Nursing home staff’s experiences and reflections regarding disordered eating among older adults: a focus group and vignette-based study

BACKGROUND: Eating disorders are often perceived to mainly affect young women, however previous research shows that they can both appear and persist in older populations. Research on eating disorders in older people is scarce, and there are no treatment guidelines or specialized diagnostic criteria, meaning that disordered eating in older adults is often misattributed to dementia, somatic illness, or the ageing process itself. This increases the risk of incorrect diagnosis and treatment, and hinders person-centred care. In order to start bridging this knowledge gap, the present study aimed to describe nursing home staff's experiences and reflections on disordered eating among the residents. METHODS: The study adopted a qualitative approach and a descriptive design. A total of 26 participants (registered nurses, licensed practical nurses and care assistants) were recruited from three nursing homes in mid-Sweden. Four focus group interviews were conducted, using a fictional patient case - a vignette - to help discussion. The interviews were audio recorded, transcribed, and analysed using qualitative content analysis inspired by Graneheim and Lundman. RESULTS: Three themes were identified during the analysis. The theme It's not disordered eating behavior, it's dementia or ageing - or is it? referred to staff's initial attribution of all problematic eating behaviors to dementia or other age-related illnesses. The theme Lack of knowledge, lack of time, lack of resources - We don't know, and no one else does, either contained reflections on the lack of education and resources that was experienced in all professions. The theme Navigating conflicts of interest related to problematic eating behaviors - a rocky path included perceptions of conflicts and ethical dilemmas related to food and eating. CONCLUSIONS: Staff in nursing homes do not have sufficient training and resources to identify and diagnose residents with disordered eating behaviors, which is a barrier to safe and person-centred care.