Extending an approach to hospital malnutrition to community care

Abstract

This feature investigates the potential relevance to community care of a new food provision and nutritional management system for older hospital patients. A qualitative study identified the core factors contributing to inadequate food intake in older patients in hospital, including: poor mealtime ambience; lack of necessary mealtime assistance; inflexible meal provision; lack of monitoring of nutrient intake and absence of accountability in nutritional care. Many of these factors are also relevant to older people living in the community. To address these issues, we designed a new system for the nutritional care of the older patient: 'hospitalfoodie'. Hospitalfoodie facilitates: patient nutritional screening; patient-tailored food choice; and information exchange among the healthcare team. The system introduces a more flexible approach to provision of food, including the development of nutrient-dense 'mini meals' for older patients. The system facilitates monitoring of patient food intake against their nutrition targets and alerts staff of nutrition shortfalls. The relevance of components of hospitalfoodie to community nutritional care was explored through qualitative interviews and focus groups with a range of care providers.

Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis

“…No intervention addressed the barrier of loneliness. Qualitative studies showed older adults may struggle with cooking [46, 49, 50] and eating alone [51]. A possible solution may be to offer ideas to help patients connect with others, but none of the interventions offered such self-help advice.…”

“…through education) or measure reactions to screening. We currently have little data on how older adults perceive screening or why they are reluctant to be screened [48, 49]. Notably, findings relating to patients’ barriers to screening emerged largely from HCPs’ experiences [48, 49, 55].…”

“…We currently have little data on how older adults perceive screening or why they are reluctant to be screened [48, 49]. Notably, findings relating to patients’ barriers to screening emerged largely from HCPs’ experiences [48, 49, 55]. Moreover, we noted some conflicting findings, such as that some patients are willing to be screened when the purpose of screening is explained to them [55], whilst others seem to prefer not to know [55].…”

Factors influencing hospital foodservice staff's capacity to deliver a nutrition intervention

“…Findings suggest that the nutrition intervention may have lacked relative advantage over the current menu and compatibility with patients’ appetite, food and size preferences and perspectives on food waste. These barriers to intake have been reported elsewhere . Consequently, foodservice staff felt that patients were resistant towards the higher energy menu.…”

“…These barriers to intake have been reported elsewhere. [22][23][24] Consequently, foodservice staff felt that patients were resistant towards the higher energy menu. Lambert et al 19 also report nurses' challenges in encouraging patients to consume ONS.…”