Design of a Food Preference Assessment Tool for Older Patients in Geriatrics units_DYSPHAGING-PREFERENCES

Design of a Food Preference Assessment Tool for Older Patients in Geriatrics Units

Swallowing disorders - or oral dysphagia (OD) - are identified as a cause of malnutrition. They gradually lead patients to withdraw certain foods from their diet, leading to progressive dietary imbalances, or increased cardiovascular risks. Two European societies (the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society) have defined recommendations that include raising awareness of OD, the use of screening scores, preventive measures, diagnostic standardization and interventions implemented (re-education, adaptation of textures). We recently reported the results of the DYSPHAGING Pilot Study that validated the feasibility of a standardized care path including a systematic screening of OD and the implementation of preventive measures in geriatric wards.

DYSPHAGING Preferences is a three-step research program designed to develop (step 1) a specific device to evaluate food preferences in geriatric populations, adapted from the CFTPQ, evaluate its test-retest reliability (step 2), and perform a cross-sectional study to explore individual differences within the older population depending on their geriatric characteristics and, among them, on the presence or not of OD (step 3).

The World Health Organization (WHO) has made the healthy aging of the population a priority in the orientation of public policies for the period 2016-2030. Aging is associated with a progressive decline in various physiological functions that can lead to a gradual risk of sarcopenia, malnutrition, dysphagia, osteoporosis and frailty. Due to multiples etiologies and both morbidity and mortality consequences, the management of malnutrition is one of the main challenges in the older population.

Swallowing disorders - or oral dysphagia (OD) - are identified as a cause of malnutrition. They gradually lead patients to withdraw certain foods from their diet, leading to progressive dietary imbalances, or increased cardiovascular risks. Two European societies (the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society) have defined recommendations that include raising awareness of OD, the use of screening scores, preventive measures, diagnostic standardization and interventions implemented (re-education, adaptation of textures). The investigators recently reported the results of the DYSPHAGING Pilot Study that validated the feasibility of a standardized care path including a systematic screening of OD and the implementation of preventive measures in geriatric wards.

Current recommendations for the treatment of undernutrition involve increasing energy and protein intake. Apart from the quantitative needs, qualitative properties of the food delivered are less emphasized. Some surveys in geriatric populations have shown increased preferences for fruits, vegetables and fish, and a reduction in the variety of dishes or the consumption of dairy and meat products. In subjects with swallowing disorders, preferences are mainly oriented towards adapted textures, like foods finely cut into small pieces. However, hedonic properties have rarely been evaluated, and the combination of dietary restriction with the consumption of texture-modified foods can lead older patients to nutritional deficiencies.

In this context, strategies are needed to better tailor food intakes to the preferences of geriatric patients. In adult populations, individual differences in texture and taste perceptions have been demonstrated and impacted food appreciation. In addition, and more specifically in an older population polypharmacy, smell, mood or cognitive disorders, OD are highly prevalent and may have an impact on such appreciation.

Some tools have been developed to evaluate food preferences in different specific populations, but most of them are IT-based and poorly adapted to vulnerable older patients, due to frequent praxis, cognitive or visual impairments. Another tool, the Child Food Texture Preference Questionnaire (CFTPQ), has been specifically developed for pediatric populations. The CFTPQ is based on forced-choice question methods, that are, sequential choices between alternative meal presentations previously identified by the participants. Such procedures are widely used in consumer preference assessment surveys and in geriatric populations to assess the food preferences of patients with poor appetites, representative of hospital populations In addition, several studies have shown a concordance between the choices made by patients and their actual food consumption. However, the meal presentations included in the CFTPQ are inappropriate for a geriatric population.

Based on CFPTQ developed by Laureati et al. 2020, the DYSPHAGING preferences questionnaire is using a forced-choice method. The device is divided into two-stages:

• A first stage of individual recognition in which the patient is asked to answer the following question "have you already eaten this product?" for each of the foods evaluated in each of the 6 categories.
• A second stage in which the same patient is asked to choose between two paired foods presented at the same time ("which one of the two presented products would you like to eat?").

Evaluation of preference will be defined using food preference index, as previously described by Laureati et al. 2020, and defined as follow:

PREFERENCE INDEX = [(Sum of scores of valid pairs/number of valid pairs) -1]x100

• Valid pair is considered when both foods have been previously recognized on the individual recognition part. A minimum of six valid pairs is requested for each category.
• Scores correspond to a numerical value: for each pair of foods compared, when the food in the category is prioritized by the participant, the pair is given a score of 2; otherwise, it is given a score of 1. For a food category, the scores for each pair are summed. Only valid pairs are considered for sum calculations.

DYSPHAGING Preferences is a three-step research program designed to develop (step 1) a specific device to evaluate food preferences in geriatric populations, adapted from the CFTPQ, evaluate its test-retest reliability (step 2), and perform a cross-sectional study to explore individual differences within the participant depending on their geriatric characteristics and, among them, on the presence or not of OD (step 3).

Inclusion Criteria:

• Patient aged over 70
• Patient hospitalised in the healthcare sector (CSG, SMR)
• Patient or patient under guardianship informed of the study and having expressed no objection to participating in the study
• Patient under guardianship whose guardian has been informed of the study and has expressed no objection to the patient's participation in the study.

Exclusion Criteria:

• Patient unable to complete the questionnaire.
• Patient unable to eat orally