Client preferences for food services in geriatrics, rehabilitation and aged care: Implications for service delivery for an ageing population

Wright, Olivia Renee Louise (2006). Client preferences for food services in geriatrics, rehabilitation and aged care: Implications for service delivery for an ageing population PhD Thesis, School of Medicine, University of Queensland.

       
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Author Wright, Olivia Renee Louise
Thesis Title Client preferences for food services in geriatrics, rehabilitation and aged care: Implications for service delivery for an ageing population
School, Centre or Institute School of Medicine
Institution University of Queensland
Publication date 2006
Thesis type PhD Thesis
Abstract/Summary The focus of this work pertains to the development of a detailed and specific measurement instrument to study the satisfaction of elderly clients with health care food services, in the longer-stay section of hospitals (geriatric/rehabilitation) and in the residential aged care setting. The study investigated one of the major causes of malnutrition, i.e. poor client satisfaction with institutional food, and developed a measurement instrument for the regular evaluation of client satisfaction with longer-stay food services. The intended outcomes from this survey are the provision of meaningful indicators of client foodservice preferences and satisfaction to assist in the management of such services. Following thorough development and pre-testing (n=40), the pilot version of the Resident Foodservice Satisfaction Questionnaire (REFS) contained a cognitive screening task, 61 items relating to foodservice attributes, an overall satisfaction question as the outcome measure and a demographic/contextual information section to allow investigation of client characteristics previously shown to influence health care satisfaction, i.e. age, gender, ethnicity, length of stay, and self-rated health. The timing of meal choice, appetite, diet type, and the time of survey administration were also investigated. Information was obtained by using a combination of closed questions and the provision for general comments via openended questions. A total of 313 survey responses were available for analysis, reflecting an overall response rate of 76 per cent. An analysis of sample characteristics indicated it was representative of the longer-stay care population. The median age was 84 years, with 26.6 per cent males and 72.1 per cent females (1.3 per cent missing for gender). Test-retest reliability was established in approximately 25 per cent of the sample (89/313). Wilcoxon signed ranks tests for continuous variables and marginal homogeneity tests for categorical and ordinal variables indicated good test-retest reliability. Factor analysis procedures revealed foodservice satisfaction in residential aged care and in the rehabilitation/geriatric hospital sector was represented by: meal quality and enjoyment (α=0.91), autonomy (α=0.64), staff consideration (α=0.79), and hunger and food quantity (α=0.67). All constructs showed good internal consistency, as their Cronbach’s alpha (α) coefficients were greater than or close to 0.70. Ordered probit regression analyses indicated that foodservice satisfaction was significantly moderated by client age (p<0.05). From the analysis of stratum-specific models, marginal effects on outcome probability estimates demonstrated that clients aged 75-84 years were more likely than those aged less than 65 years to rate overall foodservice satisfaction as “very good” (Pr = 0.23), and this positive association also occurred for clients aged 95 years or more (Pr = 0.27); however, clients aged 85-94 years were less likely to provide this overall rating (Pr = 0.19), suggesting a non-linear relationship between satisfaction and age. This is an important conclusion, as it differs from the majority of published literature, where higher levels of satisfaction with services are associated with advancing age. Furthermore, the results suggest that foodservice variables representing client autonomy and choice, appetite and perceived health status appear to exert a greater influence in the longer-stay setting than food quality per se. Therefore, the survey instrument and models of foodservice quality developed are expected to make a substantial contribution to the practical measurement and application of foodservice satisfaction results in longer-stay care. They provide evidence for modifications to current menu planning and foodservice delivery methods, particularly regarding the reduction of the time-lapse between resident meal choice and consumption, augmentation of the number of meals at which choice is offered (i.e. lunch and dinner) and the fostering of resident autonomy and ownership of food choices through consultation of resident preferences. The finding that foodservice delivery aspects appeared to be more important to clients than food or meal service quality indicates that small, simple changes to the organisation and management of the delivery of food services could markedly improve client satisfaction levels, without incurring additional costs. It is expected that this would have positive economic implications of improving food consumption, client health status, minimising the risks of malnutrition and reducing the likelihood of food wastage. In addition to these practical service delivery changes, the results may be applied to refine the food and nutrition components of the existing Aged Care Accreditation Standards to improve their applicability to clients of residential aged care facilities. Further, they may assist in the design of inaugural foodservice policies for longer-stay care in Australia, to ensure the preferences of current aged care clientele are catered for and to monitor the potential service delivery changes required as a proportion of the ageing population enters formal care.

 
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Created: Fri, 21 Nov 2008, 14:19:59 EST