外文翻译餐饮经验食品服务和人员安排对机构养老中老年护理的影响.docx

外文翻译餐饮经验食品服务和人员安排对机构养老中老年护理的影响.docx

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外文翻译餐饮经验食品服务和人员安排对机构养老中老年护理的影响

中文4068字

本科毕业设计（论文）

外文翻译

原文：

Diningexperience,foodservicesandstaffingareassociatedwithqualityoflifeinelderlynursinghomeresidents

Introduction

Althoughtoday’snursinghomeresidentsaremorefunctionallyandcognitivelyimpairedthantheywere20yearsago（1-5）,nursinghomesstillaimtopreserveandpromotegoodqualityoflifefortheirresidents,howeverchallengingthismaybe.Whilebothphysicalandsocialenvironmentalfactors,suchaslevelofrecreationalactivitiesandcontroloverphysicalenvironment,havefrequentlybeenincludedindeterminantsofqualityoflifeamongfrailelderlypeople（6-8）,veryfewstudieshavedeterminedwhetherinstitutionalfactors,suchasfoodandnutritionalservicesanddiningexperience,areassociatedwithqualityoflifeinLTC.

Severalotherfactorshavealreadybeenidentifiedascontributingtothequalityoflifeoftheelderlyinhealthcareinstitutions.Forexample,chronicconditions,drugconsumption,functionalabilities,swallowingdifficulties,andnutritionalstatushaveallbeenlinkedtotheirqualityoflife（9-12）.Riskofmalnutritionhasalsobeenfoundtobeassociatedwithqualityoflifeinolderadults（10,13,14）.Winzelbergetal.（9）observedasignificantcorrelationbetweenresidents’qualityoflifescoresandtheirmentalhealthstatus（i.e.,severityofcognitivedysfunctionanddepression）.

TheAmericanDieteticAssociationputforwardapositionpaperonnutritionandagingwhichstipulatesthat,alongwithenvironmentalfactors,theenjoymentoffoodandnutritionalwell-beingplayakeypartinanolderadult’squalityoflife

（1）.Thepsychologicalandsocialaspectssurroundingmealtimecanimpactonelderlyresidents’qualityoflifebyinfluencingthepleasureofeating.Mealtimestendtogiveresidentsasenseofsecurity,belonging,structureandordertotheirday.Theycanalsogiveresidentsasenseofindependenceandcontroloverdailychoices（15）.

Apotentiallinkbetweenresidents’qualityoflifeandinstitutionalfactors,suchasthoserelatedtofoodanddiningexperience,hasbeenindicatedbysomeresearchers（16-19）.Westetal.（17）foundthatmanyresidentsfeelpowerlesswhenitcomestotheirsurroundings,suchasthelibertytochoosefoodanddiningcompanions.Residentsintheirstudyrankedagreatervarietyoffoods,mealsthatareappetizing,comfortableseatingduringmeals,calmmealtimeatmosphereandrespectforfoodpreferencesasbeingamongtheirtoptenimportantfood-relatedconcerns.Similarly,Kaneetal.（19）foundthat,whenaskedtoratetheimportanceofcontrolandchoiceovercertainareasoftheireverydaynursinghomelife,residentsprioritizedhavingchoiceandcontrolovertheirfood.

Inanotherstudy,residents’qualityoflifeseemedtoimprovefollowingtheintroductionofabuffet-stylemealservice（20）.Thistypeofserviceincludedadditionalassistanceforresidentsduringmealsandabetterdiningatmosphere.Residentscouldchoosefromagreatervarietyoffoodsandcouldreceivesecondhelpingsoffavouritefoods（20）.Highcorrelationswerealsofoundbetweenresidents’qualityoflifeandtheirenjoymentoffoodandmealtimes,andbeingabletoreceivetheirfavouritefoods（21）.AccordingtoEvansetal.（22）,residentscouldadaptbettertonursinghomelifeiftheirfoodandfoodservicepreferenceswerebeingmet.

DespitestudiesthatdemonstratethatfoodandnutritionservicesanddiningenvironmentareimportanttoLTCresidents,fewstudieshaveactuallytestedwhetherthesefactorsaresignificantlyrelatedtotheirqualityoflifeusingavalidqualityoflifemeasurementtool.

Discussion

MeasurementofQualityofLife

Veryfewstudieshaveattemptedtouseasinglemeasureofqualityoflifeforbothcognitivelyimpairedandcognitivelyintactseniors;yet,forresearchersconcernedwithimprovingthequalityoflifeofallLTCresidentsthisisanextremelyimportantissue.TheQOL-Dinstrumentwasdevelopedforuseamongcognitivelyimpairedseniors,andthoughitsinternalconsistencywashigherincognitivelyimpairedresidents,itdidhaveacceptablereliabilityforusewithcognitivelyintactresidents.Forcognitivelyimpairedresidents,reliabilityresultsforallthreesubscaleswerequitesimilarbetweenSloaneetal.’s（31）studyandours（=.57to.79）.Unfortunately,Sloaneetal.（34）didnotreportonthereliabilityofthecombinedQOL-Dscale.

MeanscoresforQOL-Danditssubscalesweresignificantlyhigherincognitivelyintactresidents,whichreflectedtheirhigherqualityoflife,especiallyintermsofactivitylevels.Twopreviousstudiesfoundthatqualityoflifedecreaseswithincreasinglevelofcognitiveimpairment（9,11）;however,Winzelbergetal.（9）usedamodifiedversionoftheLogsdonetal.’s（35）QualityofLife-Alzheimer’sDiseasescale（QOL-AD）intheirstudy,whileKerneretal.（11）usedtheQualityofWell-Being（QWB）Scale.

HealthandSocio-Demographics

Overtwo-thirdsoftheresidentsinthisstudywerecognitivelyimpaired,whichissimilartopercentagesfoundbyotherstudieswithinstitutionalizedelderly（3,36）.AsignificantlylargerpercentageofcognitivelyimpairedresidentscomparedtocognitivelyintactresidentshadaBMIlowerthan20（26.8%vs9.1%）.OtherstudiesinLTCsettingshavealsoshownthatresidentswithdementia-relateddisordersaremorepronetoweightlossandmalnutrition（3,36）.Lengthofstaywasnotsignificantlyassociatedwithqualityoflifeineithercognitivelyintactorimpairedresidents,butanincreaseinthenumberofmedicalconditionswasnegativelyassociatedwithqualityoflifeincognitivelyintactresidents.Therewasnosignificantdifferenceintypesofconditionsreportedforcognitivelyintactversusimpairedresidents.Thisissomewhatsurprisingsincedifferentconditionsshouldhaveleadtotheinstitutionalizationofbothgroupsofresidents.Inaddition,Kempenetal.（12）alsofoundthatchronicmedicalconditionswerenegativelyassociatedwithqualityoflifeincognitivelyintactolderadultsinbothcommunityandinstitutionalizedsettings.

DiningExperiencesandQualityofLife

Numberofdiningcompanionswaspositivelyassociatedwithqualityoflifeinbothcognitivelyimpairedandcognitivelyintactresidents.Thisassociationmayreflectthefactthatdiningwithothersincreasessocialinteraction,whichhasbeenfoundtobeakeycomponentofqualityoflife（37）.Numberofdiningcompanionsmayalsoberelatedtophysicalsurroundings.Kayser-Jones&Schell（38）observedthatresidentswhoateintheirroomshadlittleornosocialinteractionduringmealtime.Whenresidentswereaskedtomakealistofthoseaspectsoftheirlivesthatweremostimportanttotheirqualityoflife,theyidentifiedchoiceofdiningcompanionsandwheretoeattheirmealsastheirtoppriorities（39）.

Autonomyinrelationtofood,suchasaccesstofoodbetweenmealsandhavingfoodsbroughtinbyfamilyandfriends,alsohadapositiveassociationwithqualityoflifeinbothgroupsofresidents.Thisfindingisinlinewithotherstudiesthatfoundthatresidentsprioritizehavingchoiceandcontrolovertheirfood（16,17,19）.

Independencewitheatingwaspositivelyassociatedwithqualityoflifeincognitivelyimpairedresidents.Amongcognitivelyintactresidents,96.2%wereindependentwitheatingcomparedwithonly52.1%amongthecognitivelyimpaired（2=77.186;df=1;P=.000）.Independenceineatingcangiveresidentsasenseofcontrolovertheirfoodintake.Thissenseofcontrolincreasespleasureandenjoymentassociatedwithmealtimewhichcanimpacttheirqualityoflife.Residentswhoneedassistancewitheatingoftenhavefunctionaldisabilities,swallowingdifficultiesorseveredementias,whichaffecttheirqualityoflife（9,12）.

FoodservicesandQualityofLife

Threeofthefourfoodservicefactorswerefoundtobeassociatedwithqualityoflifeamongcognitivelyintactresidents,butonlytwowereassociatedwithqualityoflifeamongthecognitivelyimpaired.Traymealdeliverysystems,comparedtobulk,werepositivelyassociatedwithqualityoflifeinbothgroupsofresidents.ThisfindingcontradictsonepreviousstudyamongLTCresidentsthatsuggestedthereisapositiveassociationbetweenbuffet-stylediningandqualityoflife（20）.Whilethisstudydidnotmeasurequalityoflife,qualityoflifeseemedtobeenhancedthroughincreasedenjoymentofboththefoodandthediningenvironment（20）.Futurestudiesmustfurtherexploretheassociationbetweenmealdeliverysystemsandresidents’qualityoflife.

Closeto70%ofmenushadbeenrevisedwithinthelastyear（mean13.0±16.9months）.Morerecentmenurevisionhadapositiveassociationwiththequalityoflifeofcognitivelyimpairedresidents.Periodicmenurevisionlikelydecreasesfooditemsthatarelesslikedbyresidentsandincreasesitemsthataremoreenjoyedbyresidents,suchthatfoodservicepersonnelandinstitutionalcaregiverscanmoreoftensatisfythepreferencesandtastesofcognitivelyimpairedresidents.Improvedmealsatisfactiononthepartofbothresidentsandstaffwouldthenenhancequalityoflifeincognitivelyimpairedresidents.

Therapeuticmenuswaspositivelyassociatedwithqualityoflifeincognitivelyintactresidents,andmorecognitivelyintactresidentswereontherapeuticmenus（54.5%）thancognitivelyimpaired（39.9%）（2=7.598;df=1;P=.006）.Themostcommontherapeuticdietsamongcognitivelyintactresidentswerediabetic,reducedsaltandlow-fatdiets.Thesemenusmaymakecognitivelyintactresidentsfeelspecial,sincetheyrequiremorefollow-upsfromdietaryandnursingstaff.AccordingtoEvansetal.（22）,manynur