From Table to Stomach and Everything in Between:
Striving for Mealtime Success

Guest Post by: Samantha Shune, PhD, CCC-SLP

It is Monday morning. I plop my lunch bag down on my desk and spend the next several hours running in and out of my office paying it no further attention. All of a sudden I realize it is mid-afternoon and I am starving. I automatically reach for the easiest to eat item from the bag. I quickly inhale it in between answering emails, editing papers, and meeting with students. My hunger subsides. My “meal” ends.

My weekday lunch routine may in fact be familiar to many of yours:

• We eat when we have time.
• We eat because we have a basic fundamental human need for nutrition.
• We eat because our bodies tell us to.

Yet, if we had the choice [and the time!], is that the only reason we would eat?

Once every couple of weeks I try to schedule my lunch. And I try to schedule my lunch with a co-worker or two. I look forward to those lunch dates. I eagerly anticipate them as they approach. I schedule them out of my office – often out of my building. I enjoy those lunches.

Mealtimes are an essential component of daily life. However, beyond the purpose of meeting basic nutritional needs, the mealtime is highly social, serving an important interpersonal function. Thus, the shared meal incorporates two of the most fundamental and pervasive human needs that ultimately drive behavior: basic physiological needs such as food and interpersonal involvement (Baumeister & Leary, 1995; Maslow, 1943).

The mealtime may be a particularly important process for older adults, as age-related declines are observable in both nutrition and social interaction. Malnutrition, weight loss, and swallowing impairments are associated with decreased survival, and increased anxiety, social isolation, and depression (e.g., Karvonen-Gutierrez et al., 2008; Mick et al., 1991; Ney et al., 2009; Shune et al., 2012). Beyond enhancements in quality of life, social relationships also exert an independent influence on survival comparable to other well-accepted risk factors (Holt-Lunstad et al., 2010).

Eating, swallowing, communication, socialization. Sounds a lot like a typical speech-language pathology caseload. All wrapped into one singular event – the shared meal!

Mealtime Success

Thus, targeting mealtime success, especially for our vulnerable populations of older adults, should be a top therapy goal.

But, what is mealtime success?

Merriam-Webster defines the terms as follows:

Success (n): The correct or desired result of an attempt
Mealtime (n): The usual time for serving a meal

Therefore, mealtime success is the achievement of the desired result during the usual time for serving a meal. At first glance, this is a seemingly clear and straightforward definition. Yet, upon further thought, that simplicity disappears.

What is the desired result?

• Should this be the same for all individuals?
• Does it change over time?
• Do various individual and environmental factors influence the definition?
• Do all speech-language pathologists agree on what is “desired”?

Further, do all disciplines agree on what is “desired”?

• The speech-language pathologist may define the desired result along the lines of swallowing safety and efficiency.
• The occupational therapist may be concerned with increased independence with self-feeding and appropriate trunk support for eating.
• The dietitian may be measuring calories consumed and the nutritional makeup of those calories.
• The physician may be monitoring lung sounds, weight loss, and concomitant medical diagnoses.
• Nursing staff may be worried about adverse behaviors during ADLs and the need for feeding assistance.
• The family members and/or caregivers might be concerned with overall social participation in the meal.
• The patient may be yearning for their favorite food.

Rather than treating mealtimes through a multidisciplinary approach – with each discipline drawing on their knowledge, but staying within their own boundaries – we should be moving towards the integrated interdisciplinary team. We need to synthesize the contributions of each team member – from goal selection through outcome measurement.

This must start with a common definition. One goal that I have in my research is to better understand the multiple components that make up a typical meal in order to better identify how we can structure therapy to address mealtime success, not just swallow success. Another goal is to translate that knowledge into changes in clinical practice.

I may have raised more questions here than answered. I think that is where we currently are. Perhaps in a year, my musings will be different. But, for now I pose one additional question to you all:

How would you define mealtime success? I would love to hear your feedback!

About the author:
Samantha Shune, PhD, CCC-SLP is an assistant professor in Communication Disorders and Sciences and research scientist in the Prevention Science Institute at the University of Oregon. Her research program is aimed at mitigating the deleterious effects of both healthy and pathologic aging on the eating process. Drawing on her clinical background in medical speech-language pathology, she is focused on integrating the physiologic components of swallowing with a more holistic view of the mealtime process (e.g., cognition, communication, socialization/social relationships). She is particularly interested in how the translation of such research into clinical practice can promote both mealtime safety and improved quality of life for older adults and across a variety of patient populations. She can be reached at [email protected].

References Cited:

Baumeister, R. F. & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117 (3), 497-529.

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Med, 7(7), e1000216. doi:10.1371/journal.pmed.1000316.

Karvonen-Gutierrez C. A., Ronis D. L., Fowler K. E., Terrell J. E., Gruber S. B., & Duffy S. A. (2008). Quality of life scores predict survival among patients with head and neck cancer. J Clin Oncol, 26, 2754–2760.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50, 370-396.

Mick, R., Vokes, E. E., Weichselbaum, R. R., & Panje, W. R. (1991). Prognostic factors in advanced head and neck cancer patients undergoing multimodality therapy. Otolaryngol Head Neck Surg, 105, 62-73.

Ney, D., Weiss, J., Kind, A. J. H., & Robbins, J. (2009). Senescent swallowing: Impact, strategies, and interventions. Nutrition in Clinical Practice, 24(3), 395-413.

Shune, S., Karnell, L. H., Karnell, M. P., Van Daele, D .J., & Funk, G. F. (2012). The association between severity of dysphagia and survival in patients with head and neck cancer. Head & Neck, 34(6), 776-784.

A word from SwallowStudy.com:

I had the pleasure of hearing Dr Samantha Shune’s twilight session at the #ASHA14 convention. Click here to review one of my post-convention blogs on ASHAsphere.

Here is the citation of her session at ASHA:

Shune, S. (2014, November). 1221: Eating is Not Just Swallowing: Redefining the “Swallowing” Process in the Elderly. Seminar presented at the annual convention of the American Speech-Language-Hearing Association, Orlando, FL.