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Patients felt that they were frequently interrupted by doctors and nursing staff and other allied healthcare professionals during meal times .
Many wanted to eat slowly so as to not vomit or feel nauseous , but they felt rushed to eat their meals quickly because they felt that they needed to help the service staff [ by enabling them to quickly ] collect the trays at the end of meals . Some participants felt that the advance ordering of meals did not really work for them , and that ’ s because if they received the menu , let ’ s say this afternoon to order meals for tomorrow morning onwards , they may have selected a meal that they thought they might want to eat the next day , but when the meal actually arrived at the time of consumption they did not want it .
Other contributing factors reported by patients were large meal sizes , set meal timings and menu options they were not familiar with .
One interesting aspect that patients reported was they noticed that , at meal times , when they had visitors – family members or friends – who provided encouragement to eat and maybe even feeding assistance , it improved their food intake .
Several participants expressed that in their opinion , the nursing staff did not monitor how much food they were eating , and did not seem too concerned if they did not eat all the food that arrived on their tray . That undermined the perceived importance of food for the older patients .
Were these findings in line with your expectations ? Were there any responses that surprised you ? We know through previous studies that inflexible meal timings , large meal sizes and meal preferences that are not in line with what patients like can impact food intake during hospitalisation .
What this study also told us was that older hospital patients had the understanding that a poor appetite and intake was an expected outcome of being unwell and in hospital , and that they just simply accepted that as part of the whole deal of being ill .
It was also surprising that a lot of older hospital patients that we had in the study described their food intake as good and that they were eating plenty of food and enough to meet their nutritional requirements , even though the very reason that we recruited them in the study was because researchers observed them as having poor food intake in hospital .
What this tells us is that older hospital patients might need more nutrition knowledge about what is an appropriate amount of food to eat , or what is good nutrition in order to meet their requirements .
Another surprising finding was that some of the patients reportedly reduced their food intake to limit their visits to the toilet . There is evidence in the literature to say that hospital patients often reduce their fluid intake to avoid using bed pans , and that ’ s due to the associated loss of privacy and dignity . It is possible that this perceived loss of privacy and dignity also impacts older patients ’ desire to consume adequate quantities of food . To the best of our knowledge , this is the first study to identify that older hospital patients have anxieties regarding toilet visits when they are admitted to hospital , and I think that we need further investigation into this issue as a potential barrier to food intake .
Based on the study participants ’ responses , what should service , medical and nursing staff be aware of , and how can they use this information to improve the food intake of elderly patients ? We ’ ve had previous research that indicates that older adults in hospitals can take anywhere from 20 to 75 minutes to consume their meals . Perhaps food service staff can be a little bit more mindful that older adults may need more time to eat their meals , especially when they ’ re self-feeding , because they may not feel comfortable or they may not want to seek help from other nursing staff . Allowing them adequate time before going into the rooms to see if they ’ ve finished eating a meal , or seek their permission to clear the tray .
I think as far as other healthcare professionals are concerned , this would include doctors and nursing staff and allied healthcare professionals , I think it ’ s about them increasing patients ’ awareness and knowledge regarding the importance of nutrition during illness . This can be done by things like holding off showering rounds , medication rounds , diagnostic tests and procedures around meal time . The implementation of protected meal times as a strategy has been quite effective . Protective meal times is [ a protocol stating ] that , at meal times , all staff members , patients and their visitors on wards concentrate only on activities related to consumption of food by the patient . Everything else is held off .
While this strategy is quite challenging to implement in a busy hospital environment three times a day for breakfast , lunch and dinner , research suggests that it is a promising strategy and that it does influence patients ’ food intake positively .
What needs to be done on a broader level to address this issue ? Our study shows that there are multiple factors that influence older peoples ’ nutrition in hospitals . It ’ s their own perception of the importance of food during an illness . It ’ s about some of the psychological factors that influence their ability to eat . There ’ s also other hospital-related factors or organisational factors that influence how much they eat during hospitalisation .
I think regular monitoring of patients ’ food intake and asking them about barriers to food intake is important . Sometimes simple strategies – such as providing verbal encouragement at meal times , or changing the texture of the diet that is offered to the patient , or offering nutritious mid-meal snacks , or allowing patients to self-select food items from a trolley at the time of consumption – can hugely impact patients ’ food intake .
We know that poor food intake in older hospital patients is a common problem . We know that poor food intake contributes to malnutrition , which also has been associated with negative outcomes such as frequent readmission , extended length of stay in hospital , delayed convalescences , increased healthcare costs and increased risk of mortality . I think it really does come down to improving food awareness as a matter of priority . There is research to say that when physicians recommend or highlight the importance of nutrition for older patients with hip fractures , their food intake does improve . If this food awareness can be increased amongst all stakeholders , which includes healthcare staff , support staff in hospitals , patients themselves and their visitors , I think it can make a huge difference to what patients eat , especially what older adults eat during hospitalisation .
What is needed is a change in the current nutrition culture that we have in hospitals , and reinforcing that food needs to be treated like medicine , because older hospital patients do stand to gain from this . ■ agedcareinsite . com . au 25