Menu engineering for assisted-living elderly: a public health imperative.

Poor nutrition in older people is a growing public health concern. Menu engineering provides a way of improving the nutritional well-being of older people, however there is little published qualitative data examining how effective menu engineering actually is. Dr Meena Mahadevan from Montclair State University introduces new research which aims to close this scientific knowledge gap Background With a current annual increase rate of 2.8%, experts predict that the growth rates for the elderly population in the U.S. will continue to exceed the growth rates for the rest of the population.1 More than one million elderly in the nation currently reside in assisted- or independent-living facilities. While these individuals require a minimum level of assistance with activities of daily living, they exhibit greater cognitive capacity and functional independence compared to their nursing home counterparts. The high cost of nursing home care coupled with their desire to age at home have made this group one of the fast-growing segments of the elderly population in the past decade.2 With the continual rise in the number of older adults at such facilities, it is imperative that their health status is met and maintained in order to improve their quality of life. Nutritional well-being has been shown to play a vital role in the overall health, independence, and quality of life of all older adults.3 Tragically, studies show that most assisted-living elderly residents aren't eating well. Deficiencies of several key macro- and micronutrients have been documented while excessive intakes of fat, cholesterol, saturated fat, and sodium are also common in some, leading to an increase in chronic disease risk.4 Research suggests that there are many physiological, social, and environmental barriers that may deter this population from meeting and maintaining a good nutritional status. Medical conditions, medication side effects, and physiological changes that are an inevitable part of ageing can result in a reduced capacity to digest, absorb, and utilise nutrients. Physical incapacity and disabilities may serve as structural barriers that further diminish their ability to purchase, prepare, and consume balanced meals. Studies show that the elderly at assisted-living facilities are also unable to adopt healthy behaviours largely because of systemic barriers which include limited choice and poorly trained staffwho ignore their residents' nutritional needs.5 Nutritional risk among the elderly was found to be reduced when meal times are accompanied in the presence of others; but many assistedas well as independent-living elderly report feeling socially isolated and depressed.6 Inadequate nutrition knowledge, negative attitudes, selfdefeating beliefs that they are too old to benefit from eating healthily, rejection of food that does not elicit familiarity or comfort, and frustration over loss of control over daily food choices have all been identified as factors possibly contributing to a lack of motivation to eat appropriately among this group.7 Meal times Although significant progress has been made, the afore-mentioned barriers continue to complicate intervention effectiveness and stymie public health efforts to address the crises of poor nutrition in our senior citizens. It has been suggested that by simply adjusting menus and food preparation techniques to conform more closely to an individual's food preferences and needs, facilities can help improve their residents' food and nutrient intakes. Menu engineering research involving manipulations in the design, language, and layout of menus have shown promise in this regard. For example, boxing and placing an item in a prominent location, using descriptive language to provide more information on the ingredients and method of preparation used, and 'advertising' an item's health benefit by providing nutritional information have all been used as tools to influence the selection of certain items. …