Intergenerational Mealtime at a Shared Site: A Small-scale Trial

Experimental Evaluation of Intergenerational Mealtime at a Shared Site: A Randomized Wait-listed Controlled Trial

The goal of this study is to find out whether having children and older people who attend an intergenerational center eating lunch together on a regular basis may be an improvement over continuing to eat lunch with their generational peers in separate dining rooms at the center.

Specifically, the study analyzes the functioning and potential impact of an intergenerational dining room in terms of healthy eating, nutrition, self-evaluation of health and well-being, relational care, nutritional knowledge, and intergenerational attitudes. For this purpose, it sets up, in an intergenerational center, a dining room attended by children aged 2-3 years and older people aged 75 years and older who had previously been taking their lunch in separate dining rooms at the center.

The main questions this study aims to answer are:

• Does eating lunch at the intergenerational dining room improve the intake of healthy foods by children and older people compared to eating at their usual separate dining rooms with their peers?
• Does this type of intergenerational dining room serve as a space for nutritional education of children and older people?
• Does the experience of eating together have a positive influence in terms of children's attitudes towards older people and vice versa?

The term Intergenerational Dining Room (IGD) refers to the intentional and planned space that enables people from different generations to periodically share the experience of eating together in settings dedicated to delivering care and development services (e.g. residential centers, schools), community work, intergenerational practices, etc.

The conceptual framework behind IGD has been articulated through combining the following three key components:

• Relationship-Centered Care (RCC): scientific evidence suggests that older people's care should focus on promoting meaningful relationships, rather than approaching them solely from the individualistic perspective of care.
• A life-course perspective on food: the act of feeding is a social practice that cuts across the life course and contributes to the construction of intergenerational relationships. Previous studies have pointed to the importance of mealtime as a space for interaction and learning between generations.
• Commensality, education, and nutritional health in caregiving spaces: research has shown that intergenerational programs have the capacity to improve the nutrition of their participants and encourage healthy eating habits, especially in settings where access to adequate food may be a challenge.

However, despite the growing interest in these components, empirical evidence remains limited, especially for structured intergenerational mealtime interventions with rigorous evaluation of their impact. Hence the goal of this interventional study: to analyze and explain, for the case of a specific institutional context - lunchtime at an intentional shared site's intergenerational dining room - not only the type of food and nutrition patterns but also some of the processes, causal mechanisms, and impacts associated with the social act of eating lunch together as a routine intergenerational practice.

Participant population is integrated by toddlers (ages 2-3) and older people (ages 79 and above) who attend regularly a co-located Preschool and Adult Day Care Center at an intergenerational shared site.

Apart from the 3 main questions presented in the brief summary, the study shall pay attention to further questions as the following:

• Is the intergenerational dining room a space where relational care and social interactions are practiced more than at the usual separate dining rooms?
• Does the subjective perception of health and well-being improve in older people because of their participation in intergenerational meals compared to having lunch at their regular daycare dining room with generational peers?
• Do children show greater well-being and participation at lunchtime when they are at the intergenerational dining room compared to the school dining room?; 4) Overall, is the feeding experience at the intergenerational dining room more positive than at dining rooms where each generational group has lunch with generational peers?

Researchers will compare a group of toddlers and older adults having lunch together several days per week to a similar group eating lunch just with their peers to see if intergenerational mealtimes make any difference. It is expected that the total number of intergenerational meals over the 16 intervention weeks amounts to 60.

Design of this study corresponds to a randomized wait-listed controlled trial including two wait-listed intervention groups (due to limitation of space to accommodate more than 10 people at the intergenerational dining room) and one control group.

Participants in the intervention will:

• Intergenerational Dining Room - Group #1 (IG1): During 8 weeks, have lunch at the intergenerational dining room four times per week and once a week at the regular peer-based dining room. Then, move to the peer-based dining room to have lunch five days per week for another 8 weeks (follow-up period).
• Intergenerational Dining Room - Group #2 (IG2): Have lunch at the peer-based dining room five days per week for some 8 weeks (waiting period), then for the following 8 weeks eat lunch at the intergenerational dining room four times per week and once a week at the regular peer-based dining room.
• Monogenerational Dining Room - Control Group (CG): Have lunch at their regular peer-based dining rooms for 16 weeks.

Both the control and intervention groups will undergo a final follow-up period of around two weeks to determine the duration of the observed impacts.

Inclusion Criteria (older people):

• Informed consent signed by each participant or his/her legal representative.
• Eating autonomy: Ability to feed oneself without continuous assistance from another person.
• Expected stay at the Intergenerational Center until July 2025.
• Negative certificate of Sexual Offenses (mandatory in case of contact with minors).
• Screening for nutritional risk, dysphagia and oral health: Exclusion of persons with severe untreated malnutrition, severe dysphagia or oral problems preventing chewing.
• Adequate cognitive status: mild or moderate cognitive impairment (rating ≤5 on the Global Deterioration Scale - GDS).

Inclusion Criteria (toddlers):

• Informed consent: Signature of the legal guardian authorizing participation in the study.
• Child's assent: Positive expression of willingness to participate.
• Feeding autonomy: Ability to eat without continuous assistance from an adult.
• Expected permanence in the Intergenerational Center until July 2025.

Exclusion Criteria (older adults):

• Advanced cognitive impairment (GDS > 5) affecting comprehension and social interaction.
• Severe dysphagia or oral health problems preventing normal feeding.
• Unstable medical conditions that limit intergenerational dining attendance.
• History of aggressive behavior or history of refusal to interact with children.
• Lack of consent or refusal to participate in any of the study assessments.

Exclusion Criteria (toddlers):

• Need for ongoing feeding assistance.
• Severe medical conditions affecting feeding or social participation (e.g. severe metabolic disease).
• Expectation of transfer or departure from the Intergenerational Center prior to completion of the study.