Methods: Residents from five medium-sized Dutch nursing homes of similar characteristics (e.g., number of staff, provision of activities, etc.) were assigned to either an intervention or a control group. The researchers were unaware of which group wards were allocated. Staff were assigned to follow standardized protocol in either the control or intervention ward, but not both. Baseline characteristics were compared between the two groups. Primary outcome measures included quality of life (measured during a face to face interview using the validated Dutch quality of life of somatic nursing home resident questionnaire), physical performance (measured based on the nursing home physical performance test), body weight (measured at the same time each day using a variety of mechanisms), and energy intake (measured by trained dieticians).

The intervention group received family style mealtimes for six months, which incorporated five elements. These included: 1) table dressing (e.g., tablecloth; flower arrangements); 2) food services (e.g., variety of meal options served in dishes on the table); 3) staff protocols (e.g., staff sit and chat with residents; no staff changes during mealtimes); 4) resident protocols (e.g., residents serve themselves unless unable; meal begins when everyone is seated); and 5) mealtime protocol (e.g., no other activities that might disrupt the meal such as cleaning). The control group received the usual undecorated individual preplated service. Nevertheless, meals offered to both the intervention and control groups were of similar weight and nutrient content. Additional staff was not required to implement or maintain family style mealtimes.

Findings: In total, 178 (63%) participants completed the study (95 in the intervention group and 83 in the control group). Baseline characteristics of the two groups were comparable. The key finding is that the intervention group remained stable in quality of life, physical performance (fine motor function), and body weight, while the control group declined significantly. There were also differences between the two groups in physical functioning, psychosocial functioning, and perceived safety. Mean energy intake for the intervention group increased significantly and decreased significantly in the control group. No difference was found in gross motor function. Overall, family style mealtimes were found to contribute substantially to the physical and psychological well-being of residents receiving the intervention. Data were adjusted for age, length of stay, sex, and all outcome measures for the effect of nursing home.

Conclusions: While there is widespread belief that a warm and social ambience during mealtimes can contribute to the overall well-being of nursing home residents, few studies have tested this hypothesis. This study found that family style mealtimes can maintain quality of life and prevent decline in physical performance and body weight of residents. Given that nursing homes around the world face limited budgets and constrained resources, this study suggests a simple and low-cost intervention (i.e., no hiring of additional staff and low cost of getting mealtime materials) that can generate significant impacts on nursing home residents in promoting physical and psychological well-being.

References: Nijs K, Graaf C, Kok F, Staveren W. "Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomized controlled trial." British Medical Journal, 2006; 332, 1180-1184.

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