2.5. Dietary Intervention
geriatric syndrome
The aim of the nutritional education was to promote the Taiwanese Daily Food Guide for elderlies in everyday practice [We designed a bookmark with three plate images (each for one dining meal), which corresponds to the three-dimensional dining plate, in order for older adults to avoid memorizing the amount of foods. In the first week, among other things, the dietitians guided each participant to color (green for vegetables, red for protein-rich foods, brown for oil and nuts, gray for rice, and blue for milk) the designated spaces on the bookmark for each food group, corresponding to the amount he or she should ideally consume. Moreover, by adopting the concept of Bloom’s Taxonomy [In week 6, we provided individual reports about their dietary intake and frailty status assessed at baseline to motivate our participants to comply with the intervention. During week 7 and week 8, participants were asked to take one-day photos of their diet for conducting a photo-elicitation focus group. In the sessions, we used anonymized photos that participants had shared to elicit a discussion on how the presented diet might be changed in order to comply with participant’s energy requirement and targeted serving amounts of the six food groups. In the last 4 weeks of intervention, targeting the same themes as week 2 to week 5, we designed practice activities that helped to break down barriers we observed towards establishing long-term changes in dietary habits. Examples of the practice activities include tasting buns and bread made with whole grains, blindly comparing whole milk and low-fat milk, making an afternoon tea set containing a cup of tea with milk powder and nuts, and weighing out a portion of vegetables from commercially bagged vegetables and blanching it. We also encouraged participants to share how they achieved the Daily Food Guide in their own creative ways. In addition to the nutritional group activity sessions, building up the supporting environment for frailty prevention in the community center was executed. Before the intervention, we trained onsite social workers and staff to estimate participants’ energy requirements, and designed a standard operation procedure to train them for serving proper amounts of foods to individuals based on their needs. They also received training on menu planning (food diversity), food preparation (food cutting and softening), healthy cooking methods (using herbs and tasty foods in dish to replace deep frying and heavy sauces), and techniques of motivational interviews focused on geriatric syndrome prevention and control.