Eating situations among women and men post-stroke

Background: Eating occurs as a frequent activity in everyday life and one common consequence after stroke is the negative impact on the ability to eat. Aim: The overall aim of this study was to explore eating difficulties and experiences among women and men with acute stroke, three and six months after stroke.

Method: In Study I, 104 patients with acute stroke were recruited at the stroke unit, Danderyd Hospital in Sweden. Patients who were unconscious, had no oral food intake, severe aphasia or confusion, had no spouse who could give consent for participation, were non-Swedish speaking were excluded. Three months post-stroke 36 patients were followed-up regarding eating difficulties in Study II. To detect eating difficulties in Study I and II, the patients were observed during one standardized meal using a structured observation protocol. Nutritional and oral status, neurological function, neglect, degree of dependency in ADL, participation and well-being were also assessed. To explore the individual s experience and management of eating difficulties in Study III and IV, semi-structured interviews were performed at 3 and 6 months.

Results: The most common eating difficulties observed in the acute phase were in managing food on the plate, to have sufficient food consumption and to have an adequate sitting position during meal. In the acute phase, the only significant gender difference that remained, when other factors were taken into account, was inadequate food consumption if being a woman. After stroke people experience a striving for control to eat safely and properly and after six months they have a desire to master eating situations according to previous values and habits. Among the persons with eating difficulties, three months post-stroke, improvements regarding sitting position and managing food on plate and in mouth were shown, but the proportion of patients with insufficient food consumption had increased. In the acute phase, women experienced lower well-being than men did. Despite neurological and functional improvements, the well-being remained unchanged.

Conclusions: Eating difficulties after stroke are multifaceted and have to be observed as a complex eating situation including eating-related activities. There is also a need to consider other people s involvement in the eating situation. Therefore, it is important to take the time to ask the individual about the experience, previous habits and attitudes on the new eating situation.

List of scientific papers

I. Medin, J., Larson, J., von Arbin, M., Tham, K. & Wredling, R. (2010). "Eating difficulties among stroke patients in the acute state - a descriptive, crosssectional, comparative study". [Submitted]

II. Medin, J., Larson, J., von Arbin, M., Tham, K. & Wredling, R. (2010). "Eating difficulties among patients 3 months after stroke in relation to the acute phase." [Submitted]

III. Medin, J., Larson, J., von Arbin, M., Wredling, R & Tham, K (2010). "Striving for control in eating situations after stroke" Scandinavian Journal of Caring Sciences. [Accepted]
https://doi.org/10.1111/j.1471-6712.2010.00775.x

IV. Medin, J., Larson, J., von Arbin, M., Wredling, R & Tham, K. (2010). "Elderly persons experiences and management of eating situations 6 months after stroke".
https://doi.org/10.3109/09638280903514747