BACKGROUND:Long-term care (LTC) residents are prone to dehydration, which has many serious effects on health. A multicomponent intervention is required to mitigate dehydration in LTC; however, previous research has not explored the experiences of staff who deliver interventions. The purpose of this study was to explore staff perspectives on the feasibility of implementing the environmental components of a novel multicomponent hydration intervention. METHODS:The intervention was enacted over 4 weeks on an urban LTC unit in Ontario, Canada. The components were large drinking glasses (300 mL) and a purpose-built beverage trolley. Observations of workflow by research assistants were conducted throughout the intervention. Personal support staff participated in post-intervention semi-structured interviews, framed using the Behaviour Change Wheel, to determine the perceived factors influencing implementation. Reflexive thematic analysis was used to generate qualitative themes from interview transcripts. RESULTS:Eight staff members participated in post-intervention interviews. Ages ranged from 20 to 49 years, with 1-25 years of experience in LTC. While some minor improvements were suggested, staff were accepting of the environmental strategies and integrated them into the workflow consistently. Four major themes were generated via qualitative analysis and categorised using the Behaviour Change Wheel: (1) optimising efficiency (physical opportunity, reflective motivation), (2) adapting to change (reflective motivation and social opportunity), (3) knowing the resident (reflective motivation, psychological capability) and (4) supporting hydration (physical opportunity, psychological capability, reflective motivation). IMPLICATIONS FOR PRACTICE:The results of this study indicate that LTC staff perceive the environmental components of a novel hydration intervention to be feasible and useful in supporting resident hydration.

Relationship-centred mealtimes can support care home residents, who are at high risk for loneliness. However, care home staff do not consistently promote relationship-centred mealtimes. This secondary analysis examined the impact of factors (selected based on the Theory of Planned Behaviour) upon care home staff interest in making mealtimes more relationship-centred. Data were from a cross-sectional, quantitative survey of 670 care home staff from North America. We used multivariable logistic regression to test hypotheses. The model was statistically significant, and explained 13 per cent of the variance in staff members' interest in making mealtimes more relationship-centred. Respondents who were more satisfied with current mealtime practices, had used collaborative change strategies in the past, and who perceived organizational support for relationship-centred care were more likely to have interest in making mealtimes more relationship-centred. These are modifiable factors to target in interventions designed to promote care home staff interest in making mealtimes more relationship-centred.

Purpose: To assess care home and staff characteristics associated with task-focused (TF) and relationship-centred care (RCC) mealtime practices prior to the COVID-19 pandemic. Methods: Staff working in Canadian and American care homes were invited to complete a 23-item online survey assessing their perceptions of mealtime care, with one item assessing 26 potential care practices from the Mealtime Relational Care Checklist (relationship-centred = 15; task-focused = 11) reported to occur in the home prior to the pandemic. Multivariate linear regression evaluated staff and care home characteristics associated with mealtime practices. Results: Six hundred and eighty-six respondents completed all questions used in this analysis. Mean TF and RCC mealtime practices were 4.89 ± 1.99 and 9.69 ± 2.96, respectively. Staff age was associated with TF and RCC practices with those 40–55 years reporting fewer TF and those 18–39 years reporting fewer RCC practices. Those providing direct care were more likely to report TF practices. Dissatisfaction with mealtimes was associated with more TF and fewer RCC practices. Homes that were not making changes to promote RCC pre-pandemic had more TF and fewer RCC practices. Newer care homes were associated with more RCC, while small homes (≤49 beds) had more TF practices. Conclusions: Mealtime practices are associated with staff and home factors. These factors should be considered in efforts to improve RCC practices in Canadian homes.

BACKGROUND AND OBJECTIVES:Meals in long-term care (LTC) are essential to residents not only for nutrition and their physical well-being but also for their social interactions supporting resident quality of life. This study aims to understand the mealtime experiences of residents and family care partners during the coronavirus 2019 disease (COVID-19) pandemic when restrictions were put in place in LTC and retirement homes. RESEARCH DESIGN AND METHODS:Interpretive description analysis of qualitative interviews in LTC and retirement homes, with 17 family care partners and 4 residents. Convenience and snowball sampling was used to recruit participants for telephone interviews. RESULTS:Three themes were generated. Compromised mealtimes mean compromising community-meals were seen by participants as a key social and community-building event of the home; they reported this loss of community with pandemic restrictions. Participants noted that family care partners are indispensable at meals for social, psychological, and physical support. The dangers of eating alone spoke to the social isolation reported by participants that occurred during the pandemic and the risks they described of eating alone. DISCUSSION AND IMPLICATIONS:This study confirms the importance of mealtimes in LTC and retirement homes to community building and extends our understanding of the importance of family inclusion at meals and why eating alone, as happened during COVID-19, was so detrimental to residents. Effort needs to be made to value this communal activity for the well-being of residents.

Background/Objectives: Inadequate fluid intake is prevalent among older adults living in care settings and can lead to dehydration-related events such as falls and hospitalization. Staff knowledge and confidence using diverse strategies is needed to provide adequate hydration to residents. PROMOTE is a multicomponent intervention designed to support staff to increase resident fluid intake between meals. This study evaluated the educational components of PROMOTE. Methods: Participants (n = 87) working in long-term care or retirement homes completed an online pre-/post-test evaluation of a 7 min educational video. Key informant participants (n = 13) reviewed all educational materials, evaluated their usefulness and feasibility, and were interviewed to identify how to improve the materials. Results: The educational video improved knowledge (e.g., self-rating of knowledge pre-test median 8, standard error of the mean (SEM) 0.18; post-test median 9, SEM 0.13) and confidence. Participants intended to use PROMOTE strategies in their work with residents (1 [very likely] to 10 [very unlikely] median 2.0 SEM 0.27). Key informants rated the hydration of residents as an organizational priority (median 9.0 SEM 0.42) and all indicated that they would use the educational video in their future training. Less feasible educational components as rated by key informants included huddle discussions and email pushes. Posters were seen as feasible (54%) but only somewhat useful (77%). Conclusions: Brief educational videos can improve staff knowledge and confidence regarding providing adequate hydration to residents. Having several educational components that can be used with this video was viewed positively. Recommendations were made to improve the materials.

This study examined factors associated with weight change in 535 residents in 32 long term care homes where 3-month weight records were available. Trained researchers and standardized measures (e.g., nutrition status, food intake, home characteristics) were used to collect data; weight change was defined as ±2.5%. Just over 25% of the sample lost and 21% gained weight. Weight stability was compared to loss or gain. Weight loss was associated with being male, malnourished (MNA-SF or BMI <25), energy and protein intake and oral nutritional supplement use, while weight gain was associated with being female, and a physically (e.g., less noise) and socially supportive dining room. Weight stability was associated with better cognition. A high proportion of residents had a significant weight change in 3 months. Modifiable factors associated with weight stability or gain suggest focusing interventions that promote food intake and improve the mealtime environment.

Mealtimes in long-term care (LTC) can reinforce relationships between staff and residents through relationship-centred care (RCC) practices; however, meals are often task-focused (TF). This cross-sectional study explores multi-level contextual factors that contribute to RCC and TF mealtime practices. Secondary data from residents in 32 Canadian LTC homes were analyzed (n = 634; mean age 86.7 ± 7.8; 31.1% male). Data included resident health record review, standardized mealtime observation tools, and valid questionnaires. A higher average number of RCC (9.6 ± 1.4) than TF (5.6 ± 2.1) practices per meal were observed. Multi-level regression revealed that a significant proportion of variation in the RCC and TF scores was explained at the resident- (intraclass correlation coefficient [ICC]RCC = 0.736; ICCTF = 0.482), dining room- (ICCRCC = 0.210; ICCTF = 0.162), and home- (ICCRCC = 0.054; ICCTF = 0.356) levels. For-profit status and home size modified the associations between functional dependency and practices. Addressing multi-level factors can reinforce RCC practices and reduce TF practices.

Purpose: Hydration is essential for health; however, long-term care (LTC) residents consume less fluid than is recommended, which may contribute to dehydration. Residents who drink thickened liquids likely consume even less than peers. Therefore, the aims of this study were to (a) determine if LTC residents who drink thickened liquids consume less fluid compared to those consuming thin liquids and (b) determine factors associated with fluid intake of residents who drink thickened liquids. Method: Participants who drank thickened liquids ( n = 68) were compared with participants who drank thin liquids ( n = 68). Fluid intake, cognition, diet prescription, and mealtime challenges were compared between groups. A stepwise multiple regression model assessed variables associated with fluid intake of residents who consumed thickened fluids. Results: All participants consumed less than recommended fluid volumes. No statistically significant difference was found in fluid intake between groups; however, the group consuming thickened liquids drank less than those consuming thin liquids. The thickened liquid group was also more likely to eat a modified diet, had higher levels of cognitive impairment, and had more mealtime challenges requiring more assistance. As age increased, thickened liquid intake decreased across study participants. Conclusion: These results highlight the need for interventions in LTC to support fluid intake in this vulnerable population.

Context: Mealtimes in long-term care (LTC) settings play a pivotal role in the daily lives of residents. The COVID-19 pandemic and the required precautionary infection control mandates influenced many aspects of resident care within LTC homes, including mealtimes. Limited research has been conducted on how mealtimes in LTC were affected during the pandemic from staff perspectives. Objective: To understand the experiences of LTC staff on providing mealtimes during the pandemic. Methods: Semi-structured telephone interviews were conducted with 22 staff involved with mealtimes between February and April 2021. Transcripts were analysed using interpretive description. Findings: Three themes emerged from the analysis: (1) recognizing the influence of homes’ contextual factors. Home size, availability of resources, staffing levels and resident care needs influenced mealtime practices during the pandemic; (2) perceiving a compromised mealtime experience for residents and staff. Staff were frustrated and described residents as being dissatisfied with mealtime and pandemic-initiated practices as they were task-focused and socially isolating and (3) prioritizing mealtimes while trying to stay afloat. An ‘all hands-on deck’ approach, maintaining connections and being adaptive were strategies identified to mitigate the negative impact of the mandates on mealtimes during the pandemic. Limitations: Perspectives were primarily from nutrition and food service personnel. Implications: Overly restrictive public health measures resulted in mealtime practices that prioritized tasks and safety over residents’ quality of life. Learning from this pandemic experience, homes can protect the relational mealtime experience for residents by fostering teamwork, open and frequent communication and being flexible and adaptive.

Recruitment to qualitative research is an important methodological consideration. However, the process of recruitment is under-communicated in qualitative research articles and methods textbooks. A robust recruitment plan enhances trustworthiness and overall research success. Although recruitment has recently received increased attention in the qualitative methodology literature, a more nuanced understanding is required. We realized successful recruitment to our focused ethnographic inquiry. Numerous nurse educators, researchers, and administrators volunteered within three months of study initiation. Using Gibbs’ Reflective Cycle, we conducted a critical reflection on the recruitment log and participant interview data to surface factors contributing to our success. This article offers our insights into the facilitators of successful recruitment. Our reflection revealed four themes contributing to successful enrollment: (a) laying the groundwork, (b) recruitment plan, (c) building rapport, and (d) participant motivations. Two new recruitment strategies accounted for over 60% of our sample. Reporting on successful strategies for recruiting participants to qualitative research and specifying participants’ motivations to volunteer, from their perspective, make important contributions to the recruitment literature. Our article offers guidance to qualitative researchers pursuing successful recruitment. Additional research is required to evaluate the relative influence of various recruitment strategies.

BACKGROUND:Gerontological nursing is not a career choice for most new graduates. Nurse educators, who influence students' career decisions, lack expertise in older person care. The academic culture may affect educators developing gerontological expertise.PURPOSE:The study explored the culture of a Canadian pre-licensure nursing education program in relation to educators' expertise in gerontological nursing.METHODS:In a focused ethnography, 22 nurse educators/researchers/administrators participated in interviews and/or observations conducted from March 2018 to December 2018. Content analysis of interview transcripts and fieldnotes occurred concurrently with data collection.RESULTS:Themes characterizing the culture were: Structure and Hierarchy, Losing Gerontology, Teaching Challenges, and Valuing Older Persons and Their Care. Participants felt: a hierarchy limited gerontologists' support for undergraduate educators and the curriculum; the integrated curriculum reduced the focus on gerontology; limited professional development opportunities and excessive workload constrained building gerontology expertise; and valuing older persons and their care influenced access to gerontology resources.CONCLUSIONS:The culture of a pre-licensure nursing program impacted educators building expertise in older person care. More research is needed to overcome barriers that constrain educators' proficiency in gerontological nursing. Increasing the number of educators adept in gerontology will develop nurse graduates with an appreciation for working with older persons.

Objectives Poor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake. Design Qualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed. Setting Residential care. Participants 27 invited researcher and provider experts. Results Challenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals). Conclusions COVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].

Objectives: To determine if (1) number of staff or residents, when considering home-level factors and presence of family/volunteers, are associated with relationship-centered care practices at mealtimes in general and dementia care units in long-term care (LTC); and (2) the association between number of staff and relationship-centered care is moderated by number of residents and family/volunteers, profit status or chain affiliation. Design: Secondary analysis of the Making the Most of Mealtimes (M3) cross-sectional multisite study. Setting and Participants: Thirty-two Canadian LTC homes (Alberta, Manitoba, Ontario, and New Bruns-wick) and 639 residents were recruited. Eighty-two units were included, with 58 being general and 24 being dementia care units. Methods: Trained research coordinators completed the Mealtime Scan (MTS) for LTC at 4 to 6 mealtimes in each unit to determine number of staff, residents, and family or volunteers present. Relationship-centered care was assessed using the Mealtime Relational Care Checklist. The director of care or food services manager completed a home survey describing home sector and chain affiliation. Multivariable analyses were stratified by type of unit. Results: In general care units, the number of residents was negatively (P = .009), and number of staff positively (P < .001) associated with relationship-centered care (F-9,(48) = 5.48, P < .001). For dementia care units, the associations were nonsignificant (F-5,(18) = 2.74, P = .05). The association between staffing and relationship-centered care was not moderated by any variables in either general or dementia care units. Conclusion and Implications: Number of staff in general care units may increase relationship-centered care at mealtimes in LTC. Number of residents or staff did not significantly affect relationship-centered care in dementia care units, suggesting that other factors such as additional training may better explain relationship-centered care in these units. Mandating minimum staffing and additional training at the federal level should be considered to ensure that staff have the capacity to deliver relationship-centered care at mealtimes, which is considered a best practice. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Abstract This study describes changes in dining practices and provider perspectives on meal-related challenges due to the coronavirus disease (COVID-19) pandemic. An online survey was disseminated between July and September 2020 through stakeholder networks and social media with 1,036 respondents. Altered dining practices included residents eating in rooms (54.3%), spacing residents in common areas for meals (69.3%), and disposable dish use (44.9%). The most common mealtime challenges were reduced socializing opportunities at meals (29.3%), inadequate staffing (22.8%), reduced family/volunteer help (16.7%), and assisting residents to eat (10.5%). Many participants (72.2%) felt conflict balancing safety and relationship-centred care. Geographic region, home size, building age, respondent’s job title, pre-pandemic relationship-centred practices, and mealtime satisfaction, and some pandemic-initiated practices were associated with mealtime challenges and feeling conflicted in binary logistic regression analyses. Considering trade-offs between safety and relational aspects of mealtimes during the pandemic is crucial.

BACKGROUND AND PURPOSE:The purpose is to evaluate the construct validity of two generic health measures, the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in residents of long-term care (LTC) facilities, using a convergent/divergent validity approach, with the Functional Independence Measure (FIM), Quality of Life-Alzheimer's Disease (QOL-AD) and Resident Assessment Instrument (RAI) 2.0 as comparators.METHODS:Health status of 130 residents with dementia residing in one of seven LTC facilities was evaluated by their Healthcare Aides who were their primary care assistants. A priori hypotheses on the magnitude and direction of the correlations were formulated by two clinician/researchers and a researcher familiar with the measures and this population. Predicted and observed correlations were compared.RESULTS:Mean overall HUI2 (0.48, SD 0.16) and HUI3 scores (0.31, SD 0.27) were indicative of severe disability. Of the 208 a priori hypotheses, 39.9% (n = 83) matched the observed correlations, 29.8% were underestimated and 19.7% were overestimated by one category.CONCLUSIONS:Findings support the use of the HUI2 and HUI3 in measuring health-related quality of life in dementia-related research to complement disease-specific measures.

Mealtimes in long-term care (LTC) homes provide social engagement and nutritional intake to residents. Psychosocial challenges may detract from the mealtime experience, resulting in low food intake and increased risk of malnutrition. This study explores the independent effects of psychosocial factors on energy intake among LTC residents. Secondary data (Making the Most of Mealtimes [M3]) from residents in 32 Canadian LTC homes were analyzed. Data included 3-day weighed food intake, mealtime care actions taken by staff, loss of appetite, eating challenges, and other resident characteristics. Psychosocial factors (i.e., social engagement, depression, and aggressive behaviours) were measured using standardized scales. The independent effects of psychosocial factors on energy intake were tested using bivariate and linear regression analyses adjusted for loss of appetite, eating challenges, and demographic characteristics. The final sample included 604 residents (mean age = 86.8 +/- 7.8 years; 31.8% male). Of the three psychosocial factors, only social engagement was associated with energy intake. Low social engagement was associated with cognitive and functional challenges, malnutrition risk, more task-focused mealtime actions by staff, and lower energy intake. Simple regression analysis revealed that individuals with low social engagement ate 59.6 kcal less per day (95% Cl = -111.2, -8.0). This significant association remained when adjusting for loss of appetite, but was no longer significant when adjusting for eating challenges. Low social engagement occurs concurrently with physical and functional challenges among LTC residents, affecting both the nutritional and social aspects of mealtimes. Emphasis on socializing during mealtimes, especially for those with eating challenges (e.g., requiring assistance), may contribute to improved resident appetite and quality of life.

Geriatric malnutrition prevention, detection, and treatment benefit from a multidisciplinary approach, regardless of the care setting. Nutrition care pathways have been created to support multidisciplinary care for hospitals and for transitions and primary care. Conceptual models for supporting nutrition in long-term care emphasize a multidisciplinary approach.

AIM:To determine if protein and energy intake is significantly associated with a family member providing eating assistance to residents in long-term care homes as compared with staff providing this assistance, when adjusting for other covariates.BACKGROUND:Who provides eating support has the potential to improve resident food intake. Little is known about family eating assistance and if this is associated with resident food intake in long-term care.DESIGN:Cross-sectional, secondary data analysis.METHODS:Between October and January 2016, multilevel data were collected from 32 long-term care homes across four Canadian provinces. Data included 3-day weighed/observed food intake, mealtime observations, physical dining room assessments, health record review, and staff report of care needs. Residents where family provided eating assistance were compared with residents who received staff-only assistance. Regression analysis determined the association of energy and protein intake with family eating assistance versus staff assistance while adjusting for covariates.RESULTS:Of those residents who required any physical eating assistance (N = 147), 38% (N = 56) had family assistance during at least one of nine meals observed. Residents who received family assistance (N = 56) and those who did not (N = 91) were statistically different in several of their physiological eating abilities. When adjusting for covariates, family assistance was associated with significantly higher consumption of protein and energy intake.CONCLUSION:Energy and protein intake is significantly higher when family provides eating assistance. Family are encouraged to provide this direct care if it is required.IMPACT:Residents who struggle with independent eating can benefit from dedicated support during mealtimes. Findings from this study provide empirical evidence that family eating assistance is associated with improved resident food intake and provides strong justification to encourage families to be active partners in the care and well-being of their relatives. Home administrators and nursing staff should support the specialized care that families can provide at mealtimes.