Victoria Lawton
Purpose of the ProgramThe purpose of my Senior Nutrition educational program is to increase the
nutritional knowledge and nutritional health of the senior participants through
educational demonstrations, presentations, and activities.
Rationale
The average age of a person in the United States is 76, a number that
increases drastically every century as we develop new ways to eradicate major
diseases and increase the average person’s knowledge of health. As people age their
health needs change drastically to the point that many persons cannot safely live in
their own homes any longer. To address their health needs many families seek out
assisted living facilities that can provide nutritious meals for their loved one. These
facilities are becoming a more prominent option for elders, to the point that
approximately “half a million people reside in assisted living facilities” in the United
States. (Mitty, 2003, p. 32- 43) Many residents are depending on these facilities to
provide them with nutritious meals, but do not have the knowledge to determine
whether or not this expectation is being upheld. It is important to educate this
population in order for them to be more aware of their health.
A study done to assess the risk of malnutrition in seniors, aged 75 years,
living in a community, found that 21.3% had a medium risk and 1% had a high risk
for malnutrition. (Bachrach-Lindström, Christensson, Johansson, Idvall &
Söderhamn, 2009) These seniors were malnourished and didn’t realize that they are
making themselves susceptible to many problems associated with deficiencies,
including low body weight. Malnutrition and low body weight can go hand in hand if
the subject is not aware of what classifies a healthy weight, and how to achieve a
healthy weight while still satisfying all nutritional needs. A study done in a senior
community defined low body weight as having a BMI of 21 or less, and sought to
determine what factors contribute to low weight in seniors. The study found seniors
had a “misconception of what a normal weight was for their age group.” (Kayser-
Jones, Martin, Porter, Sivarajan Froelicher, Stotts, 2005) My survey data expressed
that 63% of the participants had not been educated about the changes in their
nutritional needs and had not been told about the RDAs as advised by the
government. This data shows that there is a need to educate about what the RDAs
are in general and how it can change depending on certain factors.
Most facilities that are considered assisted living or long term care plan their
meals based on the government’s recommendations for consumption, ie the food
guide pyramid or its equivalency. (Greenwood, Weinberg, Wendland, Young, 2003)
A study done in a long-term care facility in Canada assessed two types of diets
offered to determine if the nutritional value of the meals were actually meeting the
recommended daily allowance for specific nutrients. The study found that “the
diet(s) does not attain, on average, the RDA for a number of vitamins and minerals,”
meaning that even if the person consumed the entire meal, which is not the norm for
most seniors, they would still be deficient in these specific areas. Therefore, the
study concluded that any malnutrition that occurred in the residents could be
deemed “iatrogenic in nature,” meaning the fault of the facility because of the
nutrient deficient meals being provided to them. (Greenwood, et al., 2003) These
programs are designed to meet the needs of the “healthy” residents and do not
account for the increased nutrient requirements of residents with healing wounds
or diseases. My survey results yielded that 63% of the participants surveyed did not
feel the meals provided were balanced and provide adequate calories and nutrients.
Therefore, it is important to educate the residents about what their needs are, how
they may change depending on the situation, and that they are responsible for
tailoring their meals to fit their needs.
The research has also hit on the topic of availability as having an affect on the
nutritional status of the residents. Ronni Chernoff states that “not having access to
adequate food” can be a problem. (Chernoff, 2009, p. 177) Although he is talking
about the elderly not living in a community, it is still a topic of interest. My survey
assessed the availability of food choices present in the facility, besides the menu,
and 100% of participants identified the village store as an option. I also surveyed
about the accessibility of the grocery store as well as their own ability to cook. 100%
of the participants indicated that they did have access to a store and 63% indicated
that they were able to cook. Availability of choices does not appear to be an
problem, but possibly the lack of education prevents them from utilizing what is
available to them.
This research has identified critical issues that need to be addressed in a
nutrition education program:
The importance of knowing what malnutrition is and the associated health
risks
Individualized nutritional needs depending on health status
What are the generalized nutritional needs (government recommendations)
At Cardinal Village there are approximately 200 residents with varying
health issues. Ronni Chernoff states that “establishing ranges of nutrient
requirements for a heterogeneous population is difficult when they are healthy”
but when they all have differing health conditions it becomes even more difficult.
(Chernoff, 2009, p. 176) As stated above these types of facilities have to cater to
the needs of the majority, and cannot tailor their services to 200 individual
cases. Therefore, there is a need for an educational program to establish
awareness of individual needs, so that each individual can tailor their choices to
their own specific needs. Eighty-eight percent of the participants acknowledged
that there is not an educational nutrition program present in the facility, and
verbally expressed interest in such a program. I propose that we implement a
nutrition program to education the residents of cardinal village about their
nutritional needs, the generalized government recommendations, and the
associated risks of becoming malnourished if one is not getting enough
nourishment.
Target Population
There are approximately 100 residents residing in the independent living
section of Cardinal Village and about thirty of these residents participate in the
monthly group nutrition meetings run by the dietary services director. For the
Senior Nutrition program, the individuals who reside in the independent living
section of the facility and attend the monthly nutrition meetings, are the target
population. The remainder of the residents who live in the independent section of
Cardinal Village but do not attend the monthly nutrition meetings are the secondary
target population.
Needs Assessment
In order to assess the needs of the population I would begin by surveying and
collecting data from the senior citizens living at Cardinal Retirement Village. The
four major steps to be taken for this assessment would be: 1. Determine their
current situation as it relates to their health 2. Analyze the data collected from the
survey 3. Rank the needs expressed in order of importance 4. Validate that the
needs identified are truly the needs the community views as most important.
(Mckenzie, 2009, p. 100-107)
When first determining the current health status of the population, I would
use the PRECEDE model that includes the following: 1. Social diagnosis 2.
Epidemiological diagnosis 3. Environmental/Behavioral Diagnosis 4.
Educational/organizational diagnosis 5. Administrative diagnosis. For this target
population of senior citizens living at Cardinal Retirement Village in Sewell, NJ the
social diagnosis would be used to assess the quality of life of these individuals. To do
this assessment a survey would be distributed to residents prior to brunch service.
Questions would focus on the risk factors associated with living in the Cardinal
Village complex. Also, focus groups could be conducted at Resident council or the
monthly nutrition meetings to obtain a more concise view of the needs being
expressed by the general population and then more specifically by those who are
more active in the community.
Next, I would do an epidemiological diagnosis to determine the health of the
residents. This would be done by gathering information from the marketing and
dietary departments about the number of residents living in the community as well
as the types of foods provided to the residents. Information could also be gathered
from the nursing department about the extra nutritional attention that some
residents need.
The survey would also include questions that would diagnose any
environmental/behavioral issues present in the community. Questions concerning
the availability of nutritional resources in the community and in the surrounding
area would also be asked.
Next, when referring to the organizational/educational diagnosis, I would
need to determine the predisposing factors (provides motivation/rationale such as
knowledge, attitudes, and beliefs), enabling factors (enable motivation to be
realized; availability of resources, health care facilities), and reinforcing factors
(subsequent to behavior; provides rewards for continuum of behavior) (McKenzie,
2009, p.22). Questions that reflect these areas would be present in the resident
surveys given to the general population and the focus groups at resident council
and the monthly nutrition meetings. An example of predisposing factors would be
the residents knowledge, attitudes, and beliefs about nutrition options. Enabling
factors, could includes the types of food available in the facility. Finally, reinforcing
factors could include staff support and promotion of good nutritional habits and
peer role models. If the residents were to have more healthy options and have the
support of their healthcare providers and peer role models they can make better
choices.
Finally, using an administrative diagnosis, I would determine what resources
are available for us in the intervention. To obtain this information I would have to
meet with the Business Director and the Administrator to figure out what funds are
available to put towards a educational program.
After obtaining all of the information I will be able to analyze the data. The
analysis would be done by tallying the results from the survey and finding an
average response to the open-ended questions. After doing this I would list any
concerns I have with the data collected.
When I prioritize the needs indicated, I would determine the importance of
the concerns expressed because with limited resources the most important needs
should be addressed first. After we determine the nature and the severity of the
problems, we can start to develop appropriate interventions and set about
implementing them.
Finally, to validate the prioritized needs, I would have to go back through the
needs expressed by the general population are the same as those expressed by the
focus groups, and are the actual needs of the community.
Theoretical Basis
Constructs from the Social Cognitive Theory will guide the development of
this program. This theory acknowledges that personal beliefs, social interaction, and
environmental factors all simultaneously influence a person’s health decisions. This
theory is useful for a group nutrition education program because this population,
senior citizens, is more likely to participate in programs when there is a social
element involved. The social element will draw more residents into the program,
and as a result there will be a decrease in disease associated with overindulgence in
one food or mineral group such as high cholesterol, hypertension, and type two
diabetes.
This theory helps to predict behavioral choices of the target population by
identifying internal and external factors that either encourage or discourage the
target behavior. “In this model of reciprocal causality, internal personal factors in
the form of cognitive, affective, and biological events, behavioral patterns, and
environmental influences all operate as interacting determinants that influence one
another bidirectionally” (Bandura, 2001, pp. 14-15) This means that it is not just
one thing influences behavior, but a culmination of all of these factors influencing
each other that creates the change.
The constructs from the SCT that will be emphasized are self-control,
observational learning, behavioral capability, reciprocal determinism, and collective
efficacy. At the beginning of this program the residents will be asked to record their
food choices for a few days which will make them more aware of the choices they
are making, and begin their development of self-control over their eating habits. In
this program the residents will be taught what the proper portion sizes of food
groups are, and how to make a balanced plate, this way the residents will know how
to perform this behavior (observational learning). The residents typically eat all of
their meals together in a communal dining room so individuals observe others
demonstrating the ideal behavior and will learn how to perform the behavior
themselves (behavioral capability). These persons live in a senior community where
their meals are prepared for them, so their environment affects the food choices
that are available to them. If the residents come together as a group and request
changes to the menu they can influence their environment by regulating the choices
offered to them (reciprocal determinism). In order for the change to occur the group
must first believe that they have the ability to make that big of a change to their
environment (collective efficacy).
Intervention Behavioral Determinants Intermediate Behavioral Outcomes
Group Nutrition Education Observational Learning Increased Knowledge about portion sizes
Behavioral Capability Eating meals at the same table Reciprocal Determinism Increased support for the change
Collective Efficacy
Food Record Self-control Increased awareness of food choices
Ultimate Behavioral Outcomes
Residents will eat properly proportioned Meals.
Agency Information
Purpose of the Agency
The mission of Cardinal Village is to provide its residents and staff with a
safe, home-like environment in which to work and live by offering various health
treatment and prevention programs which emphasize nutrition and disease
prevention.
Goals of the Agency
To improve the overall health and safety of the residents living in our facility
To increase the occurrence of healthy nutritional behaviors in the residents
of the community.
To provide the most up to date information regarding the maintenance of
good physical and mental health during aging.
To provide balanced meals that meet the government recommendations for
the specific age bracket
To provide a forum in which the residents may voice their opinions and
objections to the food options provided by dining services.
To provide educational programs to reduce the occurrence of disease and ill
health in the residents of the community.
To incorporate programs into the community which emphasize proper
nutrition and help to develop trust between the residents and staff.
Expertise of Agency in Conducting Proposed Program
Cardinal Village Senior Living has been Gloucester County’s prime senior
living facility since it’s founding in 1989. The professional full-time staff of Cardinal
Village provides the most individualized and nutritious meals of the senior living
facilities in the Gloucester county area. Cardinal Village’s nursing staff is a mix of
CNA, HHA, CHA, CMT, LPN, and RNs who assist in the maintenance of the resident’s
nutritional health. There is also a visiting registered dietician who comes once a
month to review the meal plans to assure that they have appropriate nutritional
content. Trish Bronsky, Director of Nursing, has been at Cardinal Village for five
years and the facility has truly benefitted from her presence. She has improved the
facility by demanding that her staff maintain the highest standard of living for the
residents and bringing a sense of compassionate and an insistence on individuality
of residents. Working in conjunction with the director of food services, Ms. Bronsky,
is able to enhance quality of life by staving off nutrient deficiencies and
malnourishment in the residents.
The “Elderly Nutrition” program would provide residents with a supportive
environment in which to learn proper eating habits. By carefully selecting means the
educator will be able to deliver a program aimed at educating the participants about
the most pressing issues in nutrition so that they may stave off the diseases that
commonly decrease the quality of life in the elderly.
Also, the topics presented in the program could be customized to meet each
individual’s needs. Education is a key element of this program and informative
lectures will be scheduled regularly. By presenting this program in a way that
focuses on the group as well as the individual this program will take advantage of
group social influence on behavior change. This program will provide a safe and
supportive environment that will facilitate group education and discussions.
Program Plan/Intervention
Demonstration
Each thirty-minute session will focus on a different aspect of proper portion
sizes. The sessions will be held twice a week for a month, creating eight
opportunities for demonstrations. The portion demonstration topics will include:
fruits, vegetables, grains, protein, dairy, oils, vitamins and minerals, and reading
food labels. Each demonstration will highlight key misconceptions about portion
sizes and demonstrate how to determine portions without measurement tools. I will
use the visual of a dinner plate and draw sections representing the different food
groups. Fake foods will be used to show portions on the dinner plate. The final
session of the program will address how to read food labels especially the area that
lists the serving size. After each session there will be a short quiz to ensure that the
residents are watching and understanding the message of the demonstration.
Food Log
The residents will be introduced to the idea of tracking all of the food and
drink they consume for a weeklong period. The log must include every food and
drink consumed, including snacks and desserts and how much of each item was
consumed, recorded as accurately as possible. The residents will meet with the
program manager to determine what their caloric intake should be for their age and
physical activity level.
Food Log discussion
After a week’s time the resident will meet individually with the program
manager to discuss the log. In this meeting the manager will see how closely the
participant was to their ideal caloric intake. The manager will also show the
resident, with the use of my plate resources, the breakdown of each meal regarding
calories, vitamin and mineral content, and RDAs for key nutrients.
PowerPoint
There will be a twenty-minute PowerPoint presentation, which will be given
once a week for a month. These presentations will highlight the importance of
calcium and vitamin D to the health of the elderly. This program will discuss how
both affect bone health, how much of each is required to maintain the health of
bones, good sources of both, and the negative repercussions of not getting enough
calcium and vitamin D in the diet.
Marketing
I plan to promote my program using fliers posted around the facility. The
residents of this facility on average are not very technologically inclined. All of our
residents are in their late 70’s and on so they do not have smart phones or
computers/tablets so trying an electronic marketing plan would not be a good way
to get their attention. In the facility each resident has a mailbox outside of their
room in which we can put fliers for programs; we will utilize this as a way to reach
each of our residents individually. Also, there are large bulletin boards posted
around the facility with calendars of activities and fliers of events and programs. I
could post the fliers on these boards and also on the smaller bulletin boards in the
mailroom and village store. Posting and distributing fliers will ensure that every
resident knows that this program is going on and hopefully get the residents talking
about participating.
Program Evaluation
Process Evaluation
During implementation the program administrator would have to evaluate
the program to see if it needed any alterations before continuing on with the rest of
the program. When we begin process evaluation for this program we will ensure
that the demonstrations are being held twice weekly after brunch and are lasting
thirty minutes each (fidelity of the program). Also, participants will be given an
open-ended survey that will ask them to express their feelings about the program
thus far and give an area to supply suggestions on how to make the program better.
Another part of the process evaluation will be to assess how the participants felt
about the food logs and whether they found the activity helpful towards increasing
their understanding of proper nutrition habits. We would use a 1-5 rating scale to
assess the effectiveness of this activity. The second to last part of process we would
have to assess is the informational powerpoint presentation. I would distribute a
similar survey to the one used to assess the demonstrations that would ask the
participants if the sessions are running on time, the quality of the information being
given, and if the information conveyed was new to them or not. The last part of
process to be assessed is the effectiveness of group meal times and discussions
during this time. I would distribute a survey with the Likert scale that would ask
them to rank their degree of agreement or not with statements about the usefulness
of group meal times and mealtime discussions. Therefore, process variables would
include organized demonstration and informational lecture times, effectiveness of
the program, and quality of the information given (effectiveness of observational
learning techniques, behavioral capability, reciprocal determinism, group efficacy).
Questions that would appear on the open-ended survey would ask for comments
about the punctuality of the instructor, effectiveness of the instructor, effectiveness
of demonstration techniques, and an area for any additional constructive comments
the participants might want to include. The scale used to assess the food log would
use a 1 to represent not effective/helpful at all and a 5 to represent extremely
effective/helpful. Questions would ask about the instructions given before the
journal was assigned, the effectiveness of the journal itself, and if it helped them to
better understand the topics that were lectured on. To questions on the powerpoint
assessment survey will be open-ended to allow for the most honest feedback from
the participants. Questions would ask about the quality of information given, the
professionalism of the delivery method, and how entertaining/interactive the
presentation was. The Likert scale is to be used to assess group meal times.
Statements such as “Group meal times give me the opportunity to discuss important
issues with my peers” or “Group mealtimes help me to eat better” would be
incorporated into this section. It is important to assess the program now so that
improvements can be implemented if the participants think they are necessary.
Impact Evaluation
Impact evaluation assesses the immediate effects that the program has on
the participant. This evaluation is performed right after the completion of the
program. Impact assessment will be performed by having each of the thirty
participants perform a practical test in which they will have to identify the correct
portion size of a certain food group. Impact assessment will also be done on the food
logs that the residents have been asked to keep. To assess the discussion of the food
logs the participants will be asked to complete a Likert scale which will have
statements that the participant will have to rank their agreement or not. The last
intervention that needs to be assessed for impact is whether or not half of the thirty
participants have increased their dairy intake by one serving. To assess if
participants increased their daily dairy intake they would be asked to record their
food and drink intake for a couple more days so that we can compare that to their
original food log. Therefore impact variables to be assessed are the degree to which
the participants understood and remember the information presented to them, the
degree to which the food log increased their awareness of their dietary habits, and if
there was an increase in the number of dairy servings consumed (observational
learning, self control, behavioral capability).
The practical exam will require each participant to determine if the portion
shown is the correct serving size. They will have to do this ten separate times for
different items in the food group and will have to be correct for eight out of the ten
portions shown. The Likert scale will display questions such as “the discussion of
my food log was helpful in identifying my dietary trends” or “the discussion gave me
a good sense of what I need to do to improve my diet.” To assess if there was a
positive change in their dairy intake I would go back and count the servings of dairy
they consumed before the discussion and educational interventions and compare
that to the number of dairy servings consumed after the educational interventions
were completed.
Outcome Evaluation
Outcome objectives are measured six months to a year after the intervention
has been completed. The first outcome objective to be assessed is the participant’s
ability to retain the information about portion sizes that were conveyed through live
demonstration. To assess their memory of the portion sizes we will do the same test
used during the impact phase and the participants will have to again earn an eighty
percent proficiency on the exam. The other outcome objective to be assessed is
whether or not the residents had negotiated with the food service director to
increase the availability of dairy products during mealtimes. To assess this we
would have to ask the dietary director for the meal plans from six months prior,
before any interventions began, and count the servings of dairy that were shown on
the menu and compare them to the menus now. The outcome variables are the
maintenance of nutritional knowledge six months after the demonstrations have
been completed and the negotiation and change in the amount of dairy products
available (observational learning, reciprocal determinism, collective efficacy).
Outcome evaluations are important so that the researcher can see if the
interventions had a long term effect on the target population’s self control and
reciprocal determinism with regard to changing the options available to them at
meal times and if the main outcome variable of increased nutritional knowledge in
senior participants was reached.
Project Personnel
Job Descriptions and Qualifications
Victoria Lawton- Lecturer, Nutrition Counselor
Victoria is a registered dietician who specializes in geriatric nutrition and
prevention of diseases related to malnutrition. Victoria has a bachelor’s degree in
health and exercise science with a specialization in health promotion from Rowan
University and has obtained her Master’s degree in geriatric nutrition from the
University of Connecticut. Victoria has been working within Cardinal Village since
2010 and has assisted with doing nutrition assessments and tracking of nutritional
status since she was in school acquiring her bachelor’s from Rowan University.
Victoria will be the sole lecturer and nutrition counselor for the Geriatric Nutrition
Program.
Salary Range: $30.00 per hour
TimelineJan Feb Mar Apr May June Jul
Develop program rationale
✔
Conduct needs assessment
✔
Develop goals and objectives
✔
Create the intervention
✔
Conduct formative evaluation
✔
Assemble necessary resources
✔
Market program ✔ Phase in food logs and discussions
✔
Process evaluation of food log
✔
Impact evaluation of food log
✔
Phase in nutrition demonstrations
✔
Process evaluation of nutrition demonstrations
✔
Impact
evaluation of nutrition demonstrationsPhase in Powerpoints
✔
Process evaluation of powerpoints
✔
Impact evaluation of powerpoints
Dec. Jan. Feb Mar. AprOutcome evaluation for food logs
✔
Outcome evaluation for nutrition demonstrations
✔
Outcome evaluation for powerpoints
✔
Prepare evaluation report ✔Distribute report ✔
*Outcome evaluation will be done six months after intervention implementation
Budget Explanation
Personnel for this project will include one nutrition specialist whose duty it
will be to lecture and counsel the participants about nutrition. As a registered
clinical dietician Victoria makes approximately $58,000 a year working within
hospitals that specialize in geriatric care. At $28.00 an hour, the cost of one staff
member for 21 hours would total $588.00 for facilitating the program. There would
be an additional charge of $140.00 for five hours of program planning, (5 * 28)
$336.00 for twelve hours of clerical work (12 *28), and $336.00 for twelve hours of
evaluation (12 * 28). The staff member will have to commute 20 miles to the facility
to run this program, travel costs are based on mileage and the staff member will be
reimbursed. Total travel costs for this staff member will approximately total
$135.24. Space in the facility is available on an hourly basis ($150.00 per hour).
The space required for this program will require that the facility usage total 21
hours, totaling $3150.00 for the duration of the program.
My marketing strategy involves distributing fliers to every resident in the
independent side of the facility. The best way to assure every resident gets the flyer
I would have to mail the fliers so that they will be put in their individual mailboxes
within the facility. Postage for each flier costs $0.46, for 110 fliers to be mailed it
would cost $50.60. Also, each flier would have to be put into an envelope before
being mailed ($7.99 for a box of 100). It costs $0.10 per copy, and we need 110
copies, totaling $11.00 in printing costs (cost of paper will be figured into
curriculum materials). The total cost of marketing supplies, excluding postage is
$18.99.
With regard to printing/office supplies, booklet costs were calculated based
on the number of participants (approximately 30). Booklets will contain
educational information that supplements the demonstration and PowerPoint
lecture topics. Based on 30 binders ($3.00= $90.00 total) containing approximately
30 pages each, plus paper for quizzes after each demonstration and presentation
900 sheets of paper ($17.97 for 1,500 sheets) are needed. Also, I will be handing out
quizzes after each demonstration and presentation for each of thirty participants,
adding 360 pages to the sheet count, consequently raising the total to 1,260 sheets
of paper. Add in 110 copies for the fliers used for marketing, bringing the total up to
1,370 sheets of paper. Copy costs ($0.10 per copy) would total $126.00 for the
booklets and quizzes. Also, I will have to purchase thirty composition books for food
tracking ($1.49 each) would total $44.70. Three containers of pens ($1.29 per
container) for test completion, etc., would total $3.87. With all costs considered the
total amount for printing/office supplies is $282.54.
Equipment necessary for the program will include a projector ($175.00) and
projector screen ($1327.92) to be used for the presentations. Also, I would need a
plastic food play set ($19.97) to demonstrate portion sizes on a typical dinner plate.
I will borrow the dinner plate from the kitchen so that it is more applicable to the
participants. I will also need to purchase a measuring cup and spoon set ($9.69)
along with a clear measuring cup ($7.00) for liquids for the demonstration, totaling
$16.69 for measuring supplies. Equipment costs total $1539.58.
There will be no income from this program because we will not be charging
the residents a participation fee. As an incentive, a $100.00 Visa gift card will be the
prize at the end of the program. Each participant will write their name on a piece of
paper and put it into a jar, on the last day of the program a name will drawn and that
person will win the gift card. The person whose name was drawn would have had to
participate throughout the entire program and have earned above an 80% on each
quiz given. The total cost of the program is $6,676.95
Sample Budget Sheet
Revenue Amount
Contribution from sponsors 0
Gifts 0
Grants 0
Participant fee 0
Sale of curriculum material 0
Total income: 0
Expenditures
Curriculum Materials $282.54
Equipment $1539.58
Incentives $100.00
Marketing
Print Advertising $18.99
Other media 0
Meetings 0
Personnel (1 person)
For planning $140
Program facilitators $588.00
Clerical $336.00
Evaluator(s) $336.00
Participants 0
Postage $50.60
Space $3150.00
Supplies See curriculum materials and
equipment
Travel $135.24
Total Expenses $6,676.95
Balance $6,676.95
References
Bachrach-Lindström, M., Christensson, L., Idvall, E., Johansson, A., & Söderhamn, U. (2009). Factors associated with nutritional risk in 75-year-old community living people. International Journal of Older People Nursing, 4-9.
Bednar, C., Longley, C., & Strohl, M. (2012). Residents’ Perceptions of Food and Nutrition Services at Assisted Living Facilities. Family & Consumer Sciences Research Journal, 252-253.
Castle, N. G. (2003). Searching for and Selecting a Nursing Facility, Medical Care Research and Review. 223.
Chernoff, R. (2009). Issues in Geriatric Nutrition. American Society for Parenteral and Enteral Nutrition, 176-177.
Greenwood, C. E., Weinberg, I., Wendland, B. E., & Young, W. H. (2003). Malnutrition in Institutionalized Seniors: The Iatrogenic Component. American Geriatrics Society, 85-90.
Kayser-Jones, J., Martin, C. T., Porter, C., Sivarajan Froelicher, E., & Stotts, N. A. (2005). Factors Contributing to Low Weight in Community-Living Older Adults. Journal of the American Academy of Nurse Practitioners, 425-430.
Mckenzie, James F., Neiger, Brad L., Thackeray, Rosemary (2013). Planning, Implementing & Evaluating Health Promotion Programs: a primer. United States of America: Pearson Education, Inc.
Mitty, E. L. (2003). Policy Perspectives: Assisted Living and the Role of Nursing: As many as half a million people reside in assisted living facilities, the regulations of which vary from state to state. Nurses have an opportunity—and an obligation—to help develop policies. AJN The American Journal of Nursing, 103(8), 32-43.
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