title: Inherent flaws in a method of estimating meal intake commonly used in long-term-care facilities.
abstract: OBJECTIVE
  To evaluate the accuracy of a method used to estimate nursing home residents' meal consumption, where the meal tray is assessed as a whole and assigned a value of 0%, 25%, 50%, 75%, or 100% consumed, under both routine and controlled conditions.
  
  
  METHODS
  This study was conducted with certified nursing assistants at a 180-bed long-term-care facility in Miami, Fla.
  
  
  METHODS
  Study 1 evaluated the method under routine conditions by comparing nursing assistants' estimates to actual meal consumption of 42 residents over 109 meals. A second study evaluated the method in a controlled setting where nursing assistants were free of disincentives and distractions that might contribute to inaccurate reporting. In a crossover design, nursing assistants estimated consumption on 4 manipulated trays under conditions of both immediate and delayed reporting.
  
  
  METHODS
  An intraclass correlation coefficient and percent agreement were used to compare nursing assistants' estimates to weighed meal intakes.
  
  
  RESULTS
  Under routine conditions, the intraclass correlation coefficient between nursing assistants' estimates and the actual resident meal consumption was weak at 0.464 (95% confidence interval=0.146 to 0.664). The correct estimate was recorded 44% of the time. In the controlled setting, the nursing assistants' estimates for percent consumed agreed with weighed intakes 44% and 38% of the time with immediate and delayed recording, respectively.
  
  
  CONCLUSIONS
  This 1-step method of estimating meal consumption with an overall percentage is not sufficiently accurate to identify residents who are eating less than 75% of most meals.
authors.affiliation: Department of Dietetics and Nutrition, and Long Term Care Institute, National Policy and Resource Center on Nutrition and Aging, College of Health and Urban Affairs, Florida International University, Miami 33199, USA.
authors.forename: Victoria Hammer
authors.initials: VH
authors.lastname: Castellanos
authors.forename: Yvette N
authors.initials: YN
authors.lastname: Andrews
mesh_terms: D000368:Aged; D018592:Cross-Over Studies; D004435:Eating; D005260:Female; D005431:Florida; D015577:Geriatric Assessment; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009729:Nursing / Q000379:methods*; D009728:Nursing Assistants; D009735:Nursing Homes; D015596:Nutrition Assessment; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity