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Sample Research Proposal on Analysis on the Palatability of Foods as Prevention and Reduction on Malnutrition among Elders

Introduction

            Malnutrition according to medline plus (2006) is the "condition that occurs when a person's body is not getting enough nutrients and it may results from insufficient and not balanced diet, digestive and absorption problems and other medical conditions." Hope (2005) wrote that there are over 2000 nursing care homes in the United Kingdom that did not meet the required standards including the proper nutrition of elderly. The consequences of malnutrition among elders is very serious, it is correlated with infections such as anemia, ulcers, urinary tract infections, decreased wound healing and a lot more. Moreover, undernourished elders have higher mortality rates compare to healthy elders (Burger, Jones and Bell, 2000). There are a number of ways in reducing and preventing malnutrition among elders, one of them is giving nutritious and adequate meals, however most nutritious meals are not palatable to the taste of the elders. Thus there is a considerable reduction in the appetite of the elderly. Reestablishing the appetite of the elderly is an integral part of combating malnutrition. According to Noll (2004) in normal aging there are alterations that occur in the person's body in which decreases the gratifying aspects of eating. He wrote that as a person ages there is a significant decrease in the sense of smell and the ability to identify tastes in food.

 

Objectives of the study

            The main objectives of this study are to identify whether the palatability of foods have an effect in the food intake of elders and if palatable foods prevent or reduce malnutrition among elders.

 

Significance of the Study

            This study will be an efficient instrument in determining the effect of palatability of foods in the prevention and reduction of malnutrition on elders via conducting a survey. This study will be a useful in giving recommendations in ways in which the intake of food of elders will be increased especially in nursing homes.

 

Scope and Limitations

            The scope of this study concentrates on the effect of palatable taste of food in prevention and reduction of malnutrition among elderly. Other factors that prevent and reduce malnutrition will not be tackled in this study.

 

Review of Related Literature

            One of the major concerns among the elderly according to Donini, Savina and Canella (2003) is the deterioration of the intake of food. The researchers pointed out that the reduced intake of energy can be either social or physiological, or a combination of both factors. In the social aspect it can be due to poverty, loneliness and social isolation and the most common is depression mainly because of the loss of communication and association with the people around him or her. And on the physiological aspects the authors discussed that the loss of appetite may be due to reduced urge of food intake or more potent inhibitory signals. Medical conditions such as malabsorption and gastrointestinal infections can also contribute to the loss of appetite of elderly. Another factor is the medicines that elders intake which can cause medical conditions like those two mentioned above. The researchers suggested that health workers especially workers in the care home facilities must understand the factors that are partly responsible for the poor nutrition of the elders in order to develop and create proper preventive measures against malnutrition at the same time improving the health condition of the elders. In addition Noll (2004) suggested that the primary health workers can use the different strategies in restoring and elder's appetite due to the fact that reduced appetite and weight loss are mostly multifactorial and the best strategy is to recognize the fundamental reasons of weight and appetite loss among elders.

In addition, Braun, Kunik, Rabenek and Beyth (2001) discussed the risk factors that are associated with malnutrition, the normal aging, institutionalized patients and patients with Dementia. For the elders going through normal aging the common risk factors are:

(a) Physical Changes in which the senses such as smell and taste decrease that leads to decrease in appetite.

(b) Comorbidities- As a person ages multiple diseases begins to appear that may also lead to a decrease in appetite.

(c) Medications   There are a number of ways to manipulate and increase the food intake of the elderly. And among those is using flavor enhancements.

(d) Medications- this factor is related above since elders experienced comorbidity, they take a number of medications that usually diminished taste perceptions such as chemotherapeutic agents and anticonvulsants.

(e) Psychological Factors- depression is the most common psychological factor as stated by Donini et al, and most often it is untreated, depression usually decreases one's motivation to eat whether the person is young or old.

(f) Environmental Factors- elders that are not admitted to institutions and are living alone may have a problem in accessing food due to lack of transportation or ability to buy the basic necessities such as food.

For Institutionalized elders Braun et al enumerated these risk factors:

(a) Medications- just like normal aging elders, institutionalized elders experienced a number of diseases that needs medications that usually leads to the decrease in appetite.

(b) Psychological Factors- depression in institutionalized elders are more prevalent compare to non-institutionalized because elders are separated from their loved ones and friends and most of the relatives of these elders do not pay a visit, that leads to severe depression, it is reported to be the most common cause of weight loss in nursing care facilities.

(c) Environmental Factors- the environmental factors include the health workers, food and the facilities. A number of home care facilities do not have enough caregivers to assist all the elderly patients in which may lead to a decrease in the food intake. In food most home care facilities serve less palatable foods for specialized diets to residents. In facilities, a number of home care have been reported to have facilities that are not on standard which may also contribute to depression or appetite loss.

(d) Cultural Factors- in a diverse country like the United Kingdom, elders that are admitted in these institutions have diverse ethnic and cultural backgrounds in which have their own food preference that cannot be addressed in some home care facilities in a long-term basis.

            Braun et al also enumerated the risk factors on malnutrition associated with patients having dementia. Patients with dementia can either be admitted in a home care facility or not, these elders also experience the same risk factors as those two mentioned above, however there are additional factors:

(a) Comorbidities- Elders with dementia will commonly experience dysphagia or difficulty in swallowing that can lead to malnutrition because food intake will be lessen.

(b) Psychological Factors- Just like the first two types of elders, patients with dementia experience depression but are often difficult to distinguish. Moreover, psychosis is developed with these patients.

(c) Environmental Factors- patients with dementia admitted in home care facilities are often neglected whether intentionally or unintentionally due to the fact that their verbal skills are diminished making their needs unable to be known.

According to the National Policy and Resource Center on Nutrition and Ageing (1999) the decline in taste and smell is a common element in the process of ageing. The impairment of these senses is caused by a number of factors including pollution in the environment. Thus, the taste buds and smell receptors don't perform like in the previous years. The changes on taste and smell cause the diminished want for food. There are a number of ways in which the eating habits of elderly can be upgraded and one of those is to enhance the flavors of foods, adding different kinds of flavorings such as salts and herbs can improve the flavor and the smell of the food thus enhancing the pleasure of eating that add to the food consumption of the elders which prevents malnutrition.

            Furthermore, in the study conducted by Mathey, Siebelink, de Graaf and Van Staveern (2001) the researchers performed a 16-week parallel group intervention in which two treatments were made. Having the first group served meals with flavor enhancers and second group without flavor enhancers. The results have shown that there is a significant increase of body weight, dietary intake and consumption of the cooked meal in the group served with flavor enhancers in their meals whereas on the control group there have been no increase in their body weight, food consumption and dietary intake. The researchers have concluded that adding the flavor enhancers the meals is an efficient manner in improving the dietary intake and body weight of elderly. Moreover, Schiffman and Graham (2000) stated that there are manifestations that are now appearing that indicates the use of flavor enhancers on food can improve the palatability and intake of food, increase the flow of the saliva and immunity, diminish the chemosensory complaints of elders and lessen the use of table salt. Aside from improving the appetite, Schiffman and Warwick (1989) discussed that adding aroma to meals in order to compensate for reduced chemosensory operations is useful in amplifying nutrient-dense food intake among elders. 

            On the contrary, Essed, Van Staveren, Kok and de Graaf (2006) study, in which the researchers performed a blind 16 week parallel study having four treatments, control group, MSG group, flavor group and flavor plus MSG group. After 16 weeks the researchers have found out that there is no increase in the energy intake and body weight among the four treatments. The researchers have concluded that improving the taste of meals through adding flavors or MSG does not result in an increase of energy intake and body weight among the elderly.

            And because of the contradicting results on different studies, the purpose of this research is to assess and investigate the effects of palatable foods in their diet, whether their food intake increased or not.

 

Study Design       

            The questionnaires in the form of the Likert Scale will be made in order to assess the effects of palatable foods regarding the food intake of the elderly in home care facilities. Prior to conducting and disseminating the questionnaires the local research ethics must approved the questions first. In order to identify the samples a random sampling on patients of different home care facilities must be made. After identifying the samples a letter will be sent to the patients explaining the study and asking for permission to conduct a survey. If the patients did not agree to have a survey conducted to them, random sampling will be made again until the desired number of participants are achieved. Aside from the patients, the nurses and care givers of different home care facilities were also identified via random sampling. The health workers were randomly sampled based on the level of their expertise.

 

Methodology

            The questionnaires will be given to elderly patients as well as the health workers after the samples have answered the questionnaires it will be read and checked thoroughly by the researcher. The questionnaires of the elders will be answered analyzed first. The results on the research were coded and tackled manually. Next to be analyzed is the questionnaires of the health workers. Like in the patients, results were also analyzed, identified and coded manually. In the analysis of the data, Mann-Whitney Test will be used in order to measure the results.

 

Ethical Considerations

              The basic ethical principle when conducting a research is that the respondents must not be harmed physically and psychologically. If the respondent or respondents were injured during the process of research, the sample will be automatically be deleted.

        In the study, prior to conducting the survey of the researchers, the questions will be given first to the local research ethics committee for approval. After the approval of the questions the researchers will be able to proceed with the survey. Prior to the survey the elderly and health care workers, the researchers will send them a letter for invitation, included in the letter is the explanation of the study. If the elderly and health workers declined to participate in the survey the researchers will respect their decisions making it ethically adequate.


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