Crazy about Food

Food Security refers not only to the availability of food, but also access to sufficient, safe, nutritious food to maintain a healthy and active life. Clearly, we are talking mostly about basic needs.

But choice matters. So does quality.

When I was volunteering with Meals on Wheels, the person in charge tried her best to make sure each meal was nutritious, adequate, and safe, without compromising clients’ dietary restrictions and preferences. Fortunately for us and unfortunately for our elderly clients, most did not complain even when a vegetarian was given turkey. Some may argue that when a kitchen has to serve over 2,000 meals a day and operate under a tight budget, these errors are “excusable.” What about a much smaller facility where dietary needs and preferences are reviewed and carefully documented on a regular basis?

Although food may not be the primary complaint and most patients appear to possess the ability to accept or endure everything on their plate, it used to bother me a lot when I was working at an inpatient psychiatric facility. I know I am asking for trouble when I say this. After all, our society doesn’t have enough resources to allow all those who need to receive psychiatric care to be admitted to a facility. So, it seems like a “luxury” that these patients can have access to food, shelter, and some type of health care while hospitalized.

With age come changes in dietary needs and preferences. Medications commonly prescribed to treat certain chronic medical and psychiatric conditions also tend to affect their taste. On top of that, emotional disturbances secondary to their mental illness and hospitalization may influence their appetite and taste. Given these factors, does it really matter whether we are serving a juicy burger or something tougher than our grandfather’s leather blindfold?

Absolutely! Food is supposed to make one feel BETTER, not worse. If we insist on providing person-centered treatment, the choice they have over what they eat deserves more respect. I am not suggesting that we give someone who has swallowing problems a steak for dinner, but ignoring their medically-appropriate preferences out of carelessness or a “couldn’t care less” attitude is inexcusable.

In this age of managed-care where cost-effectiveness is always the buzz word, perhaps researchers can attempt to establish how psychiatric patients’ perception of their meal experience may be associated with their length of stay, number of aggressive behaviors, use of physical restraints, allegations of abuse and violation of patients’ rights, and staff’s job satisfaction and turnover rate.

Although there is little research in this area, there is evidence that food really matters in inpatient psychiatric settings:

http://www.hopkinsmedicine.org/nursing/news/more_food.html

http://medicineworld.org/cancer/lead/9-2006/improving-patients-meal-experience.html

“It’s OK, honey. I’ll just eat the mashed potato under the turkey.” — It makes me sad whenever I think about this.

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About C

If you consider volunteering at a luncheon for older adults as my first exposure to the field, I have been in geropsychology for at least twenty years. As family, friend, volunteer, trainee, and professional, I have found myself in adult day care centers, senior centers, senior living facilities, nursing homes, medical and psychiatric wards, hospice, and personal homes of older adults. Wherever I go, be it an orphanage, a museum, a prison, an airport, or a random corner in the neighborhood, issues related to aging and mental health often come to mind. I used to think that I could make a difference only if I became a top-notch researcher, educator, or clinician. As I continue to follow this meandering path, it dawns on me that as a nobody in the field, I can still add my light to the sum of light by sharing what I know. Over the years, I have "converted" a few very dedicated individuals to focus on aging-related work within their respective disciplines and encouraged a handful more to stay in this field despite its winding course. I believe by bringing aging and mental health issues to the foreground, we will amass a stronger force to promote advocacy, research, and quality care.
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