Sharing meals: promising nutritional interventions for primary health care

This study explored the experiences from a shared-meal intervention including nursing students and elderly people living at home receiving home care. Our findings are presented according to the following themes: “improved meal preparation”, “mixed meal experiences” and “significant experiences contributing to improved nutritional status”. The quotes are numbered and marked with an S (student) or an E (elderly) to clarify the sender.

Improved meal preparation

Improved meal preparation consists of important factors involving the meal surroundings and the facilitation and tailoring of the meal and environment. Both students and elderly participants were involved.

Mealtime environment

There were many examples of students and elderly participants making small adjustments to set a nice table and present the food in a beautiful way. Each of the participant pairs solved this differently. Some students performed these activities on their own, while some elderly persons prepared their home environment alone prior to the shared meal, and in some situations, the students and elderly participants did this together. The meals used in this project were ready-made meals that required heating:

We eat a meal and facilitate … and make sure her sitting position is good. We don’t just say “hi, let’s eat”, but we think about the meal environment as well. S#8

We found that the students and elderly participants improved the appearance of their meals by putting the food on nice plates and in bowls. They thought this was more beautiful:

The first time we put the food directly on the plate, but then we experienced that it was better to put the food in trays and serve ourselves. The first time we did it, she only had two meatballs and a spoonful of mashed potatoes. I thought: “Is this all she is having?” (laughter) But then she helped herself three times because she liked it so much, which was very nice. It showed that she wanted more food when we sat and talked, and she could help herself. S#9

Many elderly participants also used tablecloths, napkins, lit candles and decorated the table with flowers to make the food and meal situation more appetizing:

We turned off the radio when we ate. And she had already put out some nice napkins and a tablecloth and some flowers. The meals were very pleasant. S#4

We did it together. I think she experienced coping and a feeling of having a guest in the house by setting the table. S#9

Food and nutrition tailoring

Food and nutritional tailoring are important to adjust the meals and food to the various individuals’ needs. Although nutritious and tasteful, the ready-made meals were not fortified or energy dense. Ready-made meals have limited possibilities for individualization, but many students nevertheless managed to adjust the meals according to the needs of the elderly persons in various ways, e.g. by improving the energy and protein content and adjusting the portion size. The nursing students ordered the same meal as the elderly participants they were paired with to be able to mutually share the taste experience, and the students chose food that they thought the elderly person would be familiar with when they experienced difficulties choosing a meal from the menu:

I ordered the same food for her and me for us to have something in common. It is nice to talk about the food when we eat the same meal. S#10

I think it is useful for her, me being there eating with her. Because then we do something together. S#3

Many nursing students helped the elderly persons with smaller portions of food when their appetite was poor. Smaller portions can be more appetizing for elderly persons with a decreased appetite:

Some days her appetite was poor. I said: “we can share a portion, you and I?” Then she ate a small portion. It was not ideal, but better than nothing. S#3

We had two portions of the same meal and put the food on serving plates. Then we could help ourselves at the table and the portion would be smaller when appetite is poor. S#1

The students also managed to fortify the meals using extra butter, oils, cheese and cream where appropriate. To enhance the elderly persons’ nutritional intake, the students also provided…

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