Finger foods: A cross-disciplinary study about the development of finger foods for older adults with motoric eating difficulties.

Motoric eating difficulties are often a consequence of disease and affect the ability to eat independently with cutlery. Not being able to eat properly with a knife and fork may lead to reduced food intake, social withdrawal and poor quality of life. Finger foods that are easy to transport from the plate to the mouth may be a strategy to maintain autonomy, food intake and social interaction. The overall aim of this thesis was to develop attractive, functional, and nutritionally adapted finger foods based on the preferences, demands and requirements of older adults over 65 years of age with motoric eating difficulties. This thesis is based on five cross disciplinary studies and papers using mixed method methodology. It is organised into seven chapters where the results are presented in three of the chapters: Preferences, demands and requirements of older adults with motoric eating difficulties, Designing, developing and evaluating prototypes and Implementing finger food meals.

Preferences, demands and requirements of older adults with motoric eating difficulties describes the target population and their preferences, demands and requirements. Finger foods were found to be more favourable for those with major motoric eating difficulties because they were already eating with their fingers and had developed self-acceptance of their difficulties over time. In addition, sensory impairment, such as chemosensory decline, chewing and swallowing difficulties and visual impairments, are common and therefore enhanced flavour intensity, softer textures and serving the components separately on the plate are important. In order to increase the acceptability of eating with the fingers it is important to consider culinary rules, such as the type of foods in relation to viscosity, size and temperature.

Designing, developing and evaluating prototypes describes the gap where finger foods are needed and the development process. For finger foods to be a long-lasting strategy, the development should be focused on complete meals for lunch and dinner. A traditional Swedish meal comprising flatbreads, beef rolls, brown sauce and vegetables was developed and evaluated. An optimal beef roll is tender enough for the target population to chew and swallow and has a caramelised surface that increases the odour sensations and flavour. The optimal flatbread is flexible so that it can be used to wrap other foods and should be neutral in flavour so that they can be eaten with different types of dishes. A prebiotic mayonnaise was used to develop a brown sauce that had a high overall flavour intensity and higher viscosity which was optimal for dipping. In addition, oven baked vegetables and deep-fried vegetables were found to be optimal for finger foods.

Implementing finger food meals describes the functional and social aspects of eating difficulties and the use of finger foods with regard to autonomy, food intake and social interaction. From a functional perspective, a finger food meal facilitated autonomous eating. By eating finger foods, the participants did not have to rely on others to cut their food and they were able to grab the components and bring them to the mouth by themselves without spilling, in their preferred order and at their own speed. However, not all participants were able to eat a finger food meal, indicating that this new way of managing the meal and navigating the plate has to be mastered before autonomy and food intake can be assessed. There is an opportunity for social interaction when less focus is being placed on the meal itself. Moreover, the attitudes of the professional caregivers and relatives were important in the creation of a permissive environment and for enabling residents to feel comfortable eating with their fingers. Arranging the seats and tables so that residents with similar difficulties are able to eat together may help them to acquire a sense of normality and belonging. In addition, professional caregivers and relatives can help those with poor performance eat independently by mirroring the movements of eating.