58 percent of older hospital patients have problems eating, 31 percent leave most of their meal

Malnutriton a major issue among patients over 65

Older patients need greater support, fewer interruptions and more sensitive care at mealtimes, according to research published in the October issue of the UK-based Journal of Clinical Nursing.

Researchers from the University of Adelaide, Australia, spent two weeks studying 48 hospital patients and 50 nurses during mealtimes on two medical wards.

They discovered that 58 percent of the patients, who were aged 65 or over, had problems eating. Just under a third (31 percent) left more than two-thirds of their meal and only 15 percent had eaten it all.

More than half of the patients they studied (55 percent) had problems opening food and about a third found it difficult to use cutlery (36 percent) and add seasoning (32 percent).

More than a fifth (23 percent) were too far away from their food and 18 percent 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 it, practical support was only given to a small percentage of patients. For example only six percent were made more comfortable or helped with cutlery.

Interruptions were also frequent. One in five patients (19 percent) had a doctor's visit during mealtimes and more than half (51 percent) had mealtimes interrupted by other staff, mostly nurses (92 percent).

Three patients were asked about their bowels while they were eating and four male patients had urine bottles place on the table beside meals.

"Recent research suggests that 40 percent of older people are malnourished when they are admitted to hospital" says lead researcher Chenfan Xia, who was based at the University at the time of the study - with co-author Professor Helen McCutcheon - and now works in an aged care facility.

"The nutritional status of 60 percent 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."

The researchers make a number or 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. The study found that monitoring was very patchy and often only covered fluid intake.

  • Many patients were put off by large portion sizes and the researchers suggest that 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 and 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 or highlighting 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 to help patients who need help with eating and has launched a campaign Hungry to be Heard to tackle the issue in UK hospitals.

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Notes to editors

  • Mealtimes in hospital who does what? Xia and McCutcheon. Journal of Clinical Nursing. Volume 15, pages 1221-1227 (October 2006).

  • Founded in 1992, Journal of Clinical Nursing is a highly regarded peer reviewed Journal that has a truly international readership. The Journal embraces experienced clinical nurses, student nurses and health professionals, who support, inform and investigate nursing practice. It enlightens, educates, explores, debates and challenges the foundations of clinical health care knowledge and practice worldwide. Edited by Professor Roger Watson, it is published 10 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. www.blackwellpublishing.com/jcn


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