This study explored the experiences from a shared-meal intervention including nursing students and elderly people living at home receiving home care. Our findings are presented according to the following themes: “improved meal preparation”, “mixed meal experiences” and “significant experiences contributing to improved nutritional status”. The quotes are numbered and marked with an S (student) or an E (elderly) to clarify the sender.
Improved meal preparation
Improved meal preparation consists of important factors involving the meal surroundings and the facilitation and tailoring of the meal and environment. Both students and elderly participants were involved.
Mealtime environment
There were many examples of students and elderly participants making small adjustments to set a nice table and present the food in a beautiful way. Each of the participant pairs solved this differently. Some students performed these activities on their own, while some elderly persons prepared their home environment alone prior to the shared meal, and in some situations, the students and elderly participants did this together. The meals used in this project were ready-made meals that required heating:
We eat a meal and facilitate … and make sure her sitting position is good. We don’t just say “hi, let’s eat”, but we think about the meal environment as well. S#8
We found that the students and elderly participants improved the appearance of their meals by putting the food on nice plates and in bowls. They thought this was more beautiful:
The first time we put the food directly on the plate, but then we experienced that it was better to put the food in trays and serve ourselves. The first time we did it, she only had two meatballs and a spoonful of mashed potatoes. I thought: “Is this all she is having?” (laughter) But then she helped herself three times because she liked it so much, which was very nice. It showed that she wanted more food when we sat and talked, and she could help herself. S#9
Many elderly participants also used tablecloths, napkins, lit candles and decorated the table with flowers to make the food and meal situation more appetizing:
We turned off the radio when we ate. And she had already put out some nice napkins and a tablecloth and some flowers. The meals were very pleasant. S#4
We did it together. I think she experienced coping and a feeling of having a guest in the house by setting the table. S#9
Food and nutrition tailoring
Food and nutritional tailoring are important to adjust the meals and food to the various individuals’ needs. Although nutritious and tasteful, the ready-made meals were not fortified or energy dense. Ready-made meals have limited possibilities for individualization, but many students nevertheless managed to adjust the meals according to the needs of the elderly persons in various ways, e.g. by improving the energy and protein content and adjusting the portion size. The nursing students ordered the same meal as the elderly participants they were paired with to be able to mutually share the taste experience, and the students chose food that they thought the elderly person would be familiar with when they experienced difficulties choosing a meal from the menu:
I ordered the same food for her and me for us to have something in common. It is nice to talk about the food when we eat the same meal. S#10
I think it is useful for her, me being there eating with her. Because then we do something together. S#3
Many nursing students helped the elderly persons with smaller portions of food when their appetite was poor. Smaller portions can be more appetizing for elderly persons with a decreased appetite:
Some days her appetite was poor. I said: “we can share a portion, you and I?” Then she ate a small portion. It was not ideal, but better than nothing. S#3
We had two portions of the same meal and put the food on serving plates. Then we could help ourselves at the table and the portion would be smaller when appetite is poor. S#1
The students also managed to fortify the meals using extra butter, oils, cheese and cream where appropriate. To enhance the elderly persons’ nutritional intake, the students also provided an additional dessert. When the elderly persons had decreased taste sensation, the student used additional herbs and spices with the meal to improve the elderly persons’ taste experience:
But of course, we put extra butter in the mashed potatoes, little things that fortify the food. S#9
Many of the elderly participants were used to eat ready meals and were involved in the fortification of the food. The dessert was a positive contribution and improved the nutritional and energy content of the meal:
The elderly woman liked something sweet following the meal. The last day, I brought donuts that we ate. She liked that a lot. S#3
She really appreciated the dessert. She did not always finish the main meal. She put it aside and saved it for the evening, but she always managed to finish the dessert. S#10
Environment affecting the meal
We found that the students tried to create a good atmosphere for sharing a nice meal together with their elderly partner. Many students were concerned about empowering the elderly participants and tried to explore what mattered to them:
I was very lucky. We had a good chemistry and it was all very nice. I looked forward to the meal and thought this is going to be nice. I tried to think: “What can be good for this patient?” S#3
The students reported that the elderly participants expressed increased coping by preparing a meal together. However, many students experienced that the elderly participants were content when the students took care of all the practical needs around the meal:
To her, it was important to set the table nicely. I was a guest in her house, and she wanted everything to be nice and well presented. S#9
I can’t manage a lot, but I think I could have done more than I did, but he took care of everything. E#3
Mixed meal experiences
This theme contains experiences relating to mixed meal outcomes and the different influences of meals such as nutrition-related factors and the facilitators and barriers to a good meal.
Nutrition-related factors
Some students reported the meal as an opportunity to talk to the elderly participant about nutrition while others reported the opposite, i.e. the meal was primarily a good arena for social interaction and to a lesser extent giving direct nutritional advice. Some elderly participants agreed that combining eating and nutritional advice would be challenging:
I thought about fortification and energy-dense food, and I talked to the dependents about it.... and it helped because her weight increased. S#3
We talked about what food she liked, and what food she was used to eat. And we talked about her difficulties eating and her lack of appetite. But it didn’t feel natural for me to tell her: “you must eat this and this is important.” This pressure would destroy the nice meal situation that I tried to create. S#1
The conversation flowed easily. It was not a problem. We talked a lot about social things and talked a lot less about nutrition. S#4
We talked about everything. It felt like we’d known each other our whole life. E#3
If a person came to me, to eat with me and talk about nutrition, I wouldn’t like that. E#1
Nevertheless, the students demonstrated other indirect ways in which they used their obtained nutritional knowledge through food fortification, considerations related to existing medical conditions and catching up on inappropriate situations and equipment used by the elderly persons during the meals:
And he has regular plates, but I noticed that when he eats, he pushes the food to the edges of the plate. And then he has problems getting the food on to the fork. So now I made them (home-care nursing staff) order special plates to make this easier. … I do not understand why no one has thought about it already. S#11
Eating and preparing a meal together gave the students increased valuable insight into the situation of the elderly participants compared with the possibilities for the home-care nursing staff with their limited time and resources.
Facilitators and barriers to a good meal
Eating together can be an intimate, personal experience. The nursing students and elderly participants had many perspectives on the facilitators of a good meal. They all had enough time during each visit, which was important for getting to know each other and creating a nice atmosphere. Most students and elderly participants appreciated this moment together. They talked a lot about many different subjects, and the students said they felt the elderly patients enjoyed the conversations as well as the food:
It was a nice way to take care of more than just their physical needs because we had one hour where we could talk together, and in that way, we could take care of both social and psychological needs as well. S#1
My patient always talked about how nice it is to eat together. We experienced that it was very useful for her, and a good thing. S#2
I thought it was very interesting, I got varied meals, and I got to meet a nice student. We hit it off immediately, and I looked forward to every time he was coming. E#3
I said to her: “Visit me when you come back, if you are not too busy with your boyfriend” (laughter). Nice girl, I enjoyed it a lot when she came. E#4
The students mentioned some important barriers. One student said they had to end the project because the elderly person had a complicated relationship with food and did not look forward to eating with someone:
The elderly person liked to be visited but found it difficult that the visit was about food. She thought the visit was nice, and she is very social, but she could not manage to eat together with me. S#1
The students mentioned different barriers to a good meal. Some homes were challenging for creating a good appetite and meal due to hygienic factors, and some students felt that it was a difficult experience to enter a private home and eat together with someone they did not know. Others recognized the elderly participants as being lonely but felt that they needed more activities and to get out of the house instead of sharing a meal. Some participants described the intervention period as being too short to be able to create a good relationship:
I worried about what we were going to talk about. Did she have clean plates? What is the cutlery like? I worry about all these things. S#1
I think they (home-care nursing staff) were a bit sceptical about the project. I heard that. But I understand. It is not always easy to let a stranger into the house and share a meal. S#13
Significant experiences contributing to improved nutritional status
Several factors may contribute to improved nutritional status. We divided our findings into appetite and meal enjoyment, food intake and multidisciplinary nutritional care.
Appetite and meal enjoyment
Mealtimes are when many elderly persons felt most lonely and many had difficulties eating alone. The nursing students reported that their visits and the shared meals affected the elderly persons’ moods positively and was something they looked forward to. Students said the home-care nursing staff also noticed that the meal and visit evidently affected the elderly persons’ mood both before and after each meal. This was reported by both students and elderly:
She has eaten very little because she has been lonely. Just eating with someone helped her a lot because she ate the whole portion when I was there. S#4
I want to get across that this is a project I hope can last, really. I have a great impression of it and when I see how happy the patient is when I stay there, for as little as an hour maybe. S#2
I think it is very positive to have someone to share a meal with. I have problems eating alone, to me it is very good to eat together because then I manage to eat. E#1
The students reported various other possible factors influencing appetite and food intake. The food smelled good and many elderly participants clearly enjoyed the prepared food:
It smelled good both in the kitchen and in the living room. That might have stimulated the senses. S#4
It was easier to eat when I did not use all my strength in preparing the meal. E#1
Food intake
Sharing meals may have affected food intake in many of the elderly participants because many of them mentioned it as a factor that affected their food intake. Many students reported that their elderly patients ate the whole portion of food and some dessert despite having difficulties eating:
I noticed when we talked, he didn’t notice that he eats and then he eats more. S#6
She enjoyed the meal and ate all the food. Even though the portions were very big, she ate everything, which was surprising. S#5
In addition to improved appetite and enhanced food intake in the elderly, many students reported that their elderly patients gained weight. This was probably due to a combination of different measures in nutritional care:
She had lost some weight previously and then her weight increased by 1.5 kg. S#4
I think it was a combination of sharing a meal and other measures that increased her weight. S#2
Multidisciplinary nutritional care
Older patients’ nutritional care consists of many different factors and is most successful with a multidisciplinary team approach. The contribution of the nursing students was valuable. The students interacted with the patients and informed the home-care nursing staff of their observations. This resulted in the continuously improving and better tailored care of the patients:
I found it difficult to change anything because everything is controlled by the measures of the home-care nursing staff and the time allocated. But I had many good conversations with the other nurses around the nutritional situation of the patient. S#1
There was no weight documented, even though there was a danger of malnutrition. S#9
The increased care around the meal situation was also appreciated by many of the elderly participants:
It is nice that someone came to eat together with me instead of home-care nursing staff who just make sure I get enough food. E#1
The elderly participants had experiences of the home-care nursing staff’s time constraints making co-eating not feasible.