Posted at 06.10.2018
For the purpose of this assignment, I've used Gibbs' reflective cycle to reflect on the impact of psychosocial and cultural issues affecting decision making in dietetic practice. For most decades, psychosocial and cultural factors have been researched and recognised as important determinants, which can have serious impact on health insurance and eating behaviour.
In this reflective piece, I've focused how these factors have the potential to donate to malnutrition in older people. As a consequence, it is imperative that dietitians are able to recognise these issues and consider how they may impact on the negotiated advice (REF).
My subject was a 79 year old lady who had been referred to the dietetic clinic for advice on nutritional support. She had experienced an unintentional weight lack of ten kilograms ('kg') during the period of 2 yrs, since her husband had passed away. Her drastic weight loss had turn into a serious concern on her behalf, which led to her referral by her doctor ('GP').
During the consultation, the individual explained that she had lost three kg in one month, which is when she started worrying as she noticed how loose her clothes had become. I examined her food journal and asked a series of questions to discover what she may have been doing differently to take into account the weight loss.
She reported her food portions hadn't changed and that she was consuming more in order to get weight. She appeared to be getting a varied diet, although at her last visit to her GP at the beginning of the year, she was informed that she had impaired fasting glucose ('IFG'). She had therefore decreased her intake of sugary foods as she was afraid to become diabetic.
Another major event that had occurred recently was that she had moved to a smaller place which was more well suited for her since she was now on her own.
When she mentioned she was now a widow, I sympathised with her and immediately thought this is the explanation for her weight loss. Further questioning revealed that she had battled with loneliness following loss of her husband of 55 years. . Several psychosocial factors emerged out of this initial part of the consultation, which may be regarded as pressures felt by the individual. The first two included bereavement, which is classified as one of life's stresses, and the state of depression, which she may have endured third, traumatic event. .
A significant attribute of bereavement and depression is appetite loss, which is also in charge of high mortality rates in the first half a year of the increased loss of a loved one. In this case, she no more had anyone to appreciate her cooking efforts and the deprivation of companionship at mealtimes becomes a reminder of her loss. A time intended for communication, joy and bonding had turn into a painful experience, leading to lack of interest in virtually any activity related to food or eating. The reduced enjoyment of the social aspect of mealtimes had made consuming more of a chore.
It is important to keep in mind eating as a social variable and recognise that it's part in our self and social identity, which also makes it a cultural variable. It is a structured part of your respective everyday living and a valued social activity for some married people. Food habits developed throughout life are an important element of culture and strongly influences food decisions. Therefore, the strain of bereavement gets the power to alter the social, psychological and cultural need for food in this difficult time.
These issues were sensitively addressed in the consultation. The patient reported that the support of her son had helped her through the grieving process and that she had accepted losing and was shifting.
Other social determinants which impact eating behaviour include access to food, and ability to cook food and share meals with others. The individual reported she was doing her own weekly shopping and that she had started eating more ready-meals as she still struggled cooking simply for herself. Therefore, she only cooked when her son and family came to visit at the weekend. I suggested joining a social club in the area where they regularly meet for lunch and other social gatherings, which could assist in improving her moral, but she was reluctant to take action. She explained that she suffered from bladder control problems and found it embarrassing having to urinate so frequently when around people.
I thought it might be ideal if she could have that kind of social interaction as it can have a great effect on appetite and meal size. Meal ambiance which incorporates factors such as acquaintance, conversation and pleasantness, have been proven to improve degrees of ingestion and can be an important stimulus modulated to help stimulate appetite in places such as nursing homes.
The mechanisms where a person is afflicted by social support varies with respect to the individual, however, the support that can be provided from social structures has been shown to aid in maintaining nutrition using elderly people.
Relocation and change of environment can also yield negative outcomes in terms of psychosocial disturbances such as, confusion, anxiety, depression and loneliness associated with transferring from one place to another and abandoning treasured memories or souvenirs of the loved.
Two months prior, she moved to an inferior house, which have been a very stressful time on her behalf. She had settled in to the place but she reported having had trouble adjusting. This is an area I should have explored. For instance, had she made any friends in the surroundings or whether she was still able to meet her old friends, was she getting familiar with the new neighbourhood she was in, were there any safety issues that needed addressing which we're able to help support her with, and so forth. These issues would have a heavy effect on her intake and weight if indeed they were triggering her anxiety or depression.
Financial constraint is another psychosocial factor to consider when giving dietary advice, as unaffordability affects intake. The individual reported she drove to do her weekly shopping from an established supplier in town. According to her food journal, she didn't look like restricting herself. However, as research suggests, misreporting of food diaries is common where patients make an effort to present themselves more favourably.
Decline in cognitive function is
Another psychosocial issue I needed to consider was the meals anxiety which have been created following a IFG test. Her GP had told her she was at the pre-diabetic stage therefore she had eliminated most fruit and all high sugar foods from her diet as she was worried about becoming diabetic. The responsibility of disease caused her to change the way she felt about certain foods. She was now anxious about eating any foods with sugar. I explained that she did not have to exclude sugar from her diet completely. Therefore created confusion as my advice was conflicting that of her GP's. I explained about glucose absorption and that she could add sugar to her puddings, cereal and so forth, which would slow down absorption of the sugar and help with better blood glucose control but to still avoid pure kinds of sugar e. g. sweets. She was relieved to learn that and it seemed to make her happier that she could relax her diet.
From there can be an exploration of psychobehavioral models of appetite, and address
issues of depression, bereavement, and social interaction before study of personality and
access to appropriate foods
Attitude, values, beliefs, behaviours - shared by society/population
Cultural, religious and regional factors: cultural
origins, religious background, beliefs and traditions
of culture and race, geographical region.
Food habits are a component of culture that make an important contribution to
"Food habits have emerged as the culturally standardized set of
behaviors in regards to food manifested by people who have been reared within
a given cultural tradition.
some view culture and food habits as static and unchanging, it is currently recognized
that they are simply continually changing as they adapt to travel, immigration, and the socioeconomic
environment (Jerome, 1982; Lowenberg et al. , 1974; Senauer et al. , 1991;
Kittler and Sucher, 1995). When modifying food intakes to meet dietary recommendations
there are certain areas of food habits that are difficult to improve, such as
the concept of meals, meal patterns, the number of meals eaten per day, when to
eat what throughout the day, how food is acquired and prepared, the etiquette of eating
and what is considered edible as food.
(Lowenberg et al. , 1974; Kittler and Sucher, 1995). Food is obviously used to satisfy
hunger and meet nutritional needs. Food can be used to promote family unity when
members eat together. It can denote ethnic, regional and national identity. It is used
socially to develop friendships, provide hospitality, as a gift, as an important
part of holidays, celebrations and special family occasions. In religious rituals and
beliefs certain foods have specific symbolic meanings, or there could be prohibited
foods or food taboos. Food may be used to show status or prestige, make one feel
secure, express feelings and emotions, and relieve tension, stress or boredom. Food
controls the behavior of others when used as reward, punishment or as a political tool
in protests and hunger strikes.
Why decided to go down that route?
Behavioural change model
What have I learnt from this experience
What was the outcome of the experience