Elsevier

Appetite

Volume 41, Issue 2, October 2003, Pages 149-160
Appetite

Research Report
Meals and snacks among elderly self-managing and disabled women

https://doi.org/10.1016/S0195-6663(03)00052-7Get rights and content

Abstract

Aim. The aim of this study was to describe the frequency and distribution of self-managing and disabled elderly women's eating events, as well as to investigate which definition/names the women had given their different eating events and to categorise these into meals and snacks. An additional aim was to study the composition of meals and snacks, and analyse the nutritional significance of these eating events in terms of energy and macronutrients.

Subjects. Elderly women, both self-managing (n=139) and disabled (n=63; with Parkinson's disease, rheumatoid arthritis or stroke), aged 64–88 years, and living at home participated.

Methods. A repeated 24 h recall and an estimated food diary for three consecutive days were used.

Results. The eating events defined by the women that were categorised as meals contributed 74% of the total daily energy intake, while snacks contributed 22–23%. The meals that the women had defined as dinner, was the most energy dense meal. The frequency of eating events not defined by the women, was 30–34%, but contributed only 3–4% of the total daily energy intake. The disabled women had a significantly lower energy content in meals and most snacks, compared to the self-managing women.

Conclusion. The main conclusion was that elderly women still living at home had their meals distributed during the day and that these meals were characterised by individuality and flexibility.

Introduction

Research about people's food choice has mostly focused on individual foods (Meiselman, 2000). When people eat foods it is understood that they mainly choose to combine them in different meals. By combining foods at different eating events into specific meal compositions, people in different cultures and different age groups give meals different meanings. The act of giving an eating event a definition such as breakfast, lunch or dinner also shows that people characterise meals in different ways, mainly in terms of composition and the time of day meals are eaten. Thus meals can be culturally defined (Mäkelä, 2000). ‘Psychologists indicate that meals are an universal phenomenon and behavioural feature of human life, and that the three-meal-a-day pattern is widespread around the world because in most languages the existence of words for precisely three distinct meals can be revealed (Pliner & Rozin, 2000). Recurrent eating events of major significance that structure the day and to which people have given specific names are in Sweden breakfast, lunch and dinner’. Another way of understanding meals is by analysing their nutrient and energy content (de Graaf, 2000). According to de Graaf, eating events can be categorised as meals or snacks; whereas the category meals includes breakfast, lunch and dinner, all other eating events can be considered as snacks. Meal categorisation into breakfast, lunch and dinner are usually based on what time eating events are reported to be eaten. Though definitions of meals such as breakfast, lunch and dinner are often used in food and nutrition studies, it is difficult to comprehend who made the categorisation, the subject or the researcher. However, according to de Graaf (2000), it appears that although the frequency and distribution of intake vary greatly across countries, a number of constant factors exist in these patterns. De Graaf's nutritional definition of meals and snacks, thus, refers to the frequency, distribution and variability of energy and nutrient intake during the day.

Among Swedish home-living elderly (75 years and over), 76% reported consuming three meals per day, 41% consumed one snack and 32% consumed 2–3 snacks (The National Board of Health and Welfare, 2000). In a selected Swedish affluent and educated elderly population, 76% consumed three main meals a day, whereas the total mean intake of meals was 4.6 (Rothenberg, Bosaeus, & Steen, 1994). Among elderly in Kentucky, 65% consumed three meals a day and less than one-third snacked regularly (Quandt Vitolins, DeWalt, & Roos, 1997). Quandt and co-workers concluded that their results on meal skipping, little snacking and consumption of meals with low energy density could indicate a risk for malnutrition among this population group.

A significant amount of the daily energy and nutrient intake in an elderly population comes from hot meals, and a regular pattern of cooked or prepared meals increases the possibility of getting a nourishing diet (Gustafsson et al., 2002, Schlettwein-Gsell et al., 1999). Most participants in the SENECA study consumed a cooked meal every day, and the midday meal provided the largest daily energy contribution among participants from all but one town (Schlettwein-Gsell et al., 1999). Swedes in general reported consuming one hot meal per day (59%), and 34% reported consuming two hot meals, which usually included meals such as lunch and dinner (Mäkelä et al., 1999). However, according to Vincent, Lauque, Lanzmann, Vellas, and Albarede (1998), who studied a population of elderly in France, the energy contribution from dinner meals seemed to decrease with increased age, but was compensated by an increased energy contribution from breakfast or lunch.

In a recently published Swedish study among older women, a ‘proper meal’ was considered equal to a cooked meal with potatoes, meat and vegetables, often served with gravy (Sidenvall, Nydahl, & Fjellström, 2000). This has been discussed in earlier studies by both Murcott, 1982, Charles and Kerr, 1988. In an elderly Scottish population, healthy eating was conceptualised as ‘proper meals’, which in turn were characterised as dinner and clearly distinguished from light meals and snacks (McKie, 1999). A proper meal in a Nordic study was defined as consisting of center-of-the-plate menu items, such as meat or fish, a staple food, i.e. the fundamental items of the diet (Davidson, 1999) and/or bread, a side dish of vegetables and optional trimmings (Mäkelä, 2000). Center-of-the-plate menu items are usually associated with older people (Spears, 1995).

Having a pattern of regular meals also facilitated what older people considered as an adequate diet to ‘keep well’ (McKie, 1999). Thus, in the Western world, where the elderly population is increasing, adequate food habits are seen as a prerequisite to maintaining good health and being able to live independently as long as possible (Fjellström et al., 2001, Tucker and Reicks, 2002).

The contribution of snacks to total daily energy intake seems to decrease with increasing age (de Graaf, 2000). Snacks also contributed a lower amount of the total energy intake among elderly than in other age groups (Summerbell, Moody, Shanks, Stock, & Geissler, 1995). In the SENECA study, there was great variation in the energy contribution of snacks among elderly in different countries, from 6 to 30% of the total daily energy intake (Schlettwein-Gsell & Barclay, 1996). It is believed that several eating events, referring to both meals and snacks, facilitate an increased energy intake, particularly in the elderly (de Graaf, 2000, Morley, 1997). The coffee break is a regular snack time in Sweden, often including buns, cookies, pastries or an open-faced sandwich (Mäkelä, 2001).

Irregular eating characterised by discontinuous snacking or frequent light eating as opposed to regular proper meals has been recognised as a growing problem in the modern consumer society and defined as ‘grazing’ (Caplan, 1997, Senauer et al., 1991). Some people suggest a trend towards an increasing number of eating events across the day, i.e. grazing, although there is little solid data to support this view (de Graaf, 2000). In the SENECA study, the mean eating frequency increased from 1988 to 1993 in a selected population of elderly in the participating centres in The Netherlands, Italy and Poland, but not in Switzerland (Schlettwein-Gsell and Barclay, 1996, Schlettwein-Gsell and Barclay, 1991).

Independence, i.e. managing by oneself in the meal and food situation, was highly valued among older women living in their homes (Sidenvall, Nydahl, & Fjellström, 2001). This was also shown among women with a declining ability that threatened the performance of food-related work (Gustafsson, Andersson, Andersson, Fjellström, & Sidenvall, 2003). Among elderly, restricted mobility had an important influence on shopping and preparation of food, which in turn resulted in infrequent intake of cooked meals leading to insufficient dietary intake (Wylie, Copeman, & Kirk, 1999). Diseases such as Parkinson's disease (PD), rheumatoid arthritis (RA) and stroke are accompanied by physical disability and problems in the meal situation (Andersson and Sidenvall, 2001, Nordenskiöld, 1996, Westergren, 2001).

Sweden is the only country in the world that has recommendations regarding the distribution of energy in meals during the day. Three main meals combined should contribute 70–95% of the daily energy intake, and 2–3 snacks the remaining 5–30% (The Swedish National Food Administration, 1997b). To our knowledge, few studies have been performed on how elderly women living at home choose to combine individual foods in meals and snacks throughout the day and night, or on what these eating events signify in terms of nutritional definitions.

The aim of this study was to describe the frequency and distribution of self-managing and disabled elderly women's eating events, as well as to investigate which definition/names the women had given their different eating events and to categorise these into meals and snacks. An additional aim was to study the composition of meals and snacks, and analyse the nutritional significance of these eating events in terms of energy and macronutrients.

Section snippets

Subjects

The study included elderly home-living women, both self-managing and disabled (having PD, RA or stroke), from the MENEW study (Meals, Eating habits and Nutrient intake among Elderly Women). The women were aged 64–88 years. The self-managing women lived in three municipalities in mid-eastern Sweden, whereas the disabled women lived in a county, covering one of the communities, in mid-eastern Sweden. The women were invited to participate in the study through a letter sent to them that contained

Results

Characteristics of self-managing and disabled women are shown in Table 3. Among the self-managing and disabled women, 55.4 and 49.2% were single-living, and 44.6 and 50.8% were cohabiting, respectively. The mean ages of self-managing and disabled women were 75.8±8.0 and 73.4±6.6 years, respectively, whereas the latter group of women was significantly younger (p=0.030). Mean BMI was 25.8±4.1 m2/kg and 25.6±4.1, respectively. The reported mean energy intake during the five days was significantly

Meals and snacks

The results of this study are based on older self-managing and disabled women's own definitions of their eating events, and subsequent categorisation of their definitions, according to de Graaf (2000), into meals (breakfast, lunch and dinner) and snacks (all other eating events). Meals contributed about 75% of the total daily energy, which was in accordance with Swedish recommendations that meals should contribute 70–95% of the daily energy intake (The Swedish National Food Administration, 1997b

Conclusion

In this study the disabled women had a significant lower intake of energy than the self-managing women. Also the energy content in meals and most snacks were lower. This can be interpreted as that the disabled women could be at greater risk for malnutrition. It was also shown that home-living elderly women, both self-managing and disabled, had an even distribution of eating events, and consequently energy intake, throughout the day from early morning to late at night. Their meals were

Acknowledgements

The study was funded by the Swedish Council for Working life and Social Research and the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning. We thank Ingegerd Andersson for help with data collection, Katarina Virhammar and Karin Nordhamn for coding and entering the nutrient data. Furthermore, a special thanks is due to all participating women for their invaluable help and co-operation in the MENEW project.

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