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Healthily LifestyleInterpersonal determinants of eating behaviours in Dutch older adults living independently: a qualitative study | BMC Nutrition | #elderly | #seniors | #execrise

Interpersonal determinants of eating behaviours in Dutch older adults living independently: a qualitative study | BMC Nutrition | #elderly | #seniors | #execrise

This study aimed to gather insight into interpersonal determinants of eating behaviour of independently living older adults, in a specific neighbourhood in the Netherlands. The study showed that older adults do not directly think of interpersonal factors influencing their eating behaviour, they rather think of individual factors (like habits and health status), or environmental factors (like food accessibility). However, interpersonal factors did seem to influence their eating behaviour as well. With respect to interpersonal factors, we identified four key topics: 1) Behaviours are shaped by someone’s context; 2) Living alone influences (determinants of) eating behaviour via multiple ways; 3) There is a salient norm that people do not interfere with others’ eating behaviour; 4) Limited use of social support (both formal and informal) for grocery shopping and cooking, except for organised eating activities in the neighbourhood.

Some results seem neighbourhood-specific. It was striking how many social events for older adults were organised in the neighbourhood, probably due to the relatively large number of older adults in the neighbourhood; 23% of the neighbourhood’s inhabitants were 65 years or older, compared to 15% in the city as a whole [23]. In the neighbourhood, there are many shops, a weekly fresh market, and good public transport options. Those facilities can explain why the older adults in this neighbourhood did not make much use of social support for their grocery shopping. The norm not to interfere with each other’s eating behaviour is probably less neighbourhood-specific, but rather part of Dutch norms in general. Literature shows that for some, like the French, eating is a social matter, where for others, like the Americans, eating is rather an individual matter, or even personal freedom or responsibility [19]. For the Dutch, it is likely that eating is perceived more as an individual affair, as the Netherlands is more individually than collectively oriented [27, 28], and individual responsibility regarding health and lifestyle are considered important [29].

Other findings of our study were expected to be more generally applicable to older adults; for example the influence of living alone [12, 30, 31]. Although living alone is sometimes classified as an individual determinant of eating behaviour [11], respondents in our study described the influence of living alone on their eating behaviour in terms of the absence or presence of others. Therefore, we included living alone as one of the relevant interpersonal factors. Eating alone is associated with a reduced diet quality [32, 33]. In our study, living alone was often mentioned by the respondents as a reason to explain their food choices. The finding that they put less effort into food preparation when they are alone, is in line with other studies that showed that living alone is associated with simplified meals and less food diversity [30, 34]. Likewise, some community-dwelling older adults in the study of Van der Pols-Vijlbrief et al. [31] mentioned that eating alone causes a lack of motivation to cook nutritious meals. Moreover, some of our respondents explained that eating alone is less enjoyable, which is also in line with other studies that showed that eating alone reduces the pleasure of eating [12], and food is perceived tastier when eating together [31].

Also more generally applicable is the finding that older adults’ eating behaviour is partly led by their context. Some of our participants’ eating habits were a result of religious or (earlier) family traditions. Earlier studies described that present life of older adults is affected by habits founded in the past [35, 36]; however, these traditions can also slightly change when getting older, for example, because people become dependent on others for their groceries [34, 37]. Also, norms and preferences of others in the current social context can influence older adults’ eating behaviour, as some respondents indicated going along with their context.

One strength of this study is that it included both interviews and observations. The observations mostly confirmed the findings from the interviews and helped to better understand the perceptions and experiences that older adults described during the interviews (for example, where they did their groceries, and the eating activities they attended). It also helped to detect incidental discrepancies between what was expressed by the older adults, and what was observed by the researchers. An example of such a discrepancy is that interview participants indicated not paying attention to each other’s eating behaviour, while the observations provided some concrete examples of occasions where they did.

We aimed to interview a diverse group of older adults, to gain insight into the different perceptions that may exist among older adults in the neighbourhood of interest. Our group was diverse in terms of – among other things – age and marital status, but not in gender; the majority was female. The small number of males included in this study, may have caused some male-specific perceptions not to be detected. Moreover, there might have been selection bias as a result of recruiting participants via local welfare and health professionals. The perceptions of older adults who are not in sight of these professionals may have been missed. Moreover, the older adults involved in our study were possibly less vital than the general population of older adults, as professionals attempted to recruit interview participants with an increased fall risk (e.g. indicated by experienced falls in the previous year, balance impairment, having difficulties walking). It is known that impaired mobility can be a barrier for shopping and meal preparation [12], for which older adults then have to rely on others [38]. Therefore, selecting on increased fall risk may have influenced the findings of the current study (e.g. because interview respondents were more in need of social support than other older adults). The increased fall risk did not, however, inhibit most older adults included in our study from doing their own grocery shopping, or coming to the community centre for the interview. The observations at the supermarkets and local market helped us to get into contact with a more diverse group of older adults. In conclusion, the current methods cannot guarantee that we gained an exhaustive view of interpersonal determinants in the area of interest. This study did provide valuable insights in both neighbourhood-specific and general determinants of older adults’ eating behaviour, and particularly in the meaning of the determinants for the older adults in their daily lives.

The current study focused on interpersonal determinants. As shown in literature, determinants at an individual, environmental, or policy level will also influence eating behaviour [11]. Hence, for health promotion, it is important to consider factors at other levels as well. In our interviews, those other factors appeared too, e.g. habitual eating, taste preferences, or food availability. It would be interesting to further explore the interaction between interpersonal determinants and these factors at other levels, influencing eating behaviours. In our study, for example, some respondents described that the presence of many shops (an environmental determinant) in this neighbourhood facilitated buying their own groceries, which made them less needy for social support in grocery shopping. Another example of such interaction, from literature, is that receiving social support for grocery shopping or meal preparation can conflict with one’s own taste preferences (an individual determinant) [14, 39]: the people who provide support may use different products or cooking techniques. This was not the case in our study: participants did not make much use of social support and were therefore probably able to follow their own food preferences. So as long as their health status (an individual determinant) enables them to continue their habitual behaviour (another individual determinant), social support for grocery shopping will not influence their eating behaviour much. Likewise, as the norm was not to interfere with others’ eating behaviour, these others will not be a reason to change behaviours, which could further reinforce their habitual behaviours (an individual determinant). Detailed knowledge of these possible interactions can further inform health promotion programmes.

The insights from the current study assist in developing health-promoting strategies for older adults. In general, it is necessary to recognize the strong influence of habits (partly founded in the past) by providing advice that is in line with older adults’ own dietary patterns, and the underlying norms and preferences. The influence of living alone on the effort they are willing to spend on cooking elaborately should be considered, by providing solutions that do not require much effort in meal preparation. Social eating can be a solution for some older adults; when eating is combined with another activity the target group may be more likely to go [40]. When eating is not so much a topic of conversation for them, as in the neighbourhood of our interest, this other activity should be focused on something else, or be promoted by emphasising the social aspect of being with others (but not interfering with each other’s behaviour). The benefits of an adequate diet for staying healthy and independent can be emphasised, as these can be strong motives for older adults. Careful consideration is necessary regarding the framing of ‘older adults’ in (the recruitment for) the programme, as, in line with our finding, they do not necessarily identify themselves with this group [40].

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