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.

Comparison of Nutrient Intake and Meal Service Satisfaction of Elderly at the Local Community Centers:Free and Reduced Meal Service Charge / 대한지역사회영양학회지

The purpose of this study was to compare the nutrient intake and foodservice satisfaction of homebound elderly had lunch at the local community centers by the difference of meal service charge. Two local community center with congregate meal service program located in Daegu and Gyongsan were selected; one with free of meal service charge (F), and the other with 500-1,000 won for meal service charge (K). According to the dietary assessment, energy and nutrient intakes of the 156 elderly subjects were as a whole under the Korean Recommended Dietary Allowance (RDA). Elderly of F service center showed higher % RDA for the selected nutrients and MAR (mean adequacy ratio) than those of K service center (p<0.001). Participants were satisfied with most of the congregation meal service from community center with different reasons such as 'tasty (K service center)' and 'free of charge (F service center)'. In conclusion, elderly had the lunch at the community center with free of meal service charge was poor nutrition status and lower socioeconomic level than the other type of community center in this area. Therefore, healthy menu for elderly should be developed and managed by professional dietitian, as well as its impact on health status of this group, and congregate meal service system might be extended to the homebound elderly of whole community with free of charge.

Comparison of Nutrient Intake and Meal Service Satisfaction of Elderly at the Local Community Centers:Free and Reduced Meal Service Charge / 대한지역사회영양학회지

The purpose of this study was to compare the nutrient intake and foodservice satisfaction of homebound elderly had lunch at the local community centers by the difference of meal service charge. Two local community center with congregate meal service program located in Daegu and Gyongsan were selected; one with free of meal service charge (F), and the other with 500-1,000 won for meal service charge (K). According to the dietary assessment, energy and nutrient intakes of the 156 elderly subjects were as a whole under the Korean Recommended Dietary Allowance (RDA). Elderly of F service center showed higher % RDA for the selected nutrients and MAR (mean adequacy ratio) than those of K service center (p<0.001). Participants were satisfied with most of the congregation meal service from community center with different reasons such as 'tasty (K service center)' and 'free of charge (F service center)'. In conclusion, elderly had the lunch at the community center with free of meal service charge was poor nutrition status and lower socioeconomic level than the other type of community center in this area. Therefore, healthy menu for elderly should be developed and managed by professional dietitian, as well as its impact on health status of this group, and congregate meal service system might be extended to the homebound elderly of whole community with free of charge.

Analyzing the Operational Differences of Foodservice Center for Homebound elderly by the Presence of the Dietitian

The purposes of this study was to analyze the operational difference of foodservice center for homebound elderly by the presence of the dietitian. The questionnaire was developed to measure all variables for menu management and distributed to 103 meal service centers in charge of congregate meal service program and 57 centers for home-delivered meal service program. The data of 160 centers in charge of congregate meal service and home-delivered service centers were usable for analysis. Statistical data analysis was completed using the SAS 8.1 package program for descriptive analysis and chi-square test. Only 21.9% meal service centers had dietitians, what is more, they were not professionals who did menu management but foodservice managers, volunteers, cook or social workers. The current foodservice programs for the homebound elderly were operated without professional. In the part of menu managemet, dietitians were more actively involved in menu planning in the elderly foodservice center in the presence of the dietitians. The performance level of healthcare service was not significantly different, but the nutrition education in the elderly foodservice center with the dietitians was more frequently performed than that without the dietitians(p<0.05). In the food purchasing and food production management, the significant differences were shown that in the elderly foodservice centers in the presence of the dietitians, the proportion of the contract purchasing was significantly higher than that of direct purchasing(p<0.01). In food sanitary management, the significant differences were not shown in the part of management of keeping meal for identifying the cause of food-borne illness and left-over, but the sanitation education for the foodservice employees was performed more frequently by the presence of the dietitians(p<0.01). In conclusion, the foodservice management was more systematically conducted in the elderly foodservice centers in the presence of the dietitians than that without dietitians. The elderly foodservice program has offered the health-related support for homebound elderly. Although there were several problems in elderly foodservice management, the program delivered well-targeted, effective, and efficient nutrition services and wide range of supportive service to the at-risk older population. It needs to be managed by professional for the improvement in the elderly foodservice.

Analyzing the Operational Differences of Foodservice Center for Homebound elderly by the Presence of the Dietitian

The purposes of this study was to analyze the operational difference of foodservice center for homebound elderly by the presence of the dietitian. The questionnaire was developed to measure all variables for menu management and distributed to 103 meal service centers in charge of congregate meal service program and 57 centers for home-delivered meal service program. The data of 160 centers in charge of congregate meal service and home-delivered service centers were usable for analysis. Statistical data analysis was completed using the SAS 8.1 package program for descriptive analysis and chi-square test. Only 21.9% meal service centers had dietitians, what is more, they were not professionals who did menu management but foodservice managers, volunteers, cook or social workers. The current foodservice programs for the homebound elderly were operated without professional. In the part of menu managemet, dietitians were more actively involved in menu planning in the elderly foodservice center in the presence of the dietitians. The performance level of healthcare service was not significantly different, but the nutrition education in the elderly foodservice center with the dietitians was more frequently performed than that without the dietitians(p<0.05). In the food purchasing and food production management, the significant differences were shown that in the elderly foodservice centers in the presence of the dietitians, the proportion of the contract purchasing was significantly higher than that of direct purchasing(p<0.01). In food sanitary management, the significant differences were not shown in the part of management of keeping meal for identifying the cause of food-borne illness and left-over, but the sanitation education for the foodservice employees was performed more frequently by the presence of the dietitians(p<0.01). In conclusion, the foodservice management was more systematically conducted in the elderly foodservice centers in the presence of the dietitians than that without dietitians. The elderly foodservice program has offered the health-related support for homebound elderly. Although there were several problems in elderly foodservice management, the program delivered well-targeted, effective, and efficient nutrition services and wide range of supportive service to the at-risk older population. It needs to be managed by professional for the improvement in the elderly foodservice.

Current Status and Management of Congregate Meal Service Program for the Elderly at Community Centers

To investigate current status of the elderly meal service program, community centers nationwide were surveyed for congregate meal services. The survey was conducted during the month of December 2002 by mail using self-developed questionnaire on administration, staffs, funding, and meal service management. Only 95 out of 356 community centers (27%) answered and returned the questionnaires, and congregate meal menus were also collected from 20 centers for 492 days. Results were analyzed using SAS package program. In more than half of the elderly congregate meal service programs, following criteria were used in multiple form to allow participation; 65 years old or older, low income, or living alone. All centers served lunch, most of them free of charge, and 88.4% of them provided service 5 days a week. About 79% of the total cost occurred on the congregate meal service was supported by the government. Most of the menus served at congregate meal service were Korean style dish with rice. On the average, each meal provided 3 side dishes including kimchi, in addition to soup or stew. Only 19% of the centers have employed dietitian working for meal service programs; meal menus were prepared by social welfare workers or other non-dietetic personnels in more than 80% of the centers. Food purchasing and food hygiene control was also practiced mainly by social welfare workers or cooks. This study suggests that dietetic professionals are needed to better manage meal service programs for the elderly in both aspects, food hygiene and nutrition. Development of more nutritious menus and determination of appropriate serving sizes for the elderly meal service programs are necessary to meet the RDAs and dietary action guide for the elderly.

Analyzing the Current Congregate Meal Service Program for Homebound Elderly / 대한지역사회영양학회지

The purpose of this study is to examine the current congregate meal service program for homebound elderly. One hundred three meal service centers in charge of the congregate meal service programs as part of the elderly foodservice program were surveyed for administrative structure, menu management, food purchasing and production management, hygiene, equipment, and facilities. Statistical data analyses were completed using the SAS 8.1 program for descriptive analysis and ANOVA. The meal cost of 54.4% of the congregate meal service centers ranged from won1,500 to won1,999 per meal. According to the menu analysis, all nutrients except calcium and Vitamin B2 were at levels of more than 33% of the Recommended Dietary Allowances for Koreans. A total of 81.5% of the centers were operated without the services of a dietitian, and food purchasing, menu planning and other food-service management processes were handled by non-professionals, such as volunteers, cooks or social workers. Although 88.3% of the centers required a therapeutic diet menu for the health of the elderly, most directors (77.6%) replied that in their current status they could not afford to serve therapeutic diets. These results suggest that financial and systematic supports by government is very necessary. Fifty-five percent of the centers never used standard recipes. For determining portion sizes, 93.2% of the congregate meal service centers depended on the personal experience of the personnel. Finally, the current congregate meal services for the homebound elderly were not operated systematically. To improve the elderly food service program, it is strongly recommended that it be managed by professionals.

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.

Satisfaction of the Elderly toward Free Congregate Meal Service / 대한지역사회영양학회지

This study was designed to determine the attitude and degree of satisfaction of recipients toward the meal service program for elderly people. Nine hundred and eight elderly people(male: 301, female: 607) were interviewed by trained personnel. The results were as follows. Forty two percent of them had no income and 43.8% of the respondents were supported economically by the government. Their main reasons for attending the free congregated meal program was economic hardship(37.9%) The channels of becoming aware of the free meal program were through their friends(33.4%) and the meal service centers were located in the respondents residence area(36.0%) Thus any other advertisement from local government of official channels about the free meal program were not effective for the elderly 26.9% of the respondents felt inconvenience in visiting the meal service centers because they had some difficulty in walking, 53.5% of them however answered that they didn t have any complains and were quite satisfied with the meal service. The average satisfaction score for the free meal service was 63.4(maximum score 75) As for each evaluation item respondents were highly satisfied with volunteers attitude in meal serving(4.58+/-0.65: maximum 5 point) The evaluation score of females was generally lower than that of males(p<0.05) Oncemore, respondents who were in lowere socio-economic classes were marked by having significantly lower satisfaction scores for the meal service compared with higher scocio-economic classes. For the welfare of elderly people, meal service programs should be extended to more elderly persons and developed considering the elderlys ecological factors.