With a growing number of people reaching older age, the need for care provided in long-term care institutions is increasing. Although the goal is to deliver person-centred care that includes choice and flexibility opportunities, pre-scheduled mealtimes and set menus are still used. The aim was to explore how food choice and flexibility practices were perceived and performed by residents and staff at three care homes in Denmark. Three food journey interviews with eight residents (aged 83–96) and three focus groups with 12 people from the care and kitchen staff were conducted. Food choice and flexibility practices were mainly performed informally and selectively by the staff, and through personal practices by the residents, implying that many residents were excluded from food choice and flexibility opportunities. However, food choice and flexibility practices were also inhibited by the staff's time pressure and unfamiliarity with choice possibilities, and by the politeness of the residents. Our findings suggest that food choice and flexibility practices must be understood and performed broadly, and include various ways of listening and responding to the residents’ needs and preferences. The study highlighted the importance of incorporating the essential embodied knowledge and emotional know-how, inherent in food choice and flexibility practices, into formal and inclusive strategies concerning how to think and act in relation to the food and meal situation.

Background: Previous studies have found the Mini-mental State Examination (MMSE) predictive of capacity to consent to power of attorney and to enter into residential care. We aimed to assess the utility of the MMSE in predicting capacity to consent to research in elderly U.K. care home residents, to determine the optimal cut-point score, and to ascertain which items of the MMSE most predicted capacity.

Methods: Care home residents (n = 227) who had been recruited into a randomized controlled trial and assessed for capacity to consent were subsequently administered the MMSE and a measure of depression. A receiver operator characteristic (ROC) curve was generated and the maximal MMSE cut-point that best predicted capacity status determined. Multiple regression analyses were conducted to assess the effect of other variables on capacity status.

Results: The area under the ROC curve was 0.86 (p < 0.001, 95% CI 0.80–0.91). The optimal cut-point was 13/14, which provided a positive predictive value of 0.84 (0.79–0.89) and negative predictive value of 0.69 (0.62–0.75). The odds ratio of a MMSE score ≥14 predicting having capacity was 11.95 (6.03–23.94). Depression reduced the odds of having capacity (OR 0.32, 0.17–0.62, p = 0.001). All individual items of the MMSE apart from following a written command (“close your eyes”) had odds ratios significantly associated with capacity status. The item most associated with capacity status was being able to verbally repeat a sentence (“no ifs, ands, or buts”) correctly (OR 5.6, 95% CI 3.0–10.5).

Conclusions: The MMSE is predictive of capacity to consent to research and may have a role in guiding researchers in this domain. It should not, however, be used in lieu of a formal capacity assessment as even the optimal cut-point of 13/14 mislabeled 24% of capable subjects as lacking capacity, and 21% of incapable subjects as having capacity.