title: Nutritional implications of patient-provider interactions in hospital settings: evidence from a within-subject assessment of mealtime exchanges and food intake in elderly patients.
abstract: OBJECTIVE
  To examine the nutritional implications of the interactions taking place between patients and care providers during mealtimes in hospital settings. Specifically, we tested research propositions that the amount and nature of interpersonal behaviours exchanged between patients and providers impact patients' food intake. These propositions were derived from prior evidence of social influences on eating behaviour and a well-established framework that identifies two fundamental modalities of human interaction: striving for mastery and power (agency) and efforts to promote union with others (communion).
  
  
  METHODS
  In a within-subject naturalistic study, participants were observed on multiple meals (n=1477, 46.2 meals/participant on average), during which participants' and providers' agency- and communion-related behaviours and patients' protein and energy intake were recorded. Meal-level frequency and complementarity of patients' and providers' behaviours were computed to test research propositions.
  
  
  METHODS
  Dining room of a geriatric rehabilitation unit.
  
  
  METHODS
  Thirty-two elderly patients (21 females, mean age:78.8, 95% CI: 76.4, 81.1).
  
  
  RESULTS
  Meal-level frequency of patient-provider exchanges (P=0.016) and patients' agency-related behaviours (P=0.029), as well as mutual reciprocation of patients' and providers' communion-related behaviours (P=0.015) on a given meal were positively linked to protein intake. Higher energy intake was found during meals where patients expressed more agency-related behaviours (P=0.029).
  
  
  CONCLUSIONS
  Results present evidence that the amount and nature of patient-provider interpersonal exchanges on a given meal influence the nutritional quality of food intake in hospitalized elderly. They provide insights into how to improve the design and delivery of routine care to this malnutrition-prone population.
  
  
  BACKGROUND
  This study was supported by the Canadian Institutes of Health Research (Operating grant to Laurette Dubé, Doctoral Fellowship to Catherine Paquet) the Fonds de la Recherche en santé du Québec and by the Danone Institute (Doctoral fellowship to Danielle St-Arnaud McKenzie).
authors.affiliation: Desautels Faculty of Management, McGill University, Québec, Canada. laurette.dube@mcgill.ca
authors.forename: L
authors.initials: L
authors.lastname: Dubé
authors.forename: C
authors.initials: C
authors.lastname: Paquet
authors.forename: Z
authors.initials: Z
authors.lastname: Ma
authors.forename: D St-Arnaud
authors.initials: DS
authors.lastname: McKenzie
authors.forename: M-J
authors.initials: MJ
authors.lastname: Kergoat
authors.forename: G
authors.initials: G
authors.lastname: Ferland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology; D004435:Eating / Q000502:physiology / Q000523:psychology; D002149:Energy Intake; D005260:Female; D005521:Food Service, Hospital / Q000592:standards*; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D015596:Nutrition Assessment; D011502:Protein-Energy Malnutrition / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012919:Social Behavior