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Dining Alone vs. Communal Dining in LTC Facilities

Sandra G. Fleet

School of Nursing, James Madison University

NSG 464: Introduction to Nursing Research

Dr. Nena Powell

April 11, 2021

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Dining Alone vs. Communal Dining in LTC Facilities

One thing is for sure and that is mealtimes in a long-term care facility are a big deal to the

residents that live there. Weight loss due to social isolation in nursing facilities has increased

due to the Covid-19 pandemic. For almost a year, residents have been required to eat their meals

in their room instead of the dining hall due to restrictions from the pandemic. One may wonder

how the effects of dining alone on weight loss is compared to communal dining for these

residents. An intervention, while staying within the guidelines, is to rotate shifts with fewer

residents in the dining hall at one time and still maintaining social distancing and safety. This

will ensure all residents have their dining experience while being safe. Familiarity, routine,

tradition, and psychological and emotional togetherness with others is what should take place in

the dining halls of resident care centers at mealtimes.

Over the past year, many long-term care facilities have seen a weight decline in many of

their residents. Malnutrition can be prevented and treated; however, it remains a frequent issue

in facilities that house long-term care residents (Iuglio et al., 2018). Social challenges, as with

the restrictions from the pandemic, take away from the traditions of mealtime often leading to

poor nutritional intake and malnutrition. Greater attention on socialization during meals can

increase one’s nutritional intake, standard of life, and wellbeing (Morrison-Koechl et al., 2021).

Meals are a tradition for most people even for those living in a care facility. Mealtime is

a time for structure and routine, both of which work together providing food intake and

socialization. Gathering around a table and eating with others is common in most cultures as it is

a social event that brings everyone together. The dining hall within long-term care facilities

should be no exception as it serves as a gathering place, providing a realistic setting. Morrison-

Koechl et al., (2021) noted that this is very important, especially for those that live with
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dementia, as this may be their only chance throughout the day for social engagement.

Malnutrition and irregular intake of food has been connected to increased cognitive and

functional impairment, difficulty swallowing, eating challenges, decreased body mass index, and

a higher incidence of death (Morrison-Koechl et al., 2021).

One study among residents of a nursing facility concluded that family-style meals, where

members of the staff sat down with the residents and socialized, increased resident food intake

and prevented weight loss (Tani et al., 2018). A natural environment where residents sit together

for meals has a calming effect. Prior studies on a smaller scale found a greater relationship

between eating alone and death in the older adult population and the risk was greater for men

than women (Tani et al., 2018). Tani et al., (2018) suggested that advocating for a dining area

where residents of care facilities eat together at mealtimes may in fact protect their health.

There have been many ideas and suggestions on how to decrease malnutrition in long-

term care facilities to increase residents’ desire to move forward. Easing the stress of residents

going from being independent into a care facility can be extremely helpful for some and have

positive long-term effects on their health and wellbeing (Watkins et al., 2017). Depression

among residents in care facilities can occur due to medical issues; however, when combined with

anxiety, loneliness, and an empty mood, the state of health and wellbeing becomes a major

concern. Watkins et al., (2017) noted that depression and a lack of interest have each been

related to weight loss in long-term care residents. The mealtime experience is an essential part

of daily life and a crucial point for caring for residents; therefore, the experience may be one that

gives more meaning to their quality of life.

For residents in a long-term care facility, mealtimes are more than just about eating.

Mealtimes provide staff and the residents the means to build and keep relationships needed for
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social engagement. Meals are essential to traditions, how one identifies, and family life and food

can be a means of providing comfort, discussing feelings, celebrating, and enjoying others

(Watkins et al., 2017). In some instances, like during stressful times or in unfamiliar

surroundings, food may be the one thing that greatly shapes their quality of life.

Recently there has been change of focus from nutrition to attention being centered on the

whole meal (Odencrants et al., 2019). Odencrants et al., (2019) found that most residents

described a meal as an activity involving at least two people, that meals for them related to a

custom, and that they rarely were given the opportunity to make their own choices. Older

residents in care facilities do miss deciding what, when, and with whom to eat. Residents do not

always eat because they are hungry, they often eat because being in the dining hall is a social

event. It is the highlight of the day for some and a reason to get out of their room. Some

residents say they are not bothered by the quality of food, though it helps, but just enjoy the time

they get to spend with others. Others describe how the smell of a certain food brought back

memories and how they could pause and enjoy the moment. When residents eat together, they

eat more; having several residents together extends the length of the meal and residents are

enticed to eat more (Odencrants et al., 2019). Being in the dining hall, its atmosphere and

environment, can bring about a fulfillment of joy and togetherness.

The atmosphere and environment influence the dining experience. Sadly, many long-

term care facilities continue to have institutional characteristics in the dining area, such as

isolated kitchens and a lack of accessible snacks between meals (Iuglio et al., 2018). Key

elements associated with the dining area such as décor, color, sound, and lighting contribute to

the experience (Keller et al., 2018). Modifying the lighting in the dining area can increase

individual eating performance beings many older adults have sensitivity to glare and may need
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extra light due to vision changes. Adequate lighting has shown to be favorable as far as quality

of life and nutritional status (Iuglio et al., 2018). Along with this, having choices during

mealtimes, such as where to sit, had positive outcomes. According to Keller et al., (2018), the

psychosocial and physical characteristics of the dining environment are inevitably interrelated.

As restrictions are gently being lifted and visitors are carefully being allowed back into

nursing facilities, social engagement will increase and so will the dining experience. While there

are still procedures and mandates that must be followed, interventions must be in place to allow

for mealtime dining experiences in a safe and effective way while still following social

distancing guidelines. One intervention is to rotate in groups to the dining hall for all meals.

One staff member will oversee the process and other members will ensure residents are sent to

the dining hall at their assigned time. This will allow all residents to continue to gather and

socialize in the dining hall during meals.

Social isolation has a negative impact on the quality of life and nutritional intake in long-

term care residents. Habits and traditions, psychological and emotion connections with other

care residents, and familiarly and routine were three topics that were discussed. As Watkins et

al., (2017) stated, meals are essential to traditions and how one identifies. Social togetherness

builds psychological and emotion connections with other care residents. Social engagement is a

critical part of maintaining quality of life. Mealtime is a time for structure and routine, both of

which work together providing food intake and socialization. As said before, familiarity,

routine, tradition, and psychological and emotional togetherness with others is what should take

place in the dining halls of resident care centers at mealtimes.

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References

Iuglio, S., Keller, H., Chaudhury, H., Slaughter, S., Lengyel, C., Morrison, J., Boscart, V., &

Carrier, N. (2018). Construct validity of the dining environment audit protocol: a

secondary data analysis of the Making Most of Mealtimes (M3) study. BMC Geriatrics,

18, 1–N.PAG. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778623/

Keller, H., Chaudhury, H., Pfisterer, K., & Slaughter, S. (2018). Development and inter-rater

reliability of the mealtime scan for long-term care. Gerontologist, 58(3), e160–e167.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946921/

Morrison-Koechl, J., Wu, S., Slaughter, S., Lengyel, C., Carrier, N., & Keller, H. (2021). Hungry

for more: Low resident social engagement is indirectly associated with poor energy

intake and mealtime experience in long-term care homes. Appetite, 159.

https://www.sciencedirect.com/science/article/pii/S0195666320316664?via%3Dihub

Odencrants, S., Blomberg, K., & Wallin, A. (2019). "The meal is an activity involving at least

two people"-Experiences of meals by older persons in need of elderly care. Nursing

open, 7(1), 265–273. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/nop2.387

Tani, Y., Kondo, N., Noma, H., Miyaguni, Y., Saito, M., & Kondo, K. (2018). Eating alone yet

living with others is associated with mortality in older men: The JAGES Cohort Survey.

Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 73(7),

1330–1334. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146753/

Watkins, R., Goodwin, V., Abbott, R., Hall, A., & Tarrant, M. (2017). Exploring residents’

experiences of mealtimes in care homes: A qualitative interview study. BMC

Geriatrics, 17, 1-9.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506571/
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