Beliefs about inevitable decline among home-living older adults at risk of malnutrition : a qualitative study

Payne, L; Harris, P; Ghio, D; Slodkowska-Barabasz, J; Kelly, J; Stroud, M; Little, P; Yardley, L; Morrison, L

Abstract

Background
About 14% of free-living adults aged 65 and over are at risk of malnutrition. Malnutrition screen and treat interventions in primary care are few, show mixed results and advice given is not always accepted and followed. We need to better understand the experiences and contexts of older adults in order to develop interventions that are engaging, optimally persuasive and relevant.
Methodology
Using the Person-based Approach, we carried out 23 semi-structured interviews with purposively selected adults aged 65 and over with chronic health or social conditions associated with malnutrition risk. Thematic analysis informed the development of key principles to guide planned intervention development.
Results
We found that individuals’ beliefs about inevitable decline in appetite and eating in older age compounds the many and varied physical and physiological barriers they experience. Also, we found that expectations of decline in appetite and physical ability may encourage resignation, reduce self-efficacy to overcome barriers and reduce motivation to address weight loss and/or recognise it as an issue that needs to be addressed. Fear of loss of independence may also reduce the likelihood of asking GPs for advice.
Principal conclusions
Key findings identified include a sense of resignation, multiple different barriers to eating, and a need for independence, each underpinned by expectation of decline in older adulthood. Interventions need to address misperceptions about the inevitability of decline, highlight how and why diet recommendations are somewhat different to recommendations for the general population, and suggest easy ways to increase food intake that address common barriers.

Citation

Payne, L., Harris, P., Ghio, D., Slodkowska-Barabasz, J., Kelly, J., Stroud, M., …Morrison, L. (2020). Beliefs about inevitable decline among home-living older adults at risk of malnutrition : a qualitative study. Journal of Human Nutrition and Dietetics, 33(6), 841-851. https://doi.org/10.1111/jhn.12807

• Journal Article Type: Article
• Acceptance Date: Jul 23, 2020
• Online Publication Date: Aug 25, 2020
• Publication Date: Dec 1, 2020
• Deposit Date: Aug 19, 2020
• Publicly Available Date: Sep 2, 2020
• Journal: Journal of Human Nutrition and Dietetics
• Print ISSN: 0952-3871
• Electronic ISSN: 1365-277X
• Publisher: Wiley
• Volume: 33
• Issue: 6
• Pages: 841-851
• DOI: https://doi.org/10.1111/jhn.12807
• Publisher URL: https://doi.org/10.1111/jhn.12807
• Related Public URLs: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-277X
• Additional Information: Projects : Screening and Treating Malnutrition in Older Adults (STREAM)