Improving Appetite in Geriatric Patients: A Research Proposal

This research proposal aims to improve the appetite of geriatric patients in a clinical setting through the use of flavor-enhanced food. The study will compare the dietary intake of older adults residing in hospital and community settings before and after the intervention. The research design is a case control study, and data will be collected through anthropometric measurements and questionnaires. The study aims to provide evidence for the effectiveness of flavor-enhanced food in improving appetite in geriatric patients.

Running head: REASEARCH PROPOSAL
REASEARCH PROPOSAL
Name of the Student
Name of the university
Author’s note

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Introduction
Ageing is associated with several physiological changes that can cause a decrease
appetite. Changes to the digestive system, changes to the responsiveness and the levels of the
certain hormones is also necessary for the decreased appetite of the older adults (Divert et al.,
2014). Again, the presence of acute infections might lead to a decreased appetite in elderly
patients. Hence, it is the responsibility of the geriatric nurses to look out for the ways to improve
the refusal to the eating behavior in elderly. This paper will discuss about an intervention for
improving the appetite of the geriatric patients in a clinical setting.
Background
As set out in a case report by Meier and Ong (2015), patients, be it an adult patient or
geriatric patient, have got the autonomy to refuse the intake of the food. Owing to this right the
patients might willing stop eating and drinking. Again, the health care professional are not
provided with the authority to force any patients to consume food and drink. In relation to this,
Divert et al., (2013) have stated that ageing is a crucial period in relation to the selection of food
and the eating behavior in humans and the repeated exposure to an assortment of the food
products in the form of an important determinants for selecting or refusing a drink. According to
Cerri et al. (2015), the prevalence of malnutrition and sarcopenia has been witnessed among 23
% of the hospitalised patients, 10.3 % of the discharged patients have died within three months
of discharge. Maitre et al. (2014) have confirmed that most of the geriatric patients are picky
eaters and substances like appetite enhancer, changing the flavour of hospital made food can be

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helpful in increasing the appetite of the patients. This evidence provides the rationale for
choosing the option of addition of flavours in the food of the geriatric patients.
Formulation of the PICO
The below mentioned PICO has been used for the formulation of the research question.
This framework had been useful for searching the relevant papers from the electronic data bases
for conducting the literature reviews (Hastings & Fisher, 2014).
P/population Older patients in nursing home and/or
community
I/intervention Flavour enhanced food
C/comparison Normal food
O/outcome Improved dietary intake
Table 1- PICO framework for the research plan
Research question: Can flavour enhanced foods improve dietary intake among older adults
residing in hospital and community settings?

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Conceptual framework
Dependent variable
 Use of flavors like chicken flavors, fish
flavors, and turkey flavors.
Independent variable
 Increased appetite in geriatric
patients
Instrument used
 Measurement of the body mass index before and after the
interventions
 Questionnaire
 Mean and standard deviation
 SPSS and student t- test for testing the variation
Research method
 Control group (10 patients ) and intervention group (10
patients

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Literature reviews
Loss of appetite in the elderly patients in a hospital is one of the most common
problem .Eating too little can lead to malnutrition ,which in turn can cause long hospital stay and
also increases the risk of the mortality. According to a cross sectional survey conducted with the
elderly patients, it has been found that in most of the cases that loss appetite can be caused due to
loss of appetite, others have mentioned that medical treatment was more important than the food,
some of the other patients have reverted that they missed hoe made food and taking meals with
their families. Some of the patients have complained that their mea times were being interrupted
by nursing attendances or doctor’s visits. Few of the patients had evoked the bad quality of the
meals or lack of taste in the meals. According to the study by Divert et al., (2013), appetite
regulation is complex and is poorly understood.
Taste and smell losses occurs with ageing and might influence the enjoyment of the food
in the elderly patients and thereby affect the nutritional intake of the older adults. Most of the
papers on taste and ageing have focused on the taste acuity and sensitivity other than the hedonic
performances. However Masic and Yeomans, (2014) had conducted an intervention study, where
flavor enhancers were sprinkled over cooked food and measurement of the intake of the meals
were observed. As per the findings, repeated consumption of the flavor enhanced cooked meals
has led to the increase of the dietary intake of the meals, increase of the body weight after the
consumption of the flavor enhanced meals and repeated consumption of the flavor enhanced
meals. Monosodium glutamate (MSG) had been used traditionally to increase the flavor of
Umami (Masic and Yeomans, 2014). In order to test that combination of monosodium glutamate

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and inosine 5′-monophosphate (MSG/IMP) was provided to the participants. It was found that
the addition of the MSG / IMP increased the pleasantness of the soup. The addition of the
MSG/IMP had a biphasic impact on the appetite at the time of the ingestion and enhancing the
postingestive satiety.
Patient having impaired smell or taste can be improved by enhancing the flavor of the
food. This can be done by the addition of certain flavors based on their likings. The addition of
extra sugar and salt is not recommended but herbs, peppers and spices can be used safely as per
the persona preferences of the patients (Pilgrim et al., 2015).Exotic seasoning can be used only
after being approved from the physician and the dietician. Seasoning dishes with onions, garlic,
scallions, turmeric, cumin, curry and red pepper can be used in the dishes for enhancing the taste.
Some of the patients loves desserts and hence for a dessert like taste, one can opt for ginger,
cinnamon, cloves and nutmeg (Ludy, Tucker & Tan, 2015). Patients should also be encouraged
to consume a wide variety of food at each meal for sustaining appetite at the time of meal. Taste
and smell of favorite food can stimulate the appetite of the older people and case them to eat.
The effect of the flavor enhancement has been tested in non-cognitively impaired older
adults hence Pouyet et al (2015) have tested the effect of the flavor enhancement on the
cognitively challenged older adults. Two food testing methods were compared. The appetizers
were offered to the participants before the lunch and the rate of the food intake and the food
liking was measured. However the results showed a positive correlation between the liking
towards food and the food intake.
Focusing on the flavors Ogawa et al. (2018) have stated that vanilla flavoring agents in
food gives a dessert appearance to the food, which might be preferred by several adults. Maitre et

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al.,(2016) have stated that inhalation of the eugenol , that contains a vanillin group has an
appetite enhancing effect and the inhalation of the aromatic compound containing the vanillin
group lea to the increased food intake in an experimental animal model.
Research design and methodology
The research design chosen for this study would be a case control design, which is an
observational study, where two groups of older patients will be chosen. The various outcomes of
intervention will be measured. The advantage of using an observational design is that the
research method is inexpensive and can be completed in less time (Yin, 2017). This design
eliminates the variable of participants ‘interpretation of questions, which would be inherent in
the collection of participant-reported data. This case control study would compare the
effectiveness of flavors on the geriatric patients under the same population, but receiving food
without added flavors.
Data collection
The study will be conducted in the geriatric patient ward in a clinical setting. The
inclusion criteria for the selection of the participants would be (1) patients above 65 years of age
(2) without any cognitive disability (3) absence of any hypersensitivity against Monosodium
glutamate (MSG), (4) consuming meals provided by the nurses for at least 4-5 days in a week. A
total of 20 patients will be equally divided in to two groups. One group of 10 participants serving
as the intervention group and the other group of 10 serving as a control group.
After the participants have been recruited, they will be allocated by a non-randomized
way, in the case and the control group. The meals received by the intervention group will be
garnished with chicken flavor, fish flavor and turkey flavor, before delivering the food to the

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patients. Nutritious soups enhanced with cream or pureed vegetables will also be served with
these flavors. Multiple flavors has not be added due to the fact that multisensory mechanisms are
involved in the perception of the flavors (Prescott, 2015). Approximately 1gm of the flavors
would be added to each of the dishes. The control group on the other hand would be served with
the same meal, except that no additional flavors would be added to it.
Instruments to be used
The anthropometric measurement should be recorded at the baseline and after the study
has been completed. The body weight of all the participants that has been recruited will be
measured in the form of an index of their direct nutritional status, which would help in the
assessment of any patients suffering from malnutrition (Heale & Twycross, 2015). The body
weight will be measured before the breakfast and at night after the meals. The patients will be
dressed in light clothes without slippers and the body weight will be measured. The height of the
patients will also be measured, as the BMI of the patient is imperative to the body height. The
dietary intake patterns for the patient has to be recorded twice at the time of lunch and the dinner
before and after the meals has been taken (Tamura et al., 2015). The food prepared, the flavors
and the spices used would be approved by registered dietician of the hospital.
A questionnaire would be used for assessing the feelings and the perception of the
patients in the two groups, in relation to their hunger, appetite, smell the taste and the quality of
the food served. The questionnaire should be given to the patients prior to the starting of the
interventions, in order to assess the comparison between the implemented interventions and the
normal food that is prepared for the elderly patients in the hospital. The advantage of using a
questionnaire is that it is easy to analyze (Rowley, 2014). The researcher would the collect other

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verbal and non-verbal cues of enjoyment to detect the feelings of the patient group after the
consumption of the flavored food.
Data analysis
The quantitative approach of the study will entail the calculation of the mean and the
standard calculated at the baseline and at the end of the intervention. The variation between the
two groups would be calculated by using t-test. SPSS 21.0 software package will be used for the
quantitative analysis (Green & Salkind, 2016).
Ethical considerations
An ethical approval is required, from the ethical committee of the university, before the
conduction of the research. A consent form along with a debriefing letter will be made to sign by
the participants that will contain all information about the pros and cons of the research
conducted. The anonymity of the participants will be maintained and collected data will not be
used in the conduction of some other research trial. All the participants will be given the free will
to quit from the trial, as per their wishes. Informed consent and ethical approval will demonstrate
that the participants have voluntarily agreed to participate in the study. Preservation of privacy
and confidential is a valuable part of a research process and the view of the ethical approval is to
protect the participants (Colnerud, 2013). All the health related information of the participants
will be stored in encrypted databases to restrict any unauthorised access. Pseudonyms will be
used for the patients while referring to their baseline data. It will be ensured that the
interventions do not cause potential harm to the patients.

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Conclusions
Limitations
One of the disadvantage of the case control studies is the chance of occurrence of
selection bias. They are inefficient for rare exposers. Information on exposure is subjected to
observation bias (Mansournia et al., 2013). A case controlled study will again facilitate the
demonstration of the association between the intervention that is being applied and the enhanced
dietary intake among the patients.
Since the trial participants were not allocated to the treatment randomly, another
limitation of this study that might arise is the allocation bias. The rationale for making two
groups is that, both the perception of the group receiving flavored food and the ones receiving
normal meal would easily be evaluated. Allocation bias can be termed as the systematic
difference between the participants in the way there are allocated to the intervention. The
researcher will no doubt favor those participants who had reported a decreased appetite in order
to portray the outcome. Sometimes it is argued that nonrandomized case control studies have
limited value due to the difference between the treatment groups in the baseline characteristics
(Mansournia et al., 2013).
Another probable limitation of this study could be the sample size where, which would
might reduce the generalizability and the reliability of the result. The result might cause higher
variability that might lead to bias. Selection bias can also occur during the recruitment of the
participants (Schönbrodt & Perugini, 2013). The sample that has been recruited for the study
might not represent the general wider population. Again high degree of research boas might

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occur as the observer is a human and subconscious opinions on the demographics might affect
the analysis.
Implication of the study
Poor appetite in geriatric patient is a common problem within the hospital settings, which
might lead to weight loss and nutritional deficiencies among the older adults. Understanding the
causes of poor appetite and thinking the new way to increase the appetite of those patients can be
challenging for the geriatric nurses (Møller, 2015). The findings from this observational study
will help the clinicians to understand, whether addition of new flavors would act as an appetite
enhancer or the use of flavors and spices would be harmful for the geriatric patients. In
accordance with that, the food preparation procedure can be changed or permission for the
addition of new flavors in the food for the elderly people, to increase the appetite of the patient.
Summary
In conclusion, it can be said that although a large number of literatures support that use of
specific flavors can enhance the appetite in the elderly patients, the case control study will be
conducted for further strengthening the evidence. 20 elderly participants from the geriatric ward
will be selected for the study, divided in to a control group and an intervention group. The
intervention group will be provided with flavor added- meals and the control group with normal
meals. The body mass index of the patients and the rate of meal consumption will be calculated.
Finally a questionnaire will be deployed to understand the perception of the patients related to
the food taste and the quality of the food. The quantitative analysis of the data will be conducted
by using SPSS. Student paired-t test will be done. The meal plans in different clinical settings
can be improvised to meet the taste of the patients.

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References
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