Inherent Flaws in a Method of Estimating Meal Intake Commonly Used in Long-term-care Facilities

Objective: To evaluate the accuracy of a method used to estimate nursing home residents' meal consumption, where the meal tray is assessed as a whole and assigned a value of 0%, 25%, 50%, 75%, or 100% consumed, under both routine and controlled conditions.

Subjects/setting: This study was conducted with certified nursing assistants at a 180-bed long-term-care facility in Miami, Fla.

Methods: Study 1 evaluated the method under routine conditions by comparing nursing assistants' estimates to actual meal consumption of 42 residents over 109 meals. A second study evaluated the method in a controlled setting where nursing assistants were free of disincentives and distractions that might contribute to inaccurate reporting. In a crossover design, nursing assistants estimated consumption on 4 manipulated trays under conditions of both immediate and delayed reporting.

Statistical Analysis: An intraclass correlation coefficient and percent agreement were used to compare nursing assistants' estimates to weighed meal intakes.

Results: Under routine conditions, the intraclass correlation coefficient between nursing assistants' estimates and the actual resident meal consumption was weak at 0.464 (95% confidence interval=0.146 to 0.664). The correct estimate was recorded 44% of the time. In the controlled setting, the nursing assistants' estimates for percent consumed agreed with weighed intakes 44% and 38% of the time with immediate and delayed recording, respectively.

Applications/conclusions: This 1-step method of estimating meal consumption with an overall percentage is not sufficiently accurate to identify residents who are eating less than 75% of most meals.