Mapping the Food Environment in Nursing Homes. A Foodscape Approach to Explore the Question "Why Do Nursing Home Residents Eat What They Do?"

Despite the significant risk of nutritional problems among older adults in nursing homes, the impact of environmental and situational factors is understudied. This study explores the interaction between residents, food, and the nursing home environment, and asks "Why do residents eat what they do?." Using an ethnographic approach, the study investigates food environments in six rural nursing homes through approximately 2,000 hours of participant observations, nine interviews with residents, and four group interviews with care staff. Data analysis was conducted concurrently using the inductive methods of grounded theory. Using a "foodscape" to illustrate the nursing home environment provides valuable insights into where residents eat, how they eat, what and when they eat, and with whom they eat. Four primary concepts emerged: (1) the physical environment, (2) food patterns dictated by dietary concepts and care staff resources, (3) residents' passive involvement due to care staff's task-focused view of mealtimes, and (4) social perspectives on eating, whether in isolation or in a family-style setup. The foodscape contributes to understanding the residents' food intake and can be used to develop strategies to improve nutrition and life quality for this vulnerable group of people.