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The occurrence of malnutrition amongst the elderly is high. According to studies from Kristianstad University, approximately 65 percent are at risk of becoming malnourished. It has also been found that the amount of malnourished elderly is increasing drastically and is expected to continue. Today, malnutrition amongst elderly is already an extensive social issue, and is expected to increase even more unless major efforts are made.

On page 62 of the Swedish National Board of Health and Welfares regulations and general advice (SOSFS 2014:10) regarding prevention and/or treatment of malnutrition, all health care institutions must have routines on assessing the risk of malnutrition, offering treatment and/or remitting the patient to other healthcare providers if necessary.

Many patients that are malnourished or at risk of developing malnutrition do not only need nutritional support. They need various individually adjusted assistive eating measures to be taken. Assistive eating measures aim to support, facilitate and make it possible for the patient to reach an ideal energy and nutritional intake, and to feel dignity and well-being through their diet. Assistive eating measures can include; feeding, assistive eating devices and assistance or supervision during the mealtime.

See the signals

If we are able to detect the signs that someone may not be eating well or may not be eating enough at an early stage we would be able to avoid a massive amount of human suffering and would be able to reduce societal costs substantially.


Aging is associated with several physiological, physiological and social changes. Many of these negatively affect appetite, ability to eat and absorb nutrients which clearly increases the risk of malnutrition.


Health conditions, side effects of disease and medication are contributing factors to how the appetite works. Psychological factors such as mood and values, along with depression and possible dementia, have a major impact on the appetite and hence on food intake.

Physical factors

Dysphagia, i.e. chewing and swallowing difficulties, is common amongst the elderly and amongst those with neurological diseases. Dysphagia is a common cause of malnutrition. Being unable to eat without being dependent on others to be able to eat is another contributing cause of malnutrition.

The mealtime based on seven perspectives

Responsibility and Planning

Is a key issue and is Är en nyckelfråga och handlar om ledarskap, kommunikation, samarbete och involvering. Hur har verksamheter som ordinärt eller särskilt boende fördelat ansvaret mellan vårdprofessioner och chefer? Är det ett uttalat eller outtalat ansvar? Finns rutiner och rollbeskrivningar?


Responsiveness and receptiveness to the situation of the individual is very important in healthcare. For those who want to and have the opportunity to should be offered support and the appropriate assistive aids to maintain their independence during their mealtime as much as possible.

Ergonomics and Sitting

The most common cause of difficulty eating is a bad sitting position. 50% of those who are having difficulty eating are just simply seated incorrectly. Sometimes simple adjustments can be made to make the dining area work well, in other cases, an occupational therapist may need to be requested to have a look at the posture.

Social aspects

The meal is the "icing on the cake" in our social interactions. It is during meals that we consolidate and confirm our social status, identity and self-image. Culture, tradition, religion and customs manifest during the meal which obviously affects how and what we eat.

All the senses

There is a saying that we "eat with your eyes", we also eat with our nose and mouth by experiencing smell and taste. Even our ears can come into play as sounds can affect our mealtime. Therefore, all our senses have an effect on the meal.


Many people need food with an individually adjusted energy and nutritional content. The risk of malnutrition is greatest for elderly individuals who live at home and this may be due to a variety of things, including different types of eating disorders, but also a decreased desire to eat because the person does not want to eat alone.

Oral hygiene and Swallowing

If there is a suspicion of dysphagia (difficulty eating), the swallowing function should be assessed and the consistency of the food should be revised. It is also important to have a clean mouth and teeth that are carefully taken care of.


Mealtime Quality Index

MQi measures the process quality within the mealtime situation based on research, experience and swedish, as well as, international guidelines for quality indications regarding the mealtime. MQi offers a unique possibility to learn exactly how your establishment ranks. The measurement consists of questions that are directed to staff and residents. The questions are answered through an IT-based solution that is available via AppStore.


(The app is only compatible with iPad/iOS. Not smartphones or for instance Android tablets).


Read more here

Private: Butler

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Nursing home department manager in Stockholm, Sweden said this about MQi

”It is easy to understand the report and to show it to others whilst it encourages conversations and discussions amongst staff about how they can work to improve the mealtime situation.”

Anneli Lagerberg

Department manager at the Nursing home Väderkvarnen in Stockholm City


Mealtime Course

Quality assurance of the mealtime situation

The course is interdisciplinary and is based on our philosophy "Mealtime Puzzle"  - a sustainable mealtime approach based on seven different perspectives - as well as mealtime research where the book "Svårigheter att äta" (Westergren, A. (red.) (2003). Lund: Studentlitteratur.), constitutes a large part of the content.

Through collaboration with various universities and colleges around mealtime research, the course is continuously developed as we are able to part take in the latest research.

The course is aimed at two target groups:

  1. Nursing staff and assistants
  2. Occupational therapists, physiotherapists, dietitians, speech therapists and nurses.

We offer a similar half-day course as a part of the regular content in the Karolinska Institutes occupational therapy course.

This course is new in its kind and there is currently no equivalent in Sweden. It can be completed at one time, and is offered as either a three or seven hour course depending on focus.


Cecilia Eriksson

Course Instructor and Supervisor

Mealtime Course

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