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

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

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
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Abstract

Background: Approximately 14% of free-living adults aged ≥65 years are at risk of malnutrition. Malnutrition screen and treat interventions in primary care are few, show mixed results, and the advice given is not always accepted and followed. We need to better understand the experiences and contexts of older adults when aiming to develop interventions that are engaging, optimally persuasive and relevant. Methods: Using the Person-based Approach, we carried out 23 semi-structured interviews with purposively selected adults ≥65 years 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 an inevitable decline in appetite and eating in older age compound the many and varied physical and physiological barriers that 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 general practitioners for advice. Conclusions: The key findings identified include a sense of resignation, multiple different barriers to eating and a need for independence, each underpinned by the expectation of a decline in older adulthood. Interventions need to address misperceptions about the inevitability of decline, highlight how and why diet recommendations are somewhat different from recommendations for the general population, and suggest easy ways to increase food intake that address common barriers.

Original languageEnglish
Pages (from-to)841-851
Number of pages11
JournalJournal of Human Nutrition and Dietetics
Volume33
Issue number6
Early online date25 Aug 2020
DOIs
Publication statusPublished - 6 Nov 2021

Bibliographical note

Funding Information:
This paper is from the STREAM project, which aims to develop and test an intervention targeting healthcare professionals and older adults in primary care, funded from an NIHR Programme Grant for Applied Research, Reference RP‐PG‐0614‐20004. The research programme of LY and LM is partly supported by the NIHR Southampton Biomedical Research Centre. The funding body approved the project team’s study design, although it was not involved in the data collection, analysis or write‐up.

Funding Information:
We thank the multidisciplinary team of general practitioners, research nurses, dietitians, nutritionists, researchers, programme managers, and patient and public involvement representatives who contribute to the STREAM project, as well as this study.Conflicts of interest, source of funding and authorshipThe authors declare that they have no conflicts of interest.This paper is from the STREAM project, which aims to develop and test an intervention targeting healthcare professionals and older adults in primary care, funded from an NIHR Programme Grant for Applied Research, Reference RP-PG-0614-20004. The research programme of LY and LM is partly supported by the NIHR Southampton Biomedical Research Centre. The funding body approved the project team?s study design, although it was not involved in the data collection, analysis or write-up.LP and JK obtained ethical approval. JK, LP and DG recruited participants. DG, JSB, LP and PH carried out interviews. LP, PH and LM coded the data. LP analysed the data and drafted the paper. All authors read and commented on the draft manuscript and provided clinical, nutritional or psychological expertise during the analysis of the findings. The authors declare that they have no conflicts of interest. This paper is from the STREAM project, which aims to develop and test an intervention targeting healthcare professionals and older adults in primary care, funded from an NIHR Programme Grant for Applied Research, Reference RP-PG-0614-20004. The research programme of LY and LM is partly supported by the NIHR Southampton Biomedical Research Centre. The funding body approved the project team?s study design, although it was not involved in the data collection, analysis or write-up. LP and JK obtained ethical approval. JK, LP and DG recruited participants. DG, JSB, LP and PH carried out interviews. LP, PH and LM coded the data. LP analysed the data and drafted the paper. All authors read and commented on the draft manuscript and provided clinical, nutritional or psychological expertise during the analysis of the findings.

Publisher Copyright:
© 2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association

Structured keywords

  • Physical and Mental Health

Keywords

  • eating patterns
  • intervention development
  • malnutrition
  • older adults
  • person-based approach
  • qualitative research

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