Meal and Food Provision Services for Community-dwelling Vulnerable Older Adults Perceived by Health & Welfare Service Providers in Seoul

The purpose of this study were to identify the dietary practices of vulnerable older adults and to assess the foodservice and food provision service programs perceived by the health and welfare service providers in the community. A survey was conducted on health and welfare service providers working in outreach community centers and community health centers in Seoul. A total of 260 nurses and social workers participated in the survey and 224 responses were used for data analysis after excluding significant missing data. The respondents consisted of nurses (58.5%) and social workers (41.5%). In terms of the dietary life of the vulnerable older adults, they perceived that the food cost was burdensome to the older adults and poor dental conditions prohibited them from eating various foods. The health and welfare service providers rated highly for ‘home-delivered meal and side dish services are effective for checking older adults’ conditions' but rated low for availability of menu choices. In targeting vulnerable older adults for food and nutrition service programs, the home-delivered meal service was found to be suitable for older adults living alone, those over age of 80 years, those with mobility difficulties, and those with economic difficulties. The food provision service was appropriate for older adults living with their spouse or other family members. Vulnerable older adults are a heterogeneous population with diverse needs related to food and nutrition. Home-delivered meal/side dish service and food provision services will achieve their goals when they reach the correct targets with a customized service.

A Qualitative Study on Attitude, Acceptability, and Adaptation for Home-delivered Meal Services in the Korean Elderly from the Perspective of Life Context / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to suggest the strategies for improvement of home-delivered meal services for the elderly, to identify reasons for recipients to get started with the services and to evaluate the attitude, acceptability and adaptation of recipients to the services from the perspective of life context. METHODS: The data was collected through face-to-face in-depth interviews with eighteen low-income elderly recipients of home-delivered meals and analyzed using a qualitative research method. RESULTS: The results were deduced as four themes which comprised of long-term vulnerable socioeconomic contexts resulted in entry to the services, conflicting acceptability to the services, passive adaptation to taking the services, and positive practices to cope with supplement free meals or other services. The service participation was initiated because of a combination of prolonged, vulnerable socioeconomic contexts, including poverty and unexpected life events such as diseases, disability, living alone, aging and unemployment. With regard to taking the services, conflicting acceptability was observed: positive aspects including saving living cost and good quality of meals, and negative aspects including lack of a tailored service and feeling of stigma. Although the recipients needed an individualized service, they did not express their needs and demands for the services and they accepted the unavailability as an accustomed, prolonged vulnerable socioeconomic context. With regard to lack of tailored services, either self-solution such as modification of eating patterns or community-based network and services were used. CONCLUSIONS: We suggest that a system to concretely identify recipients' attitude, acceptability and adaptation for home-delivered meal services should be developed in the establishment of a tailored nutrition support system for the low-income elderly.

Clients' Handling and Consumption of Home-delivered Meals at Home and Their Perceptions on Home-Delivered Meal Services for Older Adults / 대한지역사회영양학회지

The purposes of this study were to investigate recipients' handling and consumption of home-delivered meals at home and to assess their perceptions on home-delivered meal services for older adults. A total of 312 elderly people who received home-delivered foodservice were surveyed using an individual interview technique. A statistical data analysis was completed using SPSS (ver. 14.0). It was found that 90.2% (n = 166) of the lunch box recipients received services for six days per week, and 76.6% (n = 95) of the side-dish recipients got services once per week. More than half of the clients reported that they cooked meals by themselves on days when meals were not delivered. The two hundred thirty-two (75.3%) ate their meals as soon as they were delivered. It was found that 66.8% of the lunch box recipients and 7.3% of the side-dish recipients left delivered meals on the counter (at room temperatures) before eating. Only 11.4% of the lunch box recipients and 48.4% of the side-dish recipients kept delivered meals in the refrigerator before eating. Less than half of the lunch box recipients consumed all foods they were served at once. The reasons the recipients did not eat their all meals delivered at once were "saving for next meals" and "big portion size". Of those clients who left delivered meals, 19% of the lunch box recipients and 9.7% of the side-dish recipients ate leftovers without reheating. An average score of quality of delivered meal services was 3.5 out of 5 points. The results suggest that the clients of the home-delivered meal service should be provided information on proper handling and consumption practices with delivered meals at home. The findings of the study will be used to develop nutrition and food safety management guidelines for senior foodservice.

Analyzing the Current Practice of the Home-Delivered Meal(HDM) Service Program for Homebound Elderly / 대한지역사회영양학회지

The purpose of this study was to research the current home delivered meal (HDM) service programs for seniors living in the community. Fifty seven centers which operated a HDM service program were surveyed with respect to their administrative structure, menu management, food purchasing and production management, hygiene and equipment and facility. -Statistical data analyses were completed using the SAS 8.1 program for descriptive analysis and t-test. The results showed that 55 percent of the study group were from 70 to 79 years old. All of the participants received free HDM. As a result of the meal cost analysis, the meal cost at 56.1% of the HDM service centers was from won2,000 to won2,499 per meal. A total of 68.4% of the HDM service centers were operated without the services of a dietitian. According to the menu analysis, all nutrients except Vitamin B2 were at levels of more than 33% of the Recommended Dietary Allowances for Koreans. Although 96.6% of the HDM service centers required a therapeutic diet menu for the health of the elderly recipients, 68% of the directors responded that they could not afford to serve therapeutic meal. Food purchasing, menu planning and other foodservice management processes were handled by non-professionals, such as volunteers, cooks or social workers. Forty two percent of the HDM service centers never used standard recipes. For determining portion sizes, 75.4% of the HDM service centers depended on personal experience. Finally, the current HDM service programs for the homebound elderly were not operated systematically. It is suggested that professionally trained personnel should be included among the staff members to provide a more effective HDM service. The HDM service programs should be supported financially and systematically by the government.

Satisfaction Measurement and Needs Analysis of the Beneficiaries of the Elderly Meal Service Program

In the process of devising an efficient meal service system for the elderly, 478 elderly were interviewed at 6 different social centers with the elderly meal service program in Seoul area to monitor degree of satisfaction and/or needs of the beneficiaries regarding the program. The survey was conducted during the month of December 2002 by well-trained interviewers using self-developed questionnaire. Results were analyzed statistically using SAS package program. Most of the beneficiaries were low economic class and 76% of them had doctor diagnosed disease(s). Among the beneficiaries of congregate meal service, mean score of 12 aspects of satisfaction was 3.72 out of 5. For most of the questions, female elderly and healthy elderly responded with higher score than male elderly and unhealthy elderly, respectively (p<0.05, p<0.01). On the other hand, beneficiaries of the home-delivered meal service were little bit less satisfied with the service (3.54 out of 5). Compared to the beneficiaries of congregate meal service, larger portion of beneficiaries of home-delivered meal service wanted more meats (28.5 % vs. 17.1 %) and vegetables (23.2 % vs. 12.3 %) as side dishes. On the other hand, the most preferred type of cooking and/or seasoning was stewing for both cases. Based on these findings, it is suggested that more fresh foods should be used than processed foods in the preparation of meals for the elderly and, more fish-, meat- and vegetable- dishes should be served to come up to the needs of the elderly. Onto this, mainly Korean style meals with some intermittent Western, Japanese or Chinese style meals served at the right temperature would suffice most of the elderly needs.

Satisfaction Measurement and Needs Analysis of the Beneficiaries of the Elderly Meal Service Program

In the process of devising an efficient meal service system for the elderly, 478 elderly were interviewed at 6 different social centers with the elderly meal service program in Seoul area to monitor degree of satisfaction and/or needs of the beneficiaries regarding the program. The survey was conducted during the month of December 2002 by well-trained interviewers using self-developed questionnaire. Results were analyzed statistically using SAS package program. Most of the beneficiaries were low economic class and 76% of them had doctor diagnosed disease(s). Among the beneficiaries of congregate meal service, mean score of 12 aspects of satisfaction was 3.72 out of 5. For most of the questions, female elderly and healthy elderly responded with higher score than male elderly and unhealthy elderly, respectively (p<0.05, p<0.01). On the other hand, beneficiaries of the home-delivered meal service were little bit less satisfied with the service (3.54 out of 5). Compared to the beneficiaries of congregate meal service, larger portion of beneficiaries of home-delivered meal service wanted more meats (28.5 % vs. 17.1 %) and vegetables (23.2 % vs. 12.3 %) as side dishes. On the other hand, the most preferred type of cooking and/or seasoning was stewing for both cases. Based on these findings, it is suggested that more fresh foods should be used than processed foods in the preparation of meals for the elderly and, more fish-, meat- and vegetable- dishes should be served to come up to the needs of the elderly. Onto this, mainly Korean style meals with some intermittent Western, Japanese or Chinese style meals served at the right temperature would suffice most of the elderly needs.