Malnutrition and Seniors in Hospital

September 2006 - A new study concludes that older patients need greater support, fewer interruptions and more sensitive care at mealtimes. Researchers from Adelaide University, Australia, spent two weeks studying 48 hospital patients and 50 nurses during mealtimes on two medical wards.

The report published in the October 2006 issue of the UK-based Journal of Clinical Nursing notes that 58 per cent of patients aged 65 or over had problems eating. Just under a third (31 per cent) left more than two-thirds of their meal and only 15 per cent had eaten it all. More than half of the patients (55 per cent) had problems opening food. About a third found it difficult to use cutlery (36 per cent) and add seasoning (32 per cent). Nearly a quarter of patients (23 per cent) were too far away from their food and 18 per cent said their eating position was uncomfortable or they had problems pouring drinks.

Although nurses were good at describing the food and encouraging patients to eat, practical support was only given to a small percentage. For example only six per cent were made more comfortable or helped with cutlery. Interruptions were also frequent. One in five patients (19 per cent) had a doctor's visit during mealtimes and more than half (51 per cent) had mealtimes interrupted by other staff, mostly nurses (92 per cent). Three patients were asked about their bowels while they were eating and four male patients had urine bottles place on the table beside meals.

Lead researcher Chenfan Xia said:

"Recent research suggests that 40 per cent of older people are malnourished when they are admitted to hospital. The nutritional status of 60 per cent of all older patients will deteriorate further while they are in hospital, with those who were malnourished in the first place suffering worst. And insufficient food is regarded as a major cause of the problem.

"This is an important issue, especially with a growing elderly population, because poor nutrition and malnourishment is linked to poor health, slow recovery and longer hospital stays. However most of the research to date has been carried out in care homes, so little is known about the situation on hospital wards."

Chenfan Xia and co-author Professor Helen McCutcheon make a number of recommendations:

• Nutrition should be given a higher priority in ward routines and staff training.
• Food intake needs to be monitored in the same way as urine output and drugs. Monitoring was very patchy and often only covered fluid intake.
• Many patients were put off by large portion sizes. Serving smaller portions at more regular intervals or providing nutritious drinks between meals are two possible solutions.
• Staff often took their meal breaks at the same time as the patients. These should be rescheduled to enable them to provide more help.
• Interruptions such as doctors' visits should be discouraged during mealtimes and staff should be more sensitive about discussing issues such as toileting during meal times.

Lack of support for older patients during mealtimes was also highlighted by a recent Age Concern survey carried out in the UK. The charity found that nine out of ten nurses don't always have time for patients who need help with eating and has launched the Hungry to be Heard campaign to tackle this issue in UK hospitals.