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.

A Qualitative Study on the Experiences of Congregate Meal Services from the Low-income Elderly

The elderly population in Korea is rapidly growing. As the population ages, meals become a greater concern, as physical and psychological health problems are directly affected by dietary life, especially for the lower-income elderly. Although the government provides support through a free congregate meal service, there is a lack of systematic management of this meal service. This study investigates the experience of the elderly, especially the symbolic meaning and issues regarding the congregate meal service in their dietary life, to establish strategies for improving congregate meal services. Qualitative data was collected from ten elderly receivers of meal services through in-depth interviews and data was analyzed using Colaizzi's phenomenological research methods. Overall, 90 significant statements, 13 formulated meanings, and five theme clusters were deduced. The five theme clusters for the importance of meal services to the elderly included the followings: "a real meal", "enjoyment of living", "maintenance of regular life", "place for social life" and "meal of silence". We found that the elderly regarded the congregate free meal service not only as meals to appreciate but also as a form of social life. Furthermore, the elderly did not typically express any complaints regarding congregate meal services because they are free. The results showed that it might be difficult to evaluate the quality of meal services based on the opinions of the service receivers. This study suggests it is necessary to develop multilateral evaluation methods to reflect the needs of the elderly and to improve the congregate meal services at elderly welfare centers.

Qualitative study on home delivery meal services for the elderly / 한국영양학회지

As the importance of elderly's dietary life have increased, low-income elderly's meal should be taken care by social policies. Nevertheless, there is a lack of systematic management in home-delivery meal service. This study aims to investigate the elderly's experience on home-delivered meal service, especially identifying the symbolic meaning of home-delivered meal service on elderly's dietary life. Using an in-depth interview, qualitative data was collected from five elderly participants who received home-delivered meals. Data was analyzed based on Colaizzi's 6 steps method, deriving 148 significant statements, 18 formulated meanings, and 5 themes: , , , , and . Elderly participants regarded the home delivered meal as not only a decent meal but also felt appreciated. The home-delivered meals were found to be their only meal all day; thus, they considered these meals as a means of survival. Home-delivered meals are considered as a lack of consideration for the elderly's physical condition, including their tastes, portion size, and cooking method. Also, these elderly seemed to lose their appetite due to aging and it caused the enjoyment of eating. The elderly have kept silence never expressing any opinions regarding the home delivered meals because they were offered for free. The results suggested that the home-delivered meal service should be developed with the multilateral evaluation methods to reflect the elderly's needs to improve the quality of the home-delivered meal service.

A Study on Customized Nutrition Intervention Program Design and Application for the Low-Income Elderly / 대한지역사회영양학회지

This study aimed to plan nutrition support programs for the elderly living alone whose nutrition status were seriously concerned, conducted seven stages nutrition intervention program on a trial basis, and evaluated the effectiveness of the program of the Elderly Nutrition Support Project. Subjects were selected for personalized nutrition management based on nutritional risk score and nutrition intervention were tailored to the problems occurred. The elderly nutrition support program targets were 44 senior citizens who lived alone with low income. The 33 (as Type 1) of the subjects with whom milk, tofu, seaweed, eggs, black beans have been supported, and also provide nutrition education, and the rest 11 persons (as Type 2) to whom food was not supported but provide nutrition education programs. As a result, all subjects showed that compared with pre and post program implementation, their daily exercise time and milk and protein consumption level were increased and some improvement was observed regular meals consumption and low-salt diets. Their nutrient intake level such as calories, protein, calcium, iron improved after implementation. In addition, NSL DETERMINE scores significantly improved from 13.21 to 7.24 in Type 1 and 11.27 to 9.91 in Type 2. As positive dietary behavioral changes were observed as in that they purchased more protein and calcium rich foods.

Nutritional Status and Dietary Quality in the Low-income Elderly Residing at Home or in Health Care Facilities

The principal objective of this study was to assess the nutritional status and dietary quality in low-income elderly individuals residing at home (LH) or in health care facilities (LHCF) with dietitian. This study was conducted via anthropometric measurements, questionnaire interviews, and dietary surveys using a 24 hr recall method with 120 low-income elderly individuals (LHCF=46, LH=74). The average ages of the LH and LHCF group were 76.3 years and 78.6 years, respectively. The LH group evidenced a significantly higher frequency of skipping meals than the LHCF group. The average energy intakes of the LHCF and LH group were 1921.0 kcal and 1443.9 kcal, with a significant difference (p<0.001). Most of the nutrient intake and intake rates for recommended intake were significantly higher among the LHCF group as compared with the LH group. The LHCF group showed significantly higher values for the nutrient adequacy ratio (NAR), the mean adequacy ratio (MAR), nutrient density (ND), and the index of nutritional quality (INQ) by dietary qualitative estimation than in the LH group. The Korean diet diversity scores (KDDS) were 3.66 for LH group and 4.93 for the LHCF group, thus were significantly higher in the LHCF group than in the LH group. The results of the present study demonstrate that the LH group appeared to experience more dietary problems than the LHCF group. It was suggested that nutritional education is needed for low-income elderly individuals living at home, in order for them to learn proper dietary management. This can be achieved via educational programs in social welfare institutions, incentives toward employment as a dietitian, and implementation of community-based support.

Economic Evaluation of Visitng Nurse Services for the Low-income Elderly with Long-term Care Needs / 간호학회지

PURPOSE: This study aimed to evaluate economic viability of public health center visiting nurse services for the low-income elderly with long-term care needs. METHOD: The sample consisted of 252 community dwelling elderly who enrolled in public health center visiting nurse services for three months or more. Data was collected on physical (ADL and IADL) and cognitive impairments of the elderly, contents and frequency of visiting nurse services, cost per visit, and costs of alternative services for long-term care. RESULT: The mean score of ADL and IADL levels of the elderly was 2.80.4904, which indicated these patients were mostly independent. Eighty four percent of the elderly subjects were cognitively intact. Among visiting nurse services supplied, providing assessment was 34%, followed by education and counseling 26%, medication 22%, and referral. The mean cost per visit was 17,824.1 won, which transformed into a total cost per person per year of 161,130.2 won. Comparing the cost of a visiting nurse service with those of other long-term care alternatives, the visiting nurse service was the least costly alternative, followed by an outpatient clinic, hospital based home care, and nursing home. CONCLUSION: Overall, the results of the study provide evidence of the economic viability of visiting nurse services for the low-income elderly among long-term care alternatives.

Gender and Age Differences in the Nutritional Status of the Low Income Elderly Living in Gwangju / 대한지역사회영양학회지

This study was undertaken to assess nutritional status of the low income elderly residing in Gwangju. Anthropometric data showed that mean height of the subjects was lower than that of Korean Standard Growth data but weight was similar to that standard value. As the subjects became older, their heights and weights were decreased. Body mass index (BMI) in males and females were 22.9 and 24.4 respectively. However, BMI distribution showed that 56% of the elderly females under 75 were underweight. Advancing age conoibutes significant difference in triceps skinfold thickness in females (p<0.001). Total cholesterol level was higher in the elderly females than the males. It was found that a considerable number of subjects had anemia determined by hemoglobin and hematocrit level, which indicated un iron deficiency. Twenty-four hour dietary recall revealed that, except for phosphorus and vitamin C, all the nutrient intakes of the subjects were below 75% of Korean RDA. Surprisingly, vitamin A and riboflavin intakes of the elderly were below 50% of Korean RDA. Energy intakes of the elderly males and females were 58.7% and 59.6% of Korean RDA respectively. Unbalanced energy ratios of carbohydrate, protein and fat were noted in both genders. Nutrient intakes of females' were lower than those of males'. Thus, there was a significant gender difference in nutrient intakes. It might be further suggested that an appropriate nutritional program should be developed and implemented to improve the Poor nutritional status of the low income elderly living in cities.