Dining Environment Research Articles

Nutritional Care, Support Key for Dementia Patients

Balancing potential benefit and burden of nutritional interventions and providing support should be an integral part of dementia management, according to experts from the European Society of Clinical Nutrition and Metabolism (ESPEN). In new evidence-based guidelines, the panelists recommended screening and monitoring of body weight as well as adequate nursing support around eating and a pleasant dining environment for patients with the condition. Published in Clinical Nutrition (Clin Nutr 2015;34:1052–73) the guidelines on nutrition and dementia were written by a panel that was made up of 86 physicians, nutritionists, and dietitians experienced in treatment and nutritional therapy in patients with dementia. They assessed reports from a systematic literature search of PubMed and the Cochrane Library to arrive at a grading of the evidence and strength of recommendation. That scoring then was subject to a discussion by the experts who took into consideration risk/benefit ratios, costs, and a review of supportive evidence, which concluded when consensus was reached. The resulting guidelines span 26 recommendations, from screening and monitoring of weight through provision of meals and use of appetite stimulants, supplements, and artificial nutrition. For all individuals with dementia, regardless of the disease state, the experts recommended screening for malnutrition and close monitoring of body weight. To encourage oral nutrition, sufficient food should be available in an attractive, pleasant environment and with adequate nursing support. The panel noted that weight loss is common in patients with dementia, for a variety of reasons, such as brain atrophy and pathological changes in the olfactory system. Issues with shopping for and preparing of food may occur with early-stage disease, whereas behavioral problems and oral dysphagia are common in more advanced disease. In individuals with dementia, weight loss is associated with increased risk of mortality, hence the need for a focus on nutrition. For screening, the experts recommend using the validated Mini Nutritional Assessment-Short Form (MNA-SF) and having relatives or professional caregivers answer the six questions about a patient with dementia to ensure that the information obtained is reliable. Tools to identify specific eating disorders include the Aversive Feeding Behavior Inventory, the Edinburgh Feeding Evaluation in Dementia Questionnaire, and the Eating Behavior Scale. Weighing patients at 3-month intervals and under consistent conditions is suggested, except in patients with end-stage disease because the practice may do them more harm than good. In an LTC setting, serving meals family-style, in a home-like setting, with adequate lighting and relaxing background music, has been found to have a positive impact on nutrition in patients with dementia. The panelists also recommended that staff bring residents to tables and sit down and talk with residents as they eat, offering prompts and encouragement to promote self-feeding. An adequate diet for individuals with dementia, the experts said, should include fruits, vegetables, legumes, and unrefined cereals with moderate amounts of dairy products, low intake of meat, and regular intake of fish. Snacks should be available to supplement regular meals. In some observational studies, use of high-energy/protein foods has been shown to have a positive impact on dietary intake and body weight in patients with dementia in LTC settings. Reviewing the literature on use of appetite stimulants in patients with dementia, the panelists found only limited evidence. They also did not recommend use of omega-3-fatty acids or of vitamins B1, B6, B12, or folic acid supplements unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Systematic use of special medical foods such as lyophilized foods or nutraceutical formulations have potential to affect cognitive function, the experts said, and may be effective under certain conditions, but current evidence is too weak to support their general use. Artificial nutrition can be used for a short period of time to overcome a crisis situation in a patient with mild or moderate dementia who has markedly insufficient oral intake. The panelists did not, however, recommend artificial nutrition in patients with severe dementia or who are terminally ill. Judith M. Orvos, ELS, is a freelance medical writer and president of Orvos Communications in Washington, DC.

Food Allergy Knowledge, Attitudes, and Preparedness Among Restaurant Managerial Staff

This study surveyed 110 restaurant managerial staff in the United States to investigate their levels of food allergy knowledge, awareness, and preparedness in serving clients with food allergies. Mean food allergy knowledge score was 19.7 ± 4.6 of max 28. Most participants would modify recipes for clients with allergies (n = 85), but perceived customers should be responsible to request special meals (4.1 ± 0.9). Seventy-six participants have provided employee food allergy training. Participants identified that employee lack of commitment (3.9 ± 0.9) and time constrains (3.7 ± 1.0) were barriers to provide training. Restaurants should establish safe dining environment through well-planned food allergy policies and regular employee food allergy training.

Cutlery matters: heavy cutlery enhances diners’ enjoyment of the food served in a realistic dining environment

We report a study conducted in a realistic dining environment, in which two groups of diners were served the same three-course meal. The presentation of the starter (centred vs. offset plating), the type of cutlery used for the main course, and the shape and colour of the plate on which that dessert was served were varied. The results revealed that the weight and type of the cutlery exerted a significant impact on how artistically plated the main course was rated as being, how much the diners liked the food, and how much they would have been willing to pay for it. The change in the shape and colour of the plate also affected the diners’ liking for the dessert. Taken together, these results show that the diners’ appreciation of the food is affected by the type of the cutlery used to eat (in this case, knife and fork), in terms of liking, aesthetic value, and willingness to pay for the food, adding to a growing body of gastrophysics research highlighting the importance of food-extrinsic factors in modulating the diner’s opinion of the meal that they have been served.

Improving Food and Fluid Intake for Older Adults Living in Long-Term Care: A Research Agenda

Poor food and fluid intake and malnutrition are endemic among older adults in long-term care (LTC), yet feasible and sustainable interventions that target key determinants and improve person-centered outcomes remain elusive. Without a comprehensive study addressing a range of determinants to identify those that are of greatest importance for targeting with interventions, expert consensus can be used to develop a research agenda. International experts and stakeholders convened for a 2-day meeting to participate in a nominal group process to identify and prioritize determinants of food and fluid intake for persons living in LTC. Top determinants to address with intervention research included social interactions of residents at mealtime; self-feeding ability; the dining environment; the attitudes, knowledge, and skills of staff; adequate time to eat/availability of staff to provide assistance; sensory properties of the food; hospitality and mealtime logistics; choice and variety in the dining experience; and nutrient density of food. Multimodal interventions that could target these prioritized determinants were also suggested. This consensus process has resulted in a prioritized research agenda for the development and testing of interventions to improve food and fluid intake of older adults living in LTC.

Using the QFD Technical to improve Service Quality in Vegetarian Foods Industry

As the quality of product/service requirements of people dining rising. Because of the economic recession, the food and beverage industry is facing a strong competition. Only by understanding the true needs of consumers can their requirements are satisfied. For this reason, this study to use Quality Function Deployment (QFD) understanding the true needs of consumers, and explore a the best options to enhance service quality in order to help enhance the vegetarian industry service quality. In this study, the Taipei Spring Vegetarian Restaurant consumers empirical object. First, through literature and interviews with experts to develop a consumer questionnaire with experts and scholars questionnaire, followed by the two-stage survey analysis through SPSS, Import QFD empirical analysis. The results show that the important degree of top five items: reliability and safety of the food source, ingredients quality, health and safety of the restaurant, warm service attitude of staff, and comfortable dining environment. To improve the quality of service before four items: business philosophy, product quality, service quality, culinary and specialty

Eating/Feeding Issues in Dementia: Improving the Dining Experience

People with dementia can have problems eating/feeding, which puts them at risk of malnutrition. There are various reasons why people with dementia find eating and/or feeding problematic, including difficulty co-ordinating movements in order to get food into their mouths, difficulty maintaining attention on eating, dysphagia, level of cognitive and physical impairment, resistance to care, agitation and psychological symptoms such as depression and apathy. It has been recognised that the environment is a crucial factor that can have an impact upon people with dementia in terms of improving their quality of life. This can also be true of the dining environment. It has been suggested that a dining environment that is welcoming, relaxing and comfortable has the potential to increase food intake and social interaction, which can make the eating/feeding experience more enjoyable and thereby minimise eating/feeding difficulties in people with dementia living in care homes. This article will consider the possible causes of eating/feeding difficulties in people with dementia living in care homes and the environmental factors that may enhance the dining experience. Conflicts of interest: none

The role of physical environment in supporting person-centered dining in long-term care: a review of the literature.

The physical environment of dining rooms in long-term care facilities is increasingly recognized as an important catalyst in implementing a culture based on person-centered care philosophy. Mealtimes are important opportunities to support residents' personhood in care facilities. This article presents a critical review of the literature on evidence-based physical environmental interventions and examines their implications for creating a more person-centered dining environment, specifically for residents with dementia. The review identifies the role of a supportive dining environment to foster: a) functional ability, b) orientation, c) safety and security, d) familiarity and home-likeness, e) optimal sensory stimulation, f) social interaction, and g) privacy and personal control. It is clear from this review that there is a growing body of research to support the importance of certain physical environmental features in the dining context that can foster positive resident outcomes. The evidence indicates that well-designed physical settings play an important role in creating a person-centered dining environment to support best possible mealtime experience of residents. Gaps in the literature and directions for future research are discussed.

Assisted‐living elderly and the mealtime experience

Although there is increasing evidence of barriers to nutritional health among elderly assisted-living residents, there has not been the same emphasis when examining the ways in which these individuals experience their mealtimes, as well as the factors that they perceive as contributing to their overall sense of health and well-being. Mealtimes may be disregarded as being particularly unimportant or hurried and overlooked, especially for those residents who may be lonely and have feelings of isolation, ultimately leading to a reduced food intake and poor nutrition. A convenience sample of 38 men and women, aged ≥65years, were selected from four assisted-living facilities in and around Montclair, NJ, USA, to participate in focus group discussions. Data were analysed using content analysis procedures. Participants described their experiences of mealtimes, and the factors contributing to an overall sense of well-being during these occasions. The ability to make healthy food choices, socialise, interact with staff, friends and family members, and enjoy a tasty meal in a warm and inviting dining environment, may provide a dignity that is unmatched by other services. The findings of the present study highlight the importance of maintaining the health of elderly assisted-living residents through strategies that enhance their mealtime experiences. Listening to the food voice of elderly through research such as that carried out in the present study will help policy makers develop a plan that will effectively deal with systemic barriers prevalent in these facilities, and incorporate strategies to motivate and encourage their residents to increase their food intake and improve their health and well-being.

Research on the Restaurant Space Humanized Design

Based on the concept of humanized design, it discussed the restaurant space design. Firstly, it introduced the general situation of humanized design of the Restaurant space, and then it discussed how to achieve the humanized design of restaurant space from the aspects of reasonable layout space, the ample use of light color design, environment atmosphere created by furnishings, detail designs for vulnerable group and the rational use of environmental protection materials. The research will provide the scientific guidance for creating the humanized dining environment which can meet the psychological, physiological and emotional needs of human.

Creativity, aesthetics and eco-friendliness: A physical dining environment design synthetic assessment model of innovative restaurants

This study attempts to identify the important attributes of Innovative Physical Dining Environment Design (IPDED) through qualitative and quantitative analyses of expert viewpoints. We extend the related literature in restaurant physical environment design and construct a Multiple Criteria Decision-Making (MCDM) model that combines Decision-Making Trail and Evaluation Laboratory (DEMATEL) and Analytic Network Process (ANP) to demonstrate the interactions and relations among the criteria. The DEMATEL analysis shows that eco-friendless has direct and indirect influences on the dimensions of creativity, aesthetics and performance. Furthermore, performance is the most critical attribute of restaurant operation when the ANP analysis is applied. The results of this study provide an important reference for restaurant managers and interior designers in their decision-making process, thereby reducing risk.

Ecological Architectural Technology Optimization Design — Longgang High School’s Cafeteria Design as an Example

Problems such as poor indoor environment, pollution to the surrounding environment and waste of water and power universally exist in the school’s cafeterias. In view of this, in the design of Hanzhong Longgang High School’s cafeteria, the pre-research was firstly made to discover and analyze the existing environmental problems and their causes; then the design objectives were brought forward to lower environmental pollution, improve indoor environmental quality, and reduce energy consumption. After that, ecological technological measures were selected and optimized to be applied to the architectural space design. Lastly, architectural scheme was created. In the architectural design, the ecological technology has been applied to achieve the proposed goals in order to create a healthy and comfortable dining environment for the students, and, at the same time accumulate experience on optimized design of ecological buildings.

A randomized controlled trial of the effect of school food and dining room modifications on classroom behaviour in secondary school children

Adequate nutrition is considered important for learning, but there is little robust research on the association between diet and learning in school-aged children in industrialized countries. This study investigated the effect of tailored modifications to the food and dining experience in secondary schools on learning-related behaviours. In 2008, 12 co-educational secondary schools in England were recruited. Schools were randomly allocated to receive a tailored action plan and support to modify their food provision and dining environment over a 15-week period (intervention or to control). Learning-related behaviours were systematically observed during post-lunchtime classes at all schools. Observations were made by trained observers using a validated protocol to determine whether pupils were 'on-task' (concentrating and alert) or 'off-task' (disruptive or disengaged). In total, 156 pupils were observed (control n = 58, intervention n = 98) at baseline (12,210 and 20,560 observations, control and intervention, respectively) and at follow-up (16,846 and 23,462, respectively). On-task and off-task behaviours were similar across treatment groups at baseline. At follow-up, intervention group pupils were 18% more likely to be on-task (odds ratio (OR) 1.18, 95% confidence interval ((95% CI) 1.05-1.33) and 14% less likely to be off-task (OR 0.86, 95% CI 0.75-0.98) compared with control group pupils. This study suggests that modifying food provision and the dining environment can improve learning-related behaviours of secondary school pupils in the post-lunch period. This finding supports ongoing investment and interventions by local authorities across the United Kingdom to improve school food and lunchtime dining facilities.

Cultural Perspectives in Feeding Difficulty in Taiwanese Elderly With Dementia

To investigate factors related to feeding difficulty that is shown in the interaction between nursing assistants and elderly residents with dementia. Forty-eight residents and 31 nursing assistants were observed during meal times in a congregate dining room of a Taiwanese nursing home specializing in dementia care. Residents' eating behaviors, the dining environment, interactions between the nursing assistant and the residents, and feeding strategies used by nursing assistants were observed. Nutritional data for residents were collected from medical charts. The EdFED Scale #2 and interviews of nursing assistants provided information about feeding difficulty. Interviews also provided data on strategies used to address feeding difficulties. The most frequent feeding difficulty was refusal to eat (37.5%). The strategies used by nursing assistants were limited. Nursing assistants stated they needed more training to address feeding difficulty in residents with dementia. Future research should be focused on the interface between the residents and nursing assistants who must identify various feeding difficulties and select appropriate interventions. Results might provide information that can be used to develop effective interventions and promote high-quality mealtime care in patients with dementia.

Changes in Type of Foodservice and Dining Room Environment Preferentially Benefit Institutionalized Seniors with Low Body Mass Indexes

Objective To compare energy intakes in seniors with cognitive impairment residing in long-term care and receiving meals by bulk (cafeteria style with waitress service) vs traditional tray delivery systems and determine subject characteristics that identify responsiveness to type of foodservice provided. Design and subjects/setting Usual energy intakes were compared in subjects residing in cognitive impairment units in either the old (tray delivery, n=23) or new (bulk delivery, n=26) nursing home at Baycrest, a teaching facility associated with University of Toronto Medical School. Intervention Changes to foodservice and physical environment (from institutional to more home-like environment). Main outcome measures Twenty-one consecutive day investigator-weighed energy and macronutrient intakes and behavioral function (London Psychogeriatric Rating Scale). Statistical analyses performed Analysis of variance determined mean differences in intake and regression analyses identified predictors of sensitivity to type of food delivery systems. Results Higher 24-hour total ( P<0.001) and dinner ( P<0.001) energy intakes in subjects receiving bulk compared to tray delivery were predominantly associated with greater carbohydrate intakes ( P<0.001). Higher energy, carbohydrate, and protein, but not fat intakes, with bulk delivery were more apparent in individuals with lower body mass indexes (BMIs) (food delivery by BMI interaction, all P values <0.05). Conclusions High-risk, cognitively impaired individuals with low BMI benefited the most from the changed foodservice and physical environment, whereas individuals with higher BMIs did not show substantive changes in intake. Bulk foodservice and a home-like dining environment optimize energy intake in individuals at high risk for malnutrition, particularly those with low BMIs and cognitive impairment.

Influence of Social Acceptability and Attitudes in Restaurant Beef Consumption

ABSTRACT The competition for meeting consumer preferences for beef steak in the casual dining restaurant is increasing. In order to better understand these preferences researchers employed Sapp's expanded rational expectations intention model, a depiction of Ajzen and Fishbein's theory of reasoned action, to investigate consumers' intentions to consume beef steak in the casual dining restaurant. The expanded model added the social acceptability construct to Ajzen and Fishbein's rational expectations model. Social acceptability had significant causal path estimates for attitude, intention, and subjective norm. Additionally, researchers looked at possible gender differences in the social acceptability, attitude, and behavioral intention constructs. The path estimate between social acceptability and behavioral intention was significant for females but not for males. The attitude to behavioral intention causal path was the strongest path for both males and females; however, neither gender differed in the amount of weight placed on this causal path. The results of this study may assist the beef and restaurant industry to more effectively compete for market share by meeting consumer preferences for beef steak in the casual dining environment.