To structure care managers' approaches (upright) to and awareness (oblique) of nutritional improvement for care-dependent older people, semi-structured interviews were conducted with 12 care managers in Japan. Concerning nutritional improvement for care-dependent older people, the care managers, managing older people with [mental and physical dysfunctions due to a decline in the nutritional status] and consequently [realizing the association between their nutritional status and mental and physical functions] developed dilemmas, while perceiving [distress due to problems care managers cannot resolve alone] as a result of [insufficient nutrition education through care manager training]. Although they perceived [distress due to problems care managers cannot resolve alone], they continued to adopt approaches, such as [devising measures for nutritional management from the perspective of a care manager] and [assessing nutritional status based on the living conditions and body weight]. However, the results also revealed their dilemmas due to [difficulty in accurately assessing nutritional status], suggesting [the importance of performing nutritional management through collaboration with other professionals and services].
