Abstract
As related to eating, older adults, especially those with swallowing problems (dysphagia), experience increased risk of mortality and malnutrition, and a loss of socialization, autonomy, and identity. Given required dependencies and adaptations, these eating-related negative outcomes may be further magnified among nursing home residents. Thus, one goal of person-directed care in these facilities is to enhance the dining process by understanding how to best support dining-related quality of life while balancing safety/risks, resident preferences, and quality of care goals (e.g., quantity of intake, decreased dysphagia-related sequelae such as pneumonia). The purpose of this study was to conduct a needs assessment in skilled nursing facilities using community-based participatory research (CBPR) methods in order to understand the dining-related needs, goals, and barriers of various stakeholders. In-depth interviews were conducted with 21 individuals across seven groups: residents with dysphagia, nurses, nursing assistants, dietary staff, speech-language pathologists, occupational therapists/assistants, and residents’ family members. Interviews and data analysis were guided by grounded theory and CBPR methodology. Multiple process/procedural-based themes emerged across groups including how communication, transparency and education promote positive dining experiences, while lack of routine normalization, food presentation, and environment contribute to negative experiences. Attitude/relational-based themes centered around the meanings of autonomy and identity, the quality of staff-resident relationships, the level of staff investment, and the stigmas associated with altered eating. These findings suggest the importance of taking an interdisciplinary approach to dining and highlight potential relevant and malleable intervention targets toward the design of new dining program models.