The Meal in Geriatric Care : Habits, values and culture

Abstract: The aim of the present thesis was to study the meal situation in geriatric, care, focusing on cultural, social, psychological and nutritional qualities of the meals for the patients as well as caring strategies and actions performed at meals by the nursing staff.The studies were carried out in a rehabilitation and long-term care clinic providing geriatric care. The data were gathered during two periods. In the first period 18 consecutive elderly patients and their personal enrolled nurses participated (paper I and II). In the second study the informants were 45 patients as well as registered nurses, enrolled nurses and nurse's assistants working in the clinic (paper III, IV and V).The main approach was ethnographic, using interviews, observations and documents. Furthermore, the nutritional status was assessed by weight index and biochemistry as well as by records of dietary intake.The meal situation was found to be a meeting place between individual patients and the collective hospital culture. In the ward the patients strove to reach their own standards of acceptable table manners and retain their independence and dignity. Their conflicts at table were related to three themes. The first, "Mind your manners", demonstrated problems in managing food and objects, keeping clean, and conduct at table. The second, "Appetite for food", was connected to tradition and taste, healthy food and the need not to waste food. The third, "Be content and do not complain", illustrated the elderly patients' socialized manners in talking about meals and food.The evaluation of the elderly patients' meal patterns showed a strong reduction in daily eating frequency during the time before hospitalization, which might lead to nutritional deficiency. The nursing assessment strategies were defective as patients at risk of malnutrition were missed and patients' experiences of their own and others' limited eating competence were rarely taken into consideration enough. One reason for this was shown to be the organization of the meal and the fixed form of the working phases.Ritualized practices gave the main form to the hospital meal and the serving procedures. Based on checks of patients' ability and caregivers' working conditions, the praxis was to make eating possible and facilitate the procedures. Three norms guided the caregivers; "To provide a homelike situation with fellowship for training purposes", "To ensure each patient gets what they need/want by means of a fair method of serving" and "To keep things in order and to be responsible".The thesis points out the problem that arises when institutionalized habits and values gave the meals such a fixed form that alterations in serving procedures were difficult to make. As the elderly patients strove to keep their dignity and adapt to the demands communicated, these were factors which minimized the possibilities of adjusting the eating procedures to the individual needs of the patient.