Meal rounds: an essential aspect of quality nutrition services in long-term care.

INTRODUCTION AND RATIONALE: Weight change and, specifically, weight loss are common in residents of long-term care facilities (LTCFs). The occurrence of weight change results from multifactorial processes, some of which can be considered nutrition risk factors. Meal rounds can be a continuous quality improvement activity to readily identify nutrition risk factors that can influence weight change. METHODS: This brief report will describe the activity of meal rounds and how they can be used to improve nutrition services. Baseline data from a previously published study on 37 residents will provide proportions of nutrition risk factors identified during meal rounds that can influence weight change. OUTCOMES: Feeding and eating difficulties are prevalent in residents with dementia (eg, agitation 29.7%, resisting assistance 21.6%). Early identification of these difficulties using meal rounds may be a means of preventing weight change and promoting quality nutrition care in LTCFs. The proposed intervention of meal rounds conducted as described can improve the quality of nutrition services in LTCFs.

Mealtimes as active processes in long-term care facilities.

Mealtimes are central to the nutritional care of residents in long-term care facilities. There has been little Canadian research to guide interdisciplinary practice around mealtimes. This study included a grounded theory approach to explore mealtime experiences of 20 people with dementia living in two long-term care facilities, and the meal-related care they received from registered nurses, health care aides, and dietitians. Theoretical sampling directed the collection and analysis of data from mealtime observations in special care units and key informant interviews with care providers. The constant comparison method was used to analyze and conceptualize the data. A substantive theory emerged with three key themes: 1. Each mealtime is a unique process embedded within a long-term care facility's environment. 2. Residents are central to the process through their actions (i.e., arriving, eating, waiting, socializing, leaving, and miscellaneous distracted activities). 3. Internal (i.e., residents' characteristics) and external (i.e., co-resident, direct caregiving, indirect caregiving, administrative, and government activities) influences affect residents' actions at mealtimes. The theory suggests that optimal mealtime experiences for residents require individualized care that reflects interdisciplinary, multi-level interventions.