Rehabilitation inpatients are not meeting their energy and protein needs

Abstract

Background & aims: This study aimed to determine the amounts of energy and protein required, ordered and consumed daily by long stay rehabilitation inpatients. Methods: A quantitative, weighed plate waste study. Thirty inpatients (16 females, 14 males; mean age 79.2 years; mean length of stay 52 days) from three rehabilitation hospitals in the Illawarra region of Australia. Data were collected over two days, including nutrition assessment details and weighed plate waste. Daily energy and protein requirements, amounts ordered and consumed were the outcome measures. Statistical analyses included paired t-tests, Wilcoxon Signed Rank tests and Spearman correlations. Results: Although adequate amounts of energy and protein were provided, significantly less was consumed than was required or ordered (p<0.05). Fifty-seven percent of the supplements were wasted, although they contributed 21.5% of energy and 20.6% of protein to the intakes of those who were prescribed them. Conclusions: Promising areas for interventions to improve intakes include the use of targeted supplement usage, food fortification, designated ward feeding assistants and ongoing nutrition surveillance.

Older rehabilitation patients are at high risk of malnutrition: Evidence from a large Australian database

“…There is ample evidence to show that rehabilitation patients are unable to meet their nutritional requirements, either through oral intake alone and/or supplements. An Australian study in three rehabilitation hospitals found, despite being provided with their energy and protein requirements, only 23% of patients were able to consume sufficient energy through oral intake, including supplement prescription (37).…”

Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up

“…An Australian study reported that less than a quarter (23%) of older patients in rehabilitation hospitals were able to consume sufficient energy through oral intake, including supplement prescription, despite being provided with their energy and protein requirements. 28 A systematic review of the evidence regarding the impact of improved nutritional care on nutritional and clinical outcomes identified that high-quality studies on this topic are few. 27 Non-traditional effective ways to improve patient dietary intake have been demonstrated, including the incorporation of feeding assistants onto a trauma ward 29 or provision of a family-style dinner arrangement instead of a tray service within a nursing home setting.…”

Foodservice perspective in institutions

“…Hirsch et al (1979) reported that the percentage of calories wasted by patients on a regular diet was less than those on a modified diet. Patients ordered high energy/high protein diets are often sent large quantities of food in order to encourage higher energy intakes, but this can result in large quantities wasted (Walton et al, 2007). Patients ordered modified texture meals are another group more likely to have greater levels of plate waste, because of the unappealing nature of the food.…”

“…They can be an important occasion at which to increase the nutritional intake of vulnerable clients who may have poor appetites and they can provide more than a quarter of the daily energy intake of patients (Walton et al, 2007). One Australian survey found that most hospitals regularly provided patients with three midmeals: 98% served morning tea, 99% served afternoon tea, and 95% served supper, and 19% even offered a pre-breakfast early morning hot beverage (Mibey and Williams, 2002).…”