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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Investigations into culinary improved meals-on-wheels for nursing home residents

Research output: Book/ReportPh.D. thesisResearch

  1. An investigation of main meal preferences in nursing home residents

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Acceptance of texture-modified in-between-meals among old adults with dysphagia

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. How to Obtain Forty Percent Less Environmental Impact by Healthy, Protein-Optimized Snacks for Older Adults

    Research output: Contribution to journalJournal articleResearchpeer-review

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Nursing home residents is a population at high risk of undernutrition. This is costly not only for the society,
but also for the individual who experience reduced health and quality of life. Undernutrition is caused by a
reduced food intake due to internal and external factors in relation to the meal and the old adult, such as
impaired senses, appetite regulation, the social setting during the meal and the meal itself. In nursing homes
meals are often served through meals-on-wheels systems, which may reduce the sensory aspects of the
meals and limit appetite stimulation. A way to combat the problem could be to suit these meals according
to the sensory preferences of the target group. Different studies have investigated meal preferences in
nursing home residents, and in most cases traditional, Danish and familiar meals were found. The overall
aim of this thesis has been to investigate if a culinary improved two-course meals-on-wheels menu could
affect health-related quality of life in nursing home residents. The thesis was basis on four studies, resulting
in three papers in total.
In paper I, it was investigated, which in-between-meals were most accepted based on appearance and
flavor. Twenty texture-modified in-between-meals were assessed by 30 nursing home residents with
dysphagia. Those in-between-meals that were most accepted in relation to flavor, were also those with the
highest fat and energy content. The evaluations of appearance and flavor were in accordance in 18 of 20
(90%) in-between-meals. Sensory characteristics of the most accepted in-between-meals were that they
were frozen, cold and sweet. Similarly, forty main meals were evaluated on their appearance, flavor and
texture by 29 old adults in paper II. The aim was to investigate main meal preferences of nursing home
residents. These meals were divided in six meal type groups (mixed meat, beef, pork, fish, chicken, plantbased), and rated on three sensory aspects. The results showed that with respect to appearance pork was
liked higher than beef, with respect to flavor the meals containing beef were liked higher than the plantbased
meals. Lastly, regarding texture the meals containing fish were higher liked than meals containing
beef or plants. From these pilot studies a selected amount of meals was chosen for a culinary study using
culinary sessions with chefs from the Copenhagen House of Food to create a sensory improved intervention
menu (which included a stimulating, novel twist). This menu was tested in paper III. The design was a
cluster-randomized study, where 52 nursing home residents were randomized either to receive the control
(n=32) or intervention menu (n=20) for 12 weeks. The results showed a reduction in health-related quality
of life in the intervention group. The reason for this was possibly that the meals in this menu were less
familiar than the meals the control group received. Overall, no effects were found in either the nutritional
or functional parameters, which can be attributed the initial frailty of these old adults. Taken together the
present PhD thesis suggest that familiarity and recognizability play crucial roles for meal acceptance in
nursing home residents. Meal improvement should be done with minor adjustments and respect for meal
preferences to increase appetite and quality of life in old adults.
Original languageEnglish
Number of pages128
Publication statusPublished - 5 Mar 2019

Note re. dissertation

Vejledere: <br/>Susanne Bügel<br/>Anne Marie Beck<br/>Annemarie Olsen

ID: 56082821