title: An integrated model to measure service management and physical constraints' effect on food consumption in assisted-living facilities.
abstract: OBJECTIVE
  The United States is experiencing remarkable growth in the elderly population, which provides both opportunities and challenges for assisted-living facilities. The objective of this study was to explore how service management influences residents' actual food consumption in assisted-living facilities. Physical factors influencing residents' service evaluation and food consumption also were investigated.
  
  
  METHODS
  A total of 394 questionnaires were distributed to assisted-living residents in seven randomly selected facilities. The questionnaire was developed based on an in-depth literature review and pilot study. Residents' perceived quality evaluations, satisfaction, and physical constraints were measured. Residents' actual food consumption was measured using a plate waste technique.
  
  
  METHODS
  A total of 118 residents in five facilities completed both questionnaires and food consumption assessments.
  
  
  METHODS
  Descriptive, multivariate analyses and structural equation modeling techniques were employed.
  
  
  RESULTS
  Service management, including food and service quality and customer satisfaction, was found to significantly influence residents' food consumption. Physical constraints associated with aging, including a decline in health status, chewing problems, sensory loss, and functional disability, also significantly influenced residents' food consumption. A significant relationship was found between physical constraints and customer satisfaction.
  
  
  CONCLUSIONS
  Foodservice that provides good food and service quality increases customer satisfaction and affects residents' actual food consumption. Physical constraints also influence residents' food consumption directly, or indirectly through satisfaction. The findings suggest that food and nutrition professionals in assisted-living should consider the physical profiles of their residents to enhance residents' satisfaction and nutrient intake. Recommendations for exploring residents' perspectives are discussed.
authors.affiliation: Department of Restaurant and Institutional Management, Shih Chien University, No. 70, Ta-Chih St, Taipei, Taiwan ROC. jhuang@mail.usc.edu.tw <jhuang@mail.usc.edu.tw>
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Huang
authors.forename: Carol W
authors.initials: CW
authors.lastname: Shanklin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D005522:Food Services / Q000458:organization & administration*; D006299:Health Services for the Aged / Q000592:standards / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D013649:Taste; D014481:United States