[Dietitians' understanding of personalized nutritional guidance--proposals to increase home visits by dietitians]

Providing elderly people with nutritional care has become important. The aim of the present study is to clarify the factors limiting the widespread adoption of home visits by dietitians. From September to November 2002, we conducted a questionnaire survey of 211 dietitians belonging to the "Houeiken", a group devoted to the study of dietician's home visits. We examined the following factors: characteristics of the study subjects, result of the home visits, factors limiting the widespread adoption of home visits by dietitians, and the future of home visits by dietitians. Among the dietitians, 49.7% did nutrition management, 30.5% catering management and 12.8% performed home visits (12.8%). In total, 53.5% of the dietitians had experience with home visits, having visited an average of 1 to 5 people. Typical visits included cooking lessons (27.5%), advice on energy intake (25.3%), sharing new recipes (23.6%), and anthropometric examinations (13.3%). A total of 76.8% thought their guidance was effective and noted significant improvements in terms of caregiver's cooking skills (30.0%), patient's understanding of diet (24.0%), and dietary intake (21.5%). The factors preventing more widespread home visits by dietitians are: few people are aware that this service exists, few people believe that they need this type of assistance, it is largely unprofitable, and the number of qualified dieticians is insufficient. We believe that more medical staff should become involved in dietitian's home visits. Public policies should be implemented to lower dietitian's nutritional care fees and increase the education and number of dietitians.