Skip to main content Back to Top


Pictures Outperform Staff at Estimating Residents' Intake

Cheryl A. Thompson

Snapshots of food trays before and after meals could prompt better nutritional interventions at nursing homes by helping to identify more residents at risk of undernutrition or dehydration, researchers suggest.

Building on another group’s finding about the utility of photography in estimating portions of meals consumed, researchers from the University of California at Los Angeles (UCLA) studied 56 nursing-home residents at one facility. Malnutrition and dehydration among California nursing-home residents had been highlighted as major problems by a 1998 Government Accounting Office report. The UCLA researchers reported their findings in the February issue of the Journal of the American Geriatrics Society

Separate groups of research staff directly observed or photographed, with a disposable camera, residents’ food trays for three consecutive days, three meals each day. During the same time, nursing-home staff looked over residents' trays and documented intake in the medical record—the usual method. All the residents studied were older than 65 years and able to state their name on request or identify two common objects. 

Direct observation and photography generated roughly the same data for meal intake. The residents ate on average about 58 percent of each meal, a little more at breakfast. 

Nursing-home staff, however, documented a significantly higher average meal intake—79 percent. Staff did not identify half of the 36 residents who, according to data from direct observation and photography, ate 75 percent or less of most meals. 

The Health Care Financing Administration requires long-term-care facilities that participate in the Medicare or Medicaid programs to have staff assess residents’ nutritional intake when they eat 75 percent or less of most meals. In addition, residents must have their food intake evaluated at least annually—monthly if a full Minimum Data Set assessment must be completed each month. 

The researchers noted a downside to the photography method: Photographic materials cost $630.