Table 3.

Themes and illustrative quotes.

Themes/Sub-themes	Illustrative Quote
Current dietary patterns and experiences of appetite, energy and weight loss
Routine in meal pattern	“…she insists on having cornflakes and milk, I’m really pleased that she has that in the morning, anyway, and I always ask her every day, “Did you have breakfast?” and she always replies, “Yes, I always have breakfast.” It was drummed into her from a child I think.” (Carer 6, Female, 50–59 years)   “My three meals a day are always on time, that’s 8 o’clock, 1 o’clock and 5 o’clock.” (OP1, Female, 80–84 years)
Use of ready-made meals	“You put them in the microwave for 2½ or 3 minutes, it depends on the quantity, and that is it. Now reservation with these is perhaps these packages are covered with preservatives, that’s the only reservation I have.” (OP22, Male, 85–89 years)
Negative perceptions of snacking	“As I’ve got older, I make sure that I don’t snack and, erm, go on doing that sort of thing. Whereas when I was younger, yes, I would say I’ll just have a snack now and then get on with what I’m doing. But I know that I’ve got to eat properly, and that is very important, it makes me sit down and catch my breath.” (OP16, Female, 80–84 years)
Appetite reduction	“Well, so maybe I am less hungry than I think I am, when presented with this very appetising vegetarian dish in a helping that was supposed to be for one, I really couldn’t eat it all. So I conclude that perhaps I am less hungry than I used to be.” (OP11, Female, 75–79 years)   “But now as I’m getting older, the appetite isn’t the same, you know?” (OP9, Male, 75–79 years)
Lower energy levels	“… I wish I could tell why, I wish I could help. I wish I could tell why his energy’s dropped. I’ve told every carer and everybody medical, and … when I’ve talked to the doctor, I say, “(older person) keeps saying he’s got no energy. Could you give him something to make him energetic?”” (Carer 9, Male, 70–79 years)
Factors influencing eating habits in later life
Early life experiences	“There were no fat girls in my school… we didn’t have snacks; we were allowed three sweets after lunch… And this was not that long after the war, we were still on rations” (OP17, Female, 75–79 years)
Household composition	“I mean even when I had a family and I did it, I did my duty, but I never enjoyed it; it was always a bit of a chore, but I knew I had to do it.” (OP17, Female, 75–79 years)   “… when I was in (Caribbean country), it was a different lifestyle; you know, the wife cooks, the husband sits down and eat at the table, and the children eat on their own, and then the wife sits down and eats on her own.” (OP21, Female, 75–79 years)
Health-related factors	“He couldn’t taste anything, because I said to him, “Why aren’t you eating? You’re eating miniscule amounts of food!” and he said, “Oh, it’s because I can’t taste anything.” I thought it might be something to do with the hospital, the general anaesthetic and all that sort of stuff, I don’t know.” (Carer 8, Male, 50–59 years)   “… I mean, that’s why I did stop having wheat bran because I think oat bran is better, it’s not so wind-making as wheat bran.” (OP17, Female, 75–79 years)   “But the dietitian, after they ’d found out that I couldn’t eat certain foods because of different reasons, they told me to follow this, so this is what I follow. Even bread now, I have to eat gluten-free” (OP6, Female, 80–84 years)
Cognitive impairment	“On a typical day my mum starts the day with a huge bowl of Weetabix, and she really enjoys that. She has a carer who comes in to make it for her each morning, because off her own bat she would no longer cope with all the decisions of how to find it in the cupboard or do anything with it.” (Carer 7, Female, 60–69 years)   “… On occasion, I’ll go over there and I’ll put the food in the fridge, say two ready-made meals which are nutritious and good, … but he won’t have eaten them, they’re still there. And I say, “… you haven’t had your meal!” And he’ll say (tuts) “What, haven’t I?” I’ll say, “No.” He’ll say, “Oh, I think I have!” It’s to that stage.” (Carer 9, Male, 70–79 years)
Level of functioning influences ability to shop and prepare a meal	“There’s less desire to sit down and eat, but when I get started, I’m fine, but the bother of, I suppose, preparing it really.” (OP24, Male, 90+ years)   “Well, there’s a PlusBus, there’s a little yellow bus that comes around. Sometimes of course it doesn’t come and you don’t know why, so you’ll be sitting there waiting for it. But, no, it’s quite good when it does come. Well, I can put that (walker) on the bus, they’re used to it, because they take a lot of us old people around so, you know, the driver will help me on with that, so that’s all right.” (OP3, Female, 90+ years)
Financial resources	“Yes, I mean, I don’t want to be on 9 stone because then my blasted clothes would start to get tight and no way do I want to fiddle around altering clothes again, because I’ve made them smaller and smaller and smaller.” (OP14, Female, 75–79 years)   “Well, they wouldn’t pay us for it, would they? (slight laugh)… I think we eat badly because it’s cheaper to buy cheap old stuff.” (OP4, Female, 75–79 years)
Perceptions about diet and attitudes towards weight change
Older people do not consider low weight as a problem	“Well, my daughter keeps saying, “Oh, mam, you’re losing too much weight!” But I feel all right.” (OP20, Female, 75–79 years)   “I’ve always been slim, I’ve always had more muscle and it really was muscle not just fat. There’s too much on my tum, but that’s that. But my mother always tended to fat, but my father’s family, they have even less flesh than I do. It is partly hereditary I think.” (OP10, Female, 90+ years)
Healthy diet means low fat and high fruit and vegetables	“It means fruit and vegetables, if you conjure up in your imagination, the Mediterranean diet and that sort of thing.” (OP13, Male, 80–84 years)   “But because I’ve got high cholesterol, I’m not supposed to have a lot of eggs or cheese with it, but I do have some.” (OP15, Female, 75–79 years)
Mixed views about gaining weight	“But I’m willing to try things, yeah, because it would … yeah, because of one thing, it keeps you warmer (slight laugh) if you have a bit more weight.” (OP15, Female, 75–79 years)   “If it was tasty and something I could afford, I would think about it, yeah. I mean, I’m not particular what I eat virtually; I mean, I have a very wide range, so if someone came up with something new, I wouldn’t mind.” (OP24, Male, 90+ years)
Using personal preference and knowledge gained over life course/Lack of professional advice	“My understanding is actually very vague and superficial, it’s just what I kind of have gathered along the way; I haven’t ever made an effort to understand what food is doing to us.” (OP11, Female, 75–79 years)
Supporting nutrition in older people—current practices
Lack of initiation of discussions about diet with their GP	“I’ve never done that, I’ve never tried, never thought about it, but the thing is, I changed my GP or the GP was changed for me in recent times, and I’ve never gone and enquired about what you’re saying to me. I suppose if I asked, I’d get an answer, but I’ve never volunteered.” (OP24, Male, 90+ years)
Carers’ strategies	“… the meals, for example, I used to serve them on plates but I now serve them in shallow bowls. So it’s all these things like that, and you just have to keep moving.” (Carer 7, Female, 60—69 years)   “At first I did (buy it), just one packet to try it (oral nutritional supplement) out. And then she liked the taste. I put it in a blender and I added half a banana to it and she did like it. She just wasted a tiny bit, and I tried it, I liked it too… So then I told the doctor that she liked it, so now he has prescribed it for her.” (Focus group, Carer P3, Female, 50–59 years)
Monitoring of intake for people with dementia	“I think while I get the feedback and it’s written down that she’s having a very good breakfast and a very good supper, and she’s grazing during the day, I think I feel comfortable that that’s right for her.” (Carer 7, Female, 60–69 years)
Preferences for nutritional support
Health care professionals (not just dieticians) can give diet advice	“I’d have to take the advice of a professional person. Any professional person that’s advised me, if a doctor came and said to do something for a week, I’d do it for a week. If he prescribes pills or something else like that and says to take them, I would take them until the end.” (Carer 5, Male, 80–89 years)   “I don’t know, I haven’t really thought about it. I suppose, nurses: would nurses know about diet? Dieticians, presumably, because dieticians know about diet. Health professionals should know something, shouldn’t they, about diet obviously.” (Carer 8, Male, 50–59 years)
Good communication skills and experience in working with older people are key requisite skills	“When you get a bit older, people think you’re stupid or a child, or aren’t up to it, so they talk to you as if you’re stupid. And if somebody talks to me like that, I wouldn’t listen, absolutely not, no.” (OP17, Female, 75–79 years)   “… you can’t be taught rapport; the feeling that people have for other people and a sensitivity to what they need matters far more than a university degree.” (OP16, Female, 80–84 years)   “I think people dealing with people with dementia need training. It’s not just enough to employ the cheapest person who comes along, because it needs a lot of tact and sensitivity to be able to recognise it.” (Carer 9, Male, 70–79 years)
Education is important, but for some people provision of leaflets is not enough	“But that’s the best way to contact people is leaflets, I think. And then they’ll tell you whether they’re interested or not, and you go from there don’t you?” (OP1, Female, 80–84 years)   “… it depends how official that is, because one gets so much stuff through the post, “you should be eating this, or you should go here, go there, or do this or do that!”… You take no notice after a while, you just throw those sort of things in the bin! So while you get a letter perhaps telling you what they think it might be, that’s different, but I don’t think a leaflet put through the door is useful for someone like me; I’d just put it in the bin.” (OP3, Female, 90+ years)
Preference for an individualised approach	“Yes, if they were doing it thinking that it has got my welfare at heart, you know, not just a casual, “I think this is something old women should do” or something like that, you know, a more personal approach, I suppose really.” (OP3, Female, 90+ years)   “Someone who lives on their own, it’s got to be more direct, hasn’t it? …So I don’t know, it’s quite complex really, so you’d have to try and see what’s your target group really… And for each target group, there’d be different elderly target groups, wouldn’t there, different circumstances around what you’d need to provide in order to be successful.” (Carer 8, Male, 50–59 years)
Monitoring of intake and follow-up	“… Which people would have to fill in. So you’d fill in every day, so that you’d have a record of how much … how well or not very well following the suggestion, the advice… So you could just do it on a piece of paper … And then say at the end of the week they’d have to send it to the nurse or whoever, you know?” (OP15, Female, 75–79 years)   “… I think it (monitoring) would make a difference. I think it would be an incentive to do it, to keep doing it…. because of having made an agreement with somebody.” (OP15, Female, 75–79 years)   “… some kind of reminder would be very helpful and would help people to keep to their goals and advice about how to achieve that” (OP15, Female, 75–79 years)   “In my grandmother’s case, it wouldn’t have to be every week, maybe a couple of times a month I think. Not too many gaps, because then she’d forget and have to go over it all again, but, yeah, I think a unique service that focuses on nutrition and healthy diets, so that it’s clear for me and anybody else of her family that know that when we’re talking to her, this is correct information and not something that we imagine could be correct – fact and information, practical stuff.” (Carer 6, Female, 50–59 years)
Involving caregivers	“So, for example, in (older person)’s case, he has somebody who lives with him (I live with him) so as long as you worked with the people who lived with him, an arrangement together, so you could work with us so that we could support him, I could support him. There could then be a third person who would be giving that support, but not so much directly, if you see what I mean.” (Carer 8, Male, 50–59 years)