The Assessment of Eating Pleasure among Older Adults: Development and Preliminary Validation of the Anticipatory and Consummatory Eating Pleasure (ACEPS).

OBJECTIVE: Maintaining eating pleasure as long as possible is one of the determinants that contributes to and encourages good nutrition in the ageing population. Our study aimed to translate, adapt to the context of food and validate the Temporal Experience of Pleasure Scale (which distinguishes anticipatory and consummatory experiences of pleasure) in a food dependent older French population. DESIGN: Prospective validation study. SETTING: 199 participants dependent for their meals, over 65 years old and living at home. MEASUREMENTS: A pool of 16 self-reported items constituted the initial version of the anticipatory and consummatory eating pleasure scale (ACEPS). Demographic data, nutritional status, appetite and depressive mood were also assessed. RESULTS: The exploratory factorial analysis and also the confirmatory factor analysis highlighted a two-factor model: anticipatory eating pleasure (four items) and consummatory eating pleasure (four items). The ACEPS showed good internal consistency. A higher score on the ACEPS positively correlated with appetite. Consummatory eating pleasure positively correlated with nutritional status and negatively correlated with depressive moods. The oldest-old and also those receiving a meals-on-wheels service had lower scores for anticipatory pleasure (r=-.14, p<.03). CONCLUSION: To our knowledge, the ACEPS is the first comprehensive measure of eating pleasure distinguishing anticipatory and consummatory pleasure. This short measure, easily applicable on older people with vulnerability, allows early identification and intervention preventing malnutrition and decline in health. Specifically, encouraging anticipatory eating pleasure may be a first step to improving food intake among older adults.

Relevance and Feasibility of a Personalized Dietary Intervention in Older People with Meals-On-Wheels: A Randomized Controlled Pilot Trial.

Objective: The present study aimed at assessing the feasibility and the effectiveness of a personalized dietary intervention in a meals-on-wheels service through a randomized controlled pilot trial. Design: Sixty recipients of home-delivered meals (75% of women; 70-97 years old) were recruited and randomly assigned to a control and an experimental group and followed over a period of 4 months. In the experimental group, the nutritional status (Mini-Nutritional Assessment - MNA questionnaire), the food intake and the food preferences were measured for each participant. Based on this screening, participants were provided with dietary guidance and follow-up. Those at risk of malnutrition were proposed enriched home-delivered meals. Enrichment was set up considering food preferences of the participants. Results: Looking at the whole sample at baseline, 80% (n=48/60) were at risk of malnutrition. Furthermore, 55% (n=33/60) ate less than 2/3 of their calorie and/or protein recommended allowances. In the experimental group, the intervention led to an increase of protein intakes and to a lower extent of calorie intake. In the control group, no significant changes were observed. Conclusion: To conclude, this study suggests that providing dietary guidance and adding nutrient-dense food to meals while considering food preferences is feasible and may help older beneficiaries of meals-on-wheels to increase calorie and protein intake and improve their nutritional status. However, there is a need to develop products or recipes to enrich the meals of the elderly more efficiently to achieve the recommended allowance.

Potentially modifiable determinants of malnutrition in older adults: A systematic review.

BACKGROUND & AIMS: Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. METHODS: A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. RESULTS: Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. CONCLUSION: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly ageing population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.