Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital (original) (raw)

This review will describe the evidence for changing the hospital environment to improve nutrition of older people, with particular emphasis on the role of additional mealtime assistance. Poor nutrition among older people in hospital is well recognised in many countries and is associated with poor outcomes of hospital care including increased mortality and longer lengths of stay. Factors recognised to contribute to poor dietary intake include acute illness, co-morbidities, cognitive impairment, low mood and medication. The hospital environment has also been scrutinised with reports from many countries of food being placed out of reach or going cold because time-pressured ward and catering staff often struggle to help an increasingly dependent group of patients at mealtimes. Routine screening in hospital for people at risk of under nutrition is recommended. Coloured trays and protected mealtimes are widespread although there is relatively little evidence for their impact on dietary intake. Volunteers can be trained to sfely give additional mealtime assistance including feeding to older patients on acute medical wards. They can improve the quality of mealtime care for patients and nursing staff although the evidence for improved dietary intake is mixed. In conclusion, improving the nutrition of older patients in hospital is challenging. Initiatives such as routine screening, the use of coloured trays, protected mealtimes and additional mealtime assistance can work together synergistically. Volunteers are likely to be increasingly important in an era when healthcare systems are generally limited in both financial resources and the ability to recruit sufficient nursing staff. Volunteer: Mealtime: Older patients: Hospital Prevalence of undernutrition among older inpatients Under nutrition of older people in hospital is common and well-recognised in many countries. A retrospective pooled analysis of published datasets representing 4507 people (mean age 82 years, 75% female) from twelve countries reported the prevalence of malnutrition among hospital patients to be 39% (1). The data on hospitalised patients were drawn from studies in Belgium, Switzerland, Germany, Italy and Sweden. The median Mini Nutritional Assessment (MNA) score was similar for men and women, with only 14% being well-nourished; 45% men and 36% women were malnourished with the remainder at risk. In the same analysis, based on the MNA, the prevalence among nursing home residents was much lower at 14% and was only 6% among community dwelling older adults. Nutritional screening surveys carried out in hospitals in England between 2007 and 2011 using the Malnutrition Universal Screening Tool similarly demonstrated that 38% of patients on Care of the Elderly wards were at risk of malnutrition (2). This highlights the need to focus on nutrition in hospital.