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This study, like its predecessor, "Comer a gusto, vivir con calidad", aims to increase the well-being, nutrition and hydration of people living in nursing homes. The research is integrated into a process of institutional change of the care model at the Matia Foundation and is developed from a participatory action research approach that includes the creation of mixed research and professional care teams. The present study is the first initiative developed in our context in order to establish the effects of changes, associated with a Person-Centered Care, in the environments of residential dining rooms, on clinical, behavioral and well-being parameters of people with cognitive impairment living in psychogeriatric units. Each center carried out the implementation of the practices sequentially. One meal session was recorded every two weeks for four months for a total of eight accompaniment recordings in five gerontological centers. Through the Mini Nutritional Assessment scale, observation procedures and behavioral recording, nutritional status, hydration and satisfaction were assessed, finding statistical changes in weight, increases in nutritional status and hydration in the sample as a whole. Satisfaction increased in several centers, showing different results that can be linked to the different implementation of practices in each center.
Main objective
The study is framed within a participatory action research approach so that the following objectives can be extracted:
- At the action level: to improve the satisfaction and nutrition of the people residing in the centers through the generation of practices of the Person-Centered Care Model (hereinafter MACP).
- At the research level: to document the practices generated in the centers for the improvement of quality of life (QoL) and nutrition.
Specific objectives
- To increase the satisfaction of the participants.
- Improving the nutrition of people living with dementia through:
- To reduce the risk of malnutrition among participants.
- To reduce the risk of dehydration of the participants.
- Promote and consolidate changes in professional environments and practices consistent with the characteristics of each intervention context.
- Contribute to the attitudinal and behavioral change of professionals necessary to move from the "task to the person".
- Validate empirically relevant practices for the improvement of well-being, enjoyment, nutrition and hydration.
- Develop collaborative intervention procedures that favor the implementation and consolidation of new practices within the PCA framework.
Results
The results show, broadly speaking, a slight to significant improvement in nutritional aspects such as: intake, weight gain or hydration, which would represent an intervention option according to the MACP with possibilities of being replicated in other contexts and situations.
On the other hand, the results on emotional effects such as satisfaction are shown to be more complex in the analysis, with a great variability in the centers and a certain contradiction between the data collected as a whole and the clinical impression of the professionals. This may be due to several aspects such as the relative contribution of the sample of the centers to the overall average (centers in which participants show higher satisfaction but their number is lower compared to other centers that provide more participants), lack of systematicity of the measures and data loss, subjective biases, the reliability of an unvalidated ad hoc instrument for the assessment of such a complex aspect as satisfaction in people with dementia or the fact that people are in a state of fragility and deterioration that tends to increase over time. Other aspects that should be considered as limitations of the study are the relatively small sample (1 recording every two weeks implies the recording of 7% of the events in a meal situation) and the absence of an equivalent control group that could provide information on the evolution of people in intervention situations. Although this approach was deliberate with the intention of not interfering with or overburdening the centers in its implementation, it leads us to reflect on the need to optimize the evaluation process, taking into account the objectives of the study and the resources available to the care professionals.
This research has been recognized with the 2018 Nutrisenior Award, an award from FontActiv, the adult nutrition brand of Laboratorios Ordesa, and the portal Inforesidencias.com, which recognizes initiatives promoted by residences and centers for the elderly that improve the food and nutrition of the elderly.
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