

  15. 15.

    Donini LM, Savina C, Cannella C. Eating habits and appetite control in the elderly: The anorexia of aging. Int Psychogeriatr. 2003;15(1):73–87.

    PubMed  Article  Google Scholar 

  16. 16.

    Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev. 1996;54(1):S59–S65.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Walton K, Charlton K, McMahon A, Manning F, Galea S, Stuckey M. Exploring nutritional status, client experienes and dietary intakes. International Congress of Dietetics; 5th–8th September; Sydney 2012.

  18. 18.

    National Health and Medical Research Council.(2006) Nutreient Reference Values for Australia and New Zealand, including Recommended Dietary Intakes. Canberra: Department of Health and Ageing.

    Google Scholar 

  19. 19.

    Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr. 1985;39(Suppl 1):5–41.

    PubMed  Google Scholar 

  20. 20.

    Food Standards Australia New Zealand. (2007) AUSNUT 2007; Australian Food, Supplement & Nutrient Database 2007 for estimation of population nutrient intakes. Canberra: FSANZ.

    Google Scholar 

  21. 21.

    Milne AC, Potter J, Vivanti A, Avenell A. (2009) Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. (2).

    Google Scholar 

  22. 22.

    Beck AM, Ovesen L. Body mass index, weight loss and energy intake of old Danish nursing home residents and home-care clients. Scand J Caring Sci. 2002;16(1):86–90.

    PubMed  Article  Google Scholar 

  23. 23.

    Kretser AJ, Voss T, Kerr WW, Cavadini C, Friedmann J. Effects of two models of nutritional intervention on homebound older adults at nutritional risk. J Am Diet Assoc. 2003;103(3):329–336.

    PubMed  Article  Google Scholar 

  24. 24.

    Galea S, Walton K, Charlton K, McMahon A. What’s on the tray? The Nutritional Status and Eating Behaviours of Meals on Wheels Clients. Nutr Diet 2012. In press.

    Google Scholar 

  25. 25.

    Krassie J. Destination: Good Nutrition. Strathfield, NSW: New South Wales Department of Ageing, Disability and Home Care 2002.

    Google Scholar 

  26. 26.

    Anyanwu UO, Sharkey JR, Jackson RT, Sahyoun NR. Home food environment of older adults transitioning from hospital to home. J Nutr Gerontol Geriatr. 2011;30(2):105–121.

    PubMed  Article  Google Scholar 

  27. 27.

    De Almeida MDV, Graça P, Afonso C, Kearney JM, Gibney MJ. Healthy eating in european elderly: Concepts, barriers and benefits. J Nutr Health Aging. 2001;5(4):217–219.

    PubMed  Google Scholar 

  28. 28.

    Dietitians Association of Australia. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. 2009;66:S1–S34.

    Google Scholar 

  29. 29.

    Phillips MB, Foley AL, Barnard R, Isenring EA, Miller MD. Nutritional screening in community-dwelling older adults: a systematic literature review. Asia Pac J Clin Nutr 2010;19(3):440–449.

    PubMed  Google Scholar 

  30. 30.

    Charlton K. Nutrition screening: Time to address the skeletons in the bedroom closet as well as those in hospitals. Nutr Diet. 2010;67(4):209–212.

    Article  Google Scholar 

  31. 31.

    Flanagan D, Fisher T, Murray M, Visvanathan R, Charlton K, Thesing C, et al. Managing undernutrition in the elderly: Prevention is better than cure. Am Fam Physician. 2012;41(9):695–699.

    Google Scholar 

  32. 32.

    Wilson A, Dennison K. Meals on wheels service: Knowledge and perceptions of health professionals and older adults. Nutr Diet. 2011;68(2):155–160.

    Article  Google Scholar 

  33. 33.

    Zizza CA, Arsiwalla DD, Ellison KJ. Contribution of Snacking to Older Adults’ Vitamin, Carotenoid, and Mineral Intakes. 2010;110(5):768–772.

    CAS  Google Scholar 

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Correspondence to Karen E. Charlton.

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Charlton, K.E., Walton, K., Moon, L. et al. “It could probably help someone else but not me”: A feasibility study of a snack programme offered to meals on wheels clients. J Nutr Health Aging 17, 364–369 (2013). https://doi.org/10.1007/s12603-013-0035-6

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Key words

  • Meals on Wheels
  • snacks
  • energy
  • protein
  • malnutrition
  • qualitative methods