Perceived Barriers to Increased Whole-Grain Consumption by Older Adults in Long-Term Care Facilities
Date of Award
Level of Access Assigned by Author
Master of Science (MS)
Food Science and Human Nutrition
Mary Ellen Camire
Second Committee Member
Mary Anne Eaton
Third Committee Member
Katherine O. Musgrave
Whole-grain consumption is a vital part of a healthy balanced diet. Foods made with whole grains are rich in dietary fiber, B vitamins, minerals, antioxidants and beneficial phytochemicals. Whole grains can reduce the risk of colorectal cancer (Fechner et al., 2013), regulate weight by improving satiety (Rosen et al., 2011) and lower blood sugar (Brennan et al., 2012). The average American, however, consumes far less than the recommended amounts of whole-grain servings, or about one-third of the recommendation (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010).
The elderly population is a specific demographic group who would benefit from an increase in whole grains in the diet to improve regularity, in addition to other added health benefits. The objective of this research study was to analyze the prevalence of whole-grain foods in senior housing facilities, i.e. assisted living facilities, nursing homes, hospitals, etc. Information regarding dietary supplement usage to improve fecal movement, such as dietary fiber supplements and/or probiotics, was also gathered.
Surveys were mailed to 3,000 members of the Academy of Nutrition and Dietetics from all 50 of the United States during the spring semester of 2013. With a response rate of 25.3 percent, 759 total surveys were returned for this study. However, 30 surveys were returned blank, some with a note detailing reasoning for disqualification, i.e. retired, unemployed, etc. As a result, a total of 729 surveys were analyzed for this study. Participants were allowed to answer as many or as few questions as they wanted. Return of the survey implied acceptance of the informed consent form.
Many barriers exist when it comes to serving more whole grains in senior citizen populations. Chewing tends to be problematic, as many seniors have dentures and/or missing teeth. Six-hundred and sixty-five respondents reported that at least 25 percent of their patients had difficulty chewing. Cost tends to have the biggest impact on food purchasing decisions. Of 646 responses, 175 nutrition professionals, or 27.1 percent, noted that cost was the biggest influencer in purchasing food. The following three influencers of purchasing decisions were dietary needs of patients (22.1 percent of responses), overall nutritional content (20.1 percent of responses) and contract in place (20.3 percent of responses). Another barrier is that the nutrition professionals returning the questionnaire were usually not in charge of making food-purchasing decisions. Of 673 responses, a mere 140 nutrition professionals, or 20.8 percent, indicated that they had the purchasing power.
Most respondents, 503 out of 663 reporting, or 75.3 percent, stated that they have patients who require dietary fiber supplementation. Nutrition professionals reported spending anywhere from $0 a month per patient to over $41 a month per patient on dietary fiber supplements. The most common cost range was $11 to $20 a month per patient, based on 23 .6 percent of the 444 respondents who answered the question.
Of 651 responses from participants, 632, or 97 percent, checked off that they served whole-grain food items at least once per day. The majority of respondents (595 of 665 who answered the question, or 89.5 percent) said they would like to serve more whole-grain food items. However, most seniors do not like whole grains, or are not willing to try them. Over 54.6 percent of reporting participants, or 389 of 712, noted that poor acceptance was a leading barrier to serving more whole grains.
Barriers to serving whole grains in senior-living facilities need to be clearly identified and overcome. Poor acceptance, cost and purveyor contracts were some of the leading barriers to whole-grain consumption in this study. In the future, research needs to indicate whether it would be more cost effective for senior-living facilities to serve more whole-grain food items, rather than offering a multitude of supplements, assuming that seniors would be able and willing to eat more food. Food manufacturers need to run studies of taste, acceptance and chewing ability for whole-grain food items designed for seniors, to help improve whole-grain consumption. Lastly, nutrition professionals may need continuing education regarding types of whole grains and how to serve them. Not all respondents in this study were able to identify them correctly.
Coffman, Melodie A., "Perceived Barriers to Increased Whole-Grain Consumption by Older Adults in Long-Term Care Facilities" (2014). Electronic Theses and Dissertations. 2158.