Dietary Intake and Related Factors of Residents of Assisted Living Memory Care

Abstract

Assisted living memory care (ALMC) residents present with specific needs and challenges. Knowledge regarding their nutritional intake and the relationship to cognitive ability, demographics, and dining behaviors is limited. This quality improvement project was conducted to determine the dietary intake of ALMC residents and identify factors related to the adequacy of their dietary intake to inform the development of strategies to enhance their dietary intake. Ingested food and fluids and ingestion behaviors were recorded over a 12-hour (7 AM -7 PM) observation. Related factors examined were obtained from chart review. Food Processor Nutritional Analysis Software was used to determine nutrient intake with the calculation of percent of recommended amounts based on BMI, age, and activity level. Thirty-two residents (75% females; mean age 86.5 years, SD=7.84) of four ALMC units (eight per unit) were subjects of this study. Their Global Deterioration Scores ranged from 3 to 7, with 60% at 5 or greater. Average BMI was 25.47 kg/m2 (range 14.1-40.4 kg/m2). Major dietary components (protein, calories, carbohydrates) were consumed in adequate amounts based on the percent of recommended. The percent of recommended fiber intake was low (mean 61.57%) with saturated fat intake extremely high (mean 243.80%). Micronutrients were below recommended levels except for cholesterol, vitamin C, sodium, and iron. Four subject groups, relative to level (inadequate, moderately inadequate, adequate, exceeds recommended) of nutritional intake, were identified based on hierarchical clustering with all nutrient data. Using protein intake as a representative nutrient variable, regression analysis indicated that 44.1% of the variance was explained by cognitive ability and setting after adjusting for their interaction. A balance of adequate intake while allowing ALMC residents’ choice in food selection is essential. Further research is needed to address dining standards specific to the ALMC population that recognizes cognitive ability, food offerings, and dining behaviors.

Keywords

• Dietary intake
• dietary reference intakes
• assisted living
• dementia

Thanks

The authors are appreciative of the expertise of Felix Rivera-Mariani, Ph.D., Larkin University, Miami Florida, who conducted the statistical analysis for the study. The resident participants who were the focus of this study and the staff who care for these residents are thanked for their invaluable contribution to this study.

References

1. Abdelhamid, A., Bunn, D., Copley, M., Cowap, V., Dickinson, A., Gray, L., . . . Hooper, L. (2016). Effectiveness of interventions to directly support food and drink intake in people with dementia: Systematic review and meta-analysis. BMC Geriatrics, 16, 26.
2. Akner, G., & Flöistrup, H. (2003). Individual assessment of intake of energy, nutrients, and water in 54 elderly multidiseased nursing-home residents. Journal of Nutrition, Health & Aging, 7(1), 1-12.
3. Baglio, M. L., Baxter, S. D., Guinn, C. H., Thompson, W. O., Shaffer, N. M., & Frye, F. H. (2004). Assessment of interobserver reliability in nutrition studies that use direct observation of school meals. Journal of the American Dietetic Association, 104(9), 1385-1392.
4. Bunn, D. K., Abdelhamid, A., Copley, M., Cowap, V., Dickinson, A., Howe, A., . . . Hooper, L. (2016). Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review. BMC Geriatrics, 16, 89.
5. Bunn, D., Hooper, L., & Welch, A. (2018). Dehydration and malnutrition in residential care: Recommendations for strategies for improving practice derived from a scoping review of existing policies and guidelines. Geriatrics, 3(4), 77.
6. CDC Newsroom Releases. Centers for Disease Control and Prevention. (2016). Excess sodium intake remains common in the United States.
7. Cipriani, G., Carlesi, C., Lucetti, C., Danti, S., & Nuti, A. (2016). Eating behaviors and dietary changes in patients with dementia. American Journal of Alzheimer's Disease and Other Dementias, 31(8), 706- 716.
8. Doorduijn, A. S., van de Rest, O., van der Flier, W. M., Visser, M., & de van der Schueren, M. (2019). Energy and protein intake of Alzheimer's Disease patients compared to cognitively normal controls: Systematic review. Journal of the American Medical Directors Association, 20(1), 14-21.

9. Gaspar, P. M. (1988). What determines how much patients drink? Geriatric Nursing (New York, N.Y.), 9(4), 221-224.
10. Gaspar, P. M., Scherb, C. A., & Rivera-Mariani, F. (2019). Hydration status of assisted living memory care residents. Journal of Gerontological Nursing, 45(4), 21- 29.
11. Goes, V. F., Mello-Carpes, P. B., de Oliveira, L. O., Hack, J., Magro, M., & Bonini, J. S. (2014). Evaluation of dysphagia risk, nutritional status, and caloric intake in elderly patients with Alzheimer's. Revista LatinoAmericana de Enfermagem, 22(2), 317-324.
12. Harris-Kojetin, L., Sengupta, M., Park-Lee, E., Valverde, R., Caffrey, C., Rome, V., & Lendon, J. (2016). Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013-2014. Vital & Health Statistics. Series 3, Analytical and Epidemiological Studies, 38, x-105.
13. Keller, H. H., Carrier, N., Slaughter, S. E., Lengyel, C., Steele, C. M., Duizer, L., . . . Villalon, L. (2017). Prevalence and determinants of poor food intake of residents living in long-term care. Journal of the American Medical Directors Association, 18(11), 941- 947.
14. Liu, W., Cheon, J., & Thomas, S. A. (2014). Interventions on mealtime difficulties in older adults with dementia: A systematic review. International Journal of Nursing Studies, 51(1), 14-27.
15. Liu, W., Galik, E., Boltz, M., Nahm, E. S., & Resnick, B. (2015). Optimizing eating performance for older adults with dementia living in long-term care: A systematic review. Worldviews on Evidence-based Nursing, 12(4), 228-235.
16. Murphy, J. L., Holmes, J., & Brooks, C. (2017). Nutrition and dementia care: Developing an evidencebased model for nutritional care in nursing homes. BMC Geriatrics, 17(1), 55.
17. Reed, P. S., Zimmerman, S., Sloane, P. D., Williams, C. S., & Boustani, M. (2005). Characteristics associated with low food and fluid intake in long-term care residents with dementia. The Gerontologist, 45 Spec No 1(1), 74-80.
18. Reisburg, B. (2005). Global deterioration scale. Geriatric toolkit website. http://geriatrictoolkit.missouri.edu/cog/GlobalDeterioration-Scale.pdf
19. Simmons, S. F., Coelho, C. S., Sandler, A., & Schnelle, J. F. (2018). A quality improvement system to manage feeding assistance care in assisted-living. Journal of the American Medical Directors Association, 19(3), 262-269.
20. SQUIRE (2015). Revised standards for quality improvement reporting excellence (Squire 2.0)”.
21. U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA). 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015.
22. Volicer, L. (1987). Progression of Alzheimer-type dementia in institutionalized patients: A cross-sectional study. Journal of Applied Gerontology 6(1), 83-94.
23. Volkert, D., Chourdakis, M., Faxen-Irving, G., Frühwald, T., Landi, F., Suominen, M. H., . . . Schneider, S. M. (2015). ESPEN guidelines on nutrition in dementia. Clinical Nutrition, 34(6), 1052-1073.
24. Volkert, D., Pauly, L., Stehle, P., & Sieber, C. C. (2011). Prevalence of malnutrition in orally and tube-fed elderly nursing home residents in Germany and its relation to health complaints and dietary intake. Gastroenterology Research and Practice, 2011, 247315.
25. Whear, R., Abbott, R., Thompson-Coon, J., Bethel, A., Rogers, M., Hemsley, A., . . . Stein, K. (2014). Effectiveness of mealtime interventions on behavior symptoms of people with dementia living in care homes: A systematic review. Journal of the American Medical Directors Association, 15(3), 185-193.