Formulation and designing a comprehensive model of national elderly nutrition care

Abstract

Background and aims: The elderly population around the world is growing rapidly and has faced every society with various opportunities and challenges. Over time, the demand for primary health care, especially nutritional care, for longer and healthier lives is increasing. Therefore, every society needs planning and policy-making in the field of geriatric nutrition. The present study was conducted to evaluate the nutrition service process of the integrated health care program for the elderly in Iran and to design a comprehensive model of national eldrely nutritional care. Methods: The present study was conducted in an integrated method (quantitative and qualitative) in multi stages. First, a comparative review study of selected countries (3 developed countries and 2 countries with similar background to Iran) was done to extract structures and models of elderly nutritional care through international (PubMed, Scopus, Sciencedirect, Proquest) and national (SID, Magiran, Iranmedex) databases, as well as the websites of related institutions until 2019. Process evaluation of nutritional services for the elderly in the health care centers of Tabriz was done using two researcher-constructed questionnaires to examining the exposure, reach, and satisfaction rates of the program target group, the levels of program delivery, as well as the fidelity and context of the program. For this purpose, 256 elderly people and 76 service providers from 32 health care centers of Tabriz were selected to participated in the study using cluster sampling. The gap between the structures and models of nutritional care for the elderly in Iran and the included countries in the comparative review study was determined by the qualitative method of framework analysis. Finally, in order to design a comprehensive eldelry nutritional care model, 5 focus group discussions and 7 semi-structured face-to-face interviews were organized and the opinions of experts were analyzed using MAXQDA software version 10. The proposed model was developed by the research team and its feasibility was determined using Delphi method. Results: The results of the comparative study showed that Denmark, USA, and Japan have more comprehensive nutritional care models and programs for the elderly than Iran, Argentina and Turkey. In these countries, the private sector plays a significant role alongside the public sector. Universal health coverage as a structure to provide nutrition care is emerging in Iran and Turkey compared to Japan, Argentina and Denmark. Meals and nursing services are providing in Japan and Denmark with an emphasis on the elderly living at home. The results of the process evaluation on elderly nutritional care services in Iran showed 77.7% exposure and 20% reach of the program target group. The satisfaction rate of the elderly with the program was 58.5%. Insufficient delivery of some program components was reported; as the delivery of group sessions of nutrition education, physical activity sessions, informing clients by phone, follow-up, installation of posters in the streets, vitamin D supplementation and calcium and multivitamin supplementation were reported 83.9%, 5.5%, 59.3%, 24%, 18.7%, 24.7%, and zero percent, respectively. The fidelity rate was high for many parts of the program. Also, the multiplicity of tasks, lack of financial support and low access of the elderly to services were among the issues raised in the context section. Main gaps in the structures and models of elderly nutritional care models in Iran compared to the assessed countries included the non-allocation of insurance to special services for the elderly, insufficient universal health coverage, inadequate budget allocation, and inefficient elderly nutritional care services. The results of qualitative analysis of group discussion sessions and interviews were categorized into 8 categories, 32 main themes and 191 sub-themes. Proposed model for providing national elderly nutritional care have different components including input (National Council of the Elderly, staff and environmental organizations and service centers), process (monitoring and evaluation body, research and development of services, presentation Services), and output (service goals and ultimate goals). Finally, the Delphi study of the designed model showed a content validity index of 0.69 and a kappa of 0.66, indicated “good” feasibility in the Iranian health system. Conclusions: The present study considers a process and organizational approach and using the standard principles of providing nutrition services to proposing a suitable elderly nutritional care model with the help experts, gerontologists, nutritionists, and the elderly. In fact, the proposed coordinated model sets goals and resources and monitors the service process, which can pave the way for future research into the provision of nutritional care services for the elderly. In order to prepare an action plan and implement it, the proposed model can be submitted to the decision-making and executive levels of the country.