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[外文翻译]

1、本科毕业设计（论文）外 文 翻 译原文：dining experience , foodservices and staffing are associated with quality of life in elderly nursing home residentsintroductionalthough todays nursing home residents are more functionally and cognitively impaired than they were 20 years ago (1-5), nursing homes still aim to prese

2、rve and promote good quality of life for their residents, however challenging this may be. while both physical and social environmental factors, such as level of recreational activities and control over physical environment, have frequently been included in determinants of quality of life among frai

3、l elderly people (6-8), very few studies have determined whether institutional factors, such as food and nutritional services and dining experience, are associated with quality of life in ltc. several other factors have already been identified as contributing to the quality of life of the elderly in

4、 health care institutions. for example, chronic conditions, drug consumption, functional abilities, swallowing difficulties, and nutritional status have all been linked to their quality of life (9-12). risk of malnutrition has also been found to be associated with quality of life in older adults (10

5、,13,14). winzelberg et al. (9) observed a significant correlation between residents quality of life scores and their mental health status (i.e., severity of cognitive dysfunction and depression).the american dietetic association put forward a position paper on nutrition and aging which stipulates th

6、at, along with environmental factors, the enjoyment of food and nutritional well-being play a key part in an older adults quality of life (1). the psychological and social aspects surrounding mealtime can impact on elderly residents quality of life by influencing the pleasure of eating. mealtimes te

7、nd to give residents a sense of security, belonging, structure and order to their day. they can also give residents a sense of independence and control over daily choices (15). a potential link between residents quality of life and institutional factors, such as those related to food and dining expe

8、rience, has been indicated by some researchers (16-19). west et al. (17) found that many residents feel powerless when it comes to their surroundings, such as the liberty to choose food and dining companions. residents in their study ranked a greater variety of foods, meals that are appetizing, comf

9、ortable seating during meals, calm mealtime atmosphere and respect for food preferences as being among their top ten important food-related concerns. similarly, kane et al. (19) found that, when asked to rate the importance of control and choice over certain areas of their everyday nursing home life

10、, residents prioritized having choice and control over their food. in another study, residents quality of life seemed to improve following the introduction of a buffet-style meal service (20). this type of service included additional assistance for residents during meals and a better dining atmosphe

11、re. residents could choose from a greater variety of foods and could receive second helpings of favourite foods (20). high correlations were also found between residents quality of life and their enjoyment of food and mealtimes, and being able to receive their favourite foods (21). according to evan

12、s et al. (22), residents could adapt better to nursing home life if their food and food service preferences were being met. despite studies that demonstrate that food and nutrition services and dining environment are important to ltc residents, few studies have actually tested whether these factors

13、are significantly related to their quality of life using a valid quality of life measurement tool. discussionmeasurement of quality of lifevery few studies have attempted to use a single measure of quality of life for both cognitively impaired and cognitively intact seniors; yet, for researchers con

14、cerned with improving the quality of life of all ltc residents this is an extremely important issue. the qol-d instrument was developed for use among cognitively impaired seniors, and though its internal consistency was higher in cognitively impaired residents, it did have acceptable reliability for

15、 use with cognitively intact residents. for cognitively impaired residents, reliability results for all three subscales were quite similar between sloane et al.s (31) study and ours ( = .57 to .79). unfortunately, sloane etal. (34) did not report on the reliability of the combined qol-d scale. mean

16、scores for qol-d and its subscales were significantly higher in cognitively intact residents, which reflected their higher quality of life, especially in terms of activity levels. two previous studies found that quality of life decreases with increasing level of cognitive impairment (9,11); however,

17、 winzelberg et al. (9) used a modified version of the logsdon et al.s (35) quality of life-alzheimers disease scale (qol-ad) in their study, while kerner et al. (11) used the quality of well-being (qwb) scale. health and socio-demographicsover two-thirds of the residents in this study were cognitive

18、ly impaired, which is similar to percentages found by other studies with institutionalized elderly (3, 36). a significantly larger percentage of cognitively impaired residents compared to cognitively intact residents had a bmi lower than 20 (26.8% vs 9.1%). other studies in ltc settings have also sh

19、own that residents with dementia-related disorders are more prone to weight loss and malnutrition (3, 36). length of stay was not significantly associated with quality of life in either cognitively intact or impaired residents, but an increase in the number of medical conditions was negatively assoc

20、iated with quality of life in cognitively intact residents. there was no significant difference in types of conditions reported for cognitively intact versus impaired residents. this is somewhat surprising since different conditions should have lead to the institutionalization of both groups of resi

21、dents. in addition, kempen et al. (12) also found that chronic medical conditions were negatively associated with quality of life in cognitively intact older adults in both community and institutionalized settings. dining experiences and quality of lifenumber of dining companions was positively asso

22、ciated with quality of life in both cognitively impaired and cognitively intact residents. this association may reflect the fact that dining with others increases social interaction, which has been found to be a key component of quality of life (37). number of dining companions may also be related t

23、o physical surroundings. kayser-jones & schell (38) observed that residents who ate in their rooms had little or no social interaction during mealtime. when residents were asked to make a list of those aspects of their lives that were most important to their quality of life, they identified choice o

24、f dining companions and where to eat their meals as their top priorities (39). autonomy in relation to food, such as access to food between meals and having foods brought in by family and friends, also had a positive association with quality of life in both groups of residents. this finding is in li

25、ne with other studies that found that residents prioritize having choice and control over their food (16, 17, 19). independence with eating was positively associated with quality of life in cognitively impaired residents. among cognitively intact residents, 96.2% were independent with eating compare

26、d with only 52.1% among the cognitively impaired (2 = 77.186; df = 1; p = .000). independence in eating can give residents a sense of control over their food intake. this sense of control increases pleasure and enjoyment associated with mealtime which can impact their quality of life. residents who

27、need assistance with eating often have functional disabilities, swallowing difficulties or severe dementias, which affect their quality of life (9, 12). foodservices and quality of lifethree of the four foodservice factors were found to be associated with quality of life among cognitively intact res

28、idents, but only two were associated with quality of life among the cognitively impaired. tray meal delivery systems, compared to bulk, were positively associated with quality of life in both groups of residents. this finding contradicts one previous study among ltc residents that suggested there is

29、 a positive association between buffet-style dining and quality of life (20). while this study did not measure quality of life, quality of life seemed to be enhanced through increased enjoyment of both the food and the dining environment (20). future studies must further explore the association betw

30、een meal delivery systems and residents quality of life.close to 70% of menus had been revised within the last year (mean 13.0 16.9 months). more recent menu revision had a positive association with the quality of life of cognitively impaired residents. periodic menu revision likely decreases food i

31、tems that are less liked by residents and increases items that are more enjoyed by residents, such that foodservice personnel and institutional caregivers can more often satisfy the preferences and tastes of cognitively impaired residents. improved meal satisfaction on the part of both residents and

32、 staff would then enhance quality of life in cognitively impaired residents.therapeutic menus was positively associated with quality of life in cognitively intact residents, and more cognitively intact residents were on therapeutic menus (54.5%) than cognitively impaired (39.9%) (2 = 7.598; df = 1;

33、p = .006). the most common therapeutic diets among cognitively intact residents were diabetic, reduced salt and low-fat diets. these menus may make cognitively intact residents feel special, since they require more follow-ups from dietary and nursing staff. according to evans et al. (22), many nursi

34、ng home residents yearn for personalized nutrition care and individualized attention. it should be noted, however, that very restrictive diets may significantly reduce the pleasure of eating (1). china dishes were also associated with quality of life in cognitively intact residents. hackes et al. (4

35、0) found that serving meals on china dishes decreased food waste in ltc, possibly indicating greater satisfaction with mealtime. furthermore, china dishes may give cognitively intact residents the feeling of being at home, while insulated plastic dishes could have the opposite effect, making them fe

36、el like a patient in a hospital. cognitively impaired residents are probably much less aware of what types of dishes are used at mealtime.staffing and quality of lifethe ratio of residents per ra was positively related to quality of life in both cognitively intact and cognitively impaired residents.

37、 this finding is somewhat surprising, since the assumption has always been that having a greater number of staff to assist residents should improve their quality of life (41); however, a higher ratio of residents per ra does not necessarily mean inadequate staffing. the average ratio of residents pe

38、r ra in this study was 5.3, which is, according to simmons et al. (4), quite sufficient to ensure quality care. we also found that the ratio of residents to ras was negatively correlated with size of institution (r = -.419; p = .000). this indicates that smaller institutions tended to have higher ra

39、tios of residents per ra than larger institutions. residents in smaller homes may develop stronger and more intimate relationships with staff and other residents. they may also simply feel more “at home” in smaller facilities. perhaps residents living in smaller homes with a higher ratio of resident

40、s per ra feel more autonomous and less “looked after”, which may increase positive affect and decrease negative affect. the qol-d was one of the best measurement tools available when this research was initiated, and its reliability results with cognitively intact residents reflect the fact that it w

41、as developed primarily for use with the cognitively impaired. the qol-d measures three dimensions of quality of life (activity and positive and negative affect), while other instruments measure additional dimensions of quality of life, such as physical conditions, interpersonal relationships and mob

42、ility. future researchers should continue examining the validity of the qol-d and other quality of life instruments, in both cognitively impaired and cognitively intact ltc residents.dining experiences, food and nutritional services, and nursing personnel each play important roles in promoting and i

43、mproving quality of life among nursing home residents. results from this study suggest that quality of life may be enhanced for both cognitively intact and cognitively impaired residents by encouraging them to dine with others and increasing their autonomy in relation to food. new ltc facilities or

44、those under major renovation might also consider implementing tray-based meal delivery systems, though further studies are needed to confirm the benefits of these systems. while serving meals on china dishes, instead of plastic or insulated dishes, might improve quality of life of cognitively intact

45、 residents, the proactive diagnosis and rehabilitation of eating difficulties might improve the quality of life of cognitively impaired residents. future studies should continue to separately examine the ways in which dining experiences, food and nutritional services, and other institutional factors

46、 help determine quality of life among cognitively intact versus cognitively impaired residents in ltc settings.source：n. carrier, g.e. west, d. ouellet，the journal of nutrition, health & aging，2009，p565570译文：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介绍尽管当今的居民护理比二十年前存在更多功能上和认知上的障碍，老年护理院仍然是把保持并提高居住者的生活质量作为目标，即使这可能是个

47、挑战。而自然和社会环境这两种因素经常被认为是影响身体虚弱老年人生活质量的决定性因素，例如康乐活动的水平和如何控制自然环境。很少有研究表明是否是生活习惯因素在长期护理中对生活质量存在着影响，比如食物、护理服务和餐饮经验。几个其他因素已经被认为对保健机构里老年人的生活质量有着一定的影响。举个例子，慢性疾病、药品消费、机能状况、吞咽困难和营养状况都和他们的生活质量联系在一起。营养不良也被发现和老年人的生活质量有着联系。winzelberg等人观察得知人们生活质量的水平和他们的心理健康状况有着密切的联系（即认知功能障碍和抑郁的严重程度）。美国饮食协会在意见书中对营养与衰老作出这样的规定：随着环境因素的

48、变化，享受美食和获得营养是将会在老年人的生活质量重起着关键的作用。用餐时周围的精神和社会方面的状况也会影响老年人的生活质量，影响其是否能够愉快用餐。用餐时，人们应该有一种安全感、日常饮食有规律。此外，还应予人一种独立和自主选择的感觉。研究者指出，人们的生活质量和习惯因素有着潜在的联系，比如那些相关的食物和用餐经验。west等人发现，当谈到人们的生活环境时，大多数居住者往往感到无能为力，比如选择食物和进餐同伴的自由权。在居住者的研究排名中，食物的品种、独特的口感、用餐时舒适的座位、安静的用餐环境和尊重自己的食物偏好被列为人们所关心的十大最重要的餐饮方面的因素。similarly, kane等人发

49、现，当人们被问到在日常的护理中哪些方面最需要有自己的自主选择权时，人们的回答往往是食物的自由选择。在另外一个研究中，居住者的生活质量看起来朝着自助用餐的服务模式改进。这种服务方式对人们的用餐和就餐环境有着额外的帮助。人们可以从多样化的食物品种中选择自己喜欢的食物。人们还发现居住者的生活质量和享受美食、用餐时间、能够吃到喜欢的食物之间有着极大的相关性。根据evans等人，如果居住者能够吃到自己喜欢的食物，他们在老年护理院里的生活将更好。尽管研究表明食物、营养服务和用餐环境在长期护理中的重要性，一些研究者仍用有效的测试工具对这些因素是否真的对人们的生活质量有着很大的影响做了严格的测试。讨论生活质量

50、的衡量方式很少有研究尝试使用单一的衡量方式对认知功能受损的和认知功能完整的老年人的生活质量进行衡量；但是，对于关注提高长期护理居住者生活质量的研究者来讲，这是一个至关重要的问题。测量痴呆症患者生活质量的仪器是为认知功能障碍的老年人发明的，尽管相比之下，对于患认知障碍的居住者来说，这种仪器的内部兼容性更强，但总的来讲，用它来衡量认知功能完整的居住者，它的可信度也是可以接受的。在对于患有认知功能障碍的居住者的研究中，sloane等人和我们（=57 79）的三个分量表的可信度结果是相差无几的。遗憾的是，sloane等人并没有记录组合痴呆症患者生活质量指数的可信度。痴呆症患者生活质量和其分量表的平均数

51、明显要比认知功能完整的居住者的高，这反映出认知功能完整的居住者生活质量较高，特别是其活动程度更强。先前的两项研究发现，随着认知功能受损程度的提高，居住者生活质量会随之降低；需要说明的是，winzelberg等人在他们的研究中使用了logsdon等人的老年痴呆症患者生活质量指数的修改版本，而kerner等人使用了幸福质量指数。健康和社会经济人口在此项研究中，三分之二的居住者都有认知功能障碍，其他关于养老机构里的老年人的研究也大致是这样的比例。相比认知功能完整的居住者，有更多患有认知功能障碍的居住者的身体肥胖指数低于20（26.8% 9.1%）。其他关于长期护理的居住者的研究显示，凡是与痴呆症相关

52、的功能紊乱症的居住者都更容易出现体重减轻和营养不良的症状。无论是认知功能受损还是认知功能完整的居住者，居住时间的长短并不与他们的生活质量有密切联系，但是对于认知功能完整的居住者来讲，医疗时间的增长会对他们的生活质量产生消极影响。据报道，认知功能受损和认知功能完整的居住者的状况之间并没有很大差别。鉴于不同的状况按常理会导致两组居住者的体制化，这个报道还是很令人惊奇的。另外，kempen等人还发现，对于认知功能完整的老年人，无论他们居住在社区还是养老机构，长期的医疗会对他们的生活质量产生消极影响。餐饮体验与生活质量无论认知功能完整的居住者还是认知功能受损的居住者，用餐同伴的数量的增多会给他们的生活

53、质量带来积极影响。这种影响体现在和其他人一起进餐可以增强社会互动，据发现，这种互动是生活质量的关键决定因素。用餐伙伴的数量对居住者身体状况也有着一定影响。kayser-jones和schell通过观察发现，凡是在自己房间进餐的居住者在进餐时间很少或者根本没有社会互动。当居住者被要求列出他们认为的对生活质量的好坏起着最重要作用的几个方面时，他们大多把进餐伙伴以及进餐地点定义为首要选择。关于食物的自主权，例如可以在两餐之间的时间进餐，或者食用家里人或是朋友买来的食物，这种自主权也对这两组居住者的生活质量有着积极影响。其他研究亦有相似发现，即居住者会把选择和控制他们的食物作为优先权利。独立进餐对认知

54、功能受损居住者的生活质量有着积极影响。同96.2%独立进餐的认知功能完整的居住者相比，认知功能受损的居住者中只有52.1%可以独立进餐（2 = 77.186； df=1；p=.000）。进餐的独立可以使居住者有种对于食物摄入的控制感。这种控制感可以给他们进餐时带来更多的快感和享受，同时也影响着到他们的生活质量。进餐时需要帮助的居住者往往患有功能性障碍，吞咽困难或者轻微痴呆症，这些疾病也影响着他们的生活质量。食品服务与生活质量据研究，四分之三的食品服务因素会对认知功能完整的居住者的生活质量产生影响，但只有四分之二的因素会对认知功能受损的居住者产生影响。相比大量递送食品，用托盘递送会对两组居住者都产生积极影响。这个发现与先前有些矛盾。在先前的研究中调