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Malnutrition is prevalent in elderly hospitalised patients and has been associated with longer lengths of stay (LOS), higher rates of complications and increased hospital costs. Feeding assistance has traditionally been the role of nurses, however with an ageing population and an ever-increasing workload there may not be sufficient time to ensure the nutritional care of all patients. A program in which trained volunteers assist, socialise and feed nutritionally vulnerable patients at lunch on weekdays has been initiated in a major suburban hospital in Sydney. The pilot study reported here aimed to evaluate the lunchtime assistance program in terms of dietary intakes by comparing data from weekdays (with volunteers) and that from weekends (no volunteers). Nine patients (mean age+(SD): 89±4.6 years) participated in the study. Observations and weighed plate waste were recorded for each patient at lunch on two weekdays and two weekend days. When volunteers were present, the average protein intake increased by 10.1 g at lunch (p<0.05) and 10.7g over the whole day (p<0.05). There was also a trend to increased energy intake. Observations indicated that the volunteers, when compared to the nurses, socialised more with patients, encouraged them to eat more often and spent more time feeding them. Trialing volunteer assistance in a larger study would be useful. Observations and weighed plate waste were recorded for each patient at lunch on two weekdays and two weekend days. When volunteers were present, the average protein intake increased by 10.1 g at lunch (p<0.05) and 10.7g over the whole day (p<0.05). There was also a trend to increased energy intake. Observations indicated that the volunteers, when compared to the nurses, socialised more with patients, encouraged them to eat more often and spent more time feeding them. Trialing volunteer assistance in a larger study would be useful.

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Unyielding, disproportionate growth in the 65 years and older age group has precipitated serious concern about the propensity of health and aged-care services to cope in the very near future. Preservation of health and independence for as long as possible into later life will be necessary to attenuate demand for such services. Maintenance of nutritional status is acknowledged as fundamental for achievement of this aim. Determinants of food choice within this age group need to be identified and better understood to facilitate the development of pertinent strategies for encouraging nutritional intakes supportive of optimal health. A systematic review of the literature consistent with PRISMA guidelines was performed to identify articles investigating influences on food choice among older people. Articles were limited to those published between 1996 and 2014 and to studies conducted within countries where the dominant cultural, political and economic situations were comparable to those in Australia. Twenty-four articles were identified and subjected to qualitative analysis. Several themes were revealed and grouped into three broad domains: (i) changes associated with ageing; (ii) psychosocial aspects; and (iii) personal resources. Food choice among older people is determined by a complex interaction between multiple factors. Findings suggest the need for further investigations involving larger, more demographically diverse samples of participants, with the inclusion of a direct observational component in the study design. Unyielding, disproportionate growth in the sixty-five years and over age group has precipitated 5 serious concern about the propensity of health and aged-care services to cope in the very near 6 future. Preservation of health and independence for as long as possible into later life will 7 therefore be necessary to attenuate demand for such services. Maintenance of nutritional status 8 is acknowledged as fundamental for achievement of this aim. Determinants of food choice 9 within this age group need to be identified and better understood to facilitate the development 10 of pertinent strategies for encouraging nutritional intakes supportive of optimal health.

Introduction Nutrition screening is an initial procedure in which the risk of malnutrition is identified. The aims of this review were to identify malnutrition risk from nutrition screening studies that have used validated nutrition screening tools in community living older adults; and to identify types of nutrition interventions, pathways of care and patient outcomes following screening. Methods A systematic literature search was performed for the period from January 1994 until December 2013 using SCOPUS, CINAHL Plus with Full Text, PubMed and COCHRANE databases as well as a manual search. Inclusion and exclusion criteria were determined for the literature searches and the methodology followed the PRISMA guidelines. Results Fiftyfour articles were eligible to be included in the review and malnutrition risk varied from 0% to 83%. This large range was influenced by the different tools used and heterogeneity of study samples. Most of the studies were cross sectional and without a subsequent nutrition intervention component. Types of nutrition intervention that were identified included dietetics care, nutrition education, and referral to Meals on Wheels services and community services. These interventions helped to improve the' nutritional status of older adults. Conclusions Timely nutrition screening of older adults living in the community, if followed up with appropriate intervention and monitoring improves the nutritional status of older adults. This indicates that nutrition intervention should be considered a priority following nutrition screening for malnourished and at risk older adults. Further evaluation of outcomes of nutrition screening and associated interventions, using structured pathways of care, is warranted. Abstract IntroductionNutrition screening is an initial procedure in which the risk of malnutrition is identified. The aims of this review were to identify malnutrition risk from nutrition screening studies that have used validated nutrition screening tools in community living older adults; and to identify types of nutrition interventions, pathways of care and patient outcomes following screening. MethodsA systematic literature search was performed for the period from January 1994 until December 2013 using SCOPUS, CINAHL Plus with Full Text, PubMed and COCHRANE databases as well as a manual search. Inclusion and exclusion criteria were determined for the literature searches and the methodology followed the PRISMA guidelines. ResultsFifty-four articles were eligible to be included in the review and malnutrition risk varied from 0 % to 83%. This large range was influenced by the different tools used and heterogeneity of study samples. Most of the studies were cross sectional and without a subsequent nutrition intervention component. Types of nutrition intervention that were identified included dietetics care, nutrition education, and referral to Meals on Wheels services and community services. These interventions helped to improve the' nutritional status of older adults. ConclusionsTimely ...

(2015). Energy and protein intake increases with an electronic bedside spoken meal ordering system compared to a paper menu in hospital patients. Clinical Nutrition ESPEN, 10 (4), e134-e139.Energy and protein intake increases with an electronic bedside spoken meal ordering system compared to a paper menu in hospital patients AbstractBackground and aims Electronic bedside spoken meal ordering systems (BMOS) have the potential to improve patient dietary intakes, but there are few published evaluation studies. The aim of this study was to determine changes in the dietary intake and satisfaction of hospital patients, as well as the role of the Nutrition Assistant (NA), associated with the implementation of an electronic BMOS compared to a paper menu. Methods This study evaluated the effect of a BMOS compared to a paper menu at a 210-bed tertiary private hospital in Sydney during 2011-2012. Patient dietary intake, patient satisfaction and changes in NA role were the key outcomes measured. Dietary intake was estimated from observational recordings and photographs of meal trays (before and after patient intake) over two 48 h periods. Patient satisfaction was measured through written surveys, and the NA role was compared through a review of work schedules, observation, time recordings of patient contact, written surveys and structured interviews. Results Baseline data were collected across five wards from 54 patients (75% response rate) whilst using the paper menu service, and after BMOS was introduced across the same five wards, from 65 patients (95% response rate). Paper menu and BMOS cohorts' demographics, self-reported health, appetite, weight, body mass index, dietary requirements, and overall foodservice satisfaction remained consistent. However, 80% of patients preferred the BMOS, and importantly mean daily energy and protein intakes increased significantly (paper menu versus BMOS): 6273 kJ versus 8273 kJ and 66 g versus 83 g protein; both p < 0.05. No additional time was required for the NA role, however direct patient interaction increased significantly (p < 0.05), and patient awareness of the NA and their role increased with the BMOS. Conclusions The utilisation of a BMOS improved patient energy and protein intake. These results are most likely due to an enhancement of existing NA work processes, enabling more NA time with patients, facilitating an increase in patient participation and satisfaction with the service.

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Version:This is the authors' final version of a work that was accepted for publication in Appetite. Changes resulting from the publishing process, such as editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication.http://www.canberra.edu.au/ University of Canberra, ACT 2601 Australia, Switchboard +61 2 6201 5111. The University of Canberra is located on Ngunnawal Country. CRICOS number: University of Canberra / University of Canberra College #00212K.