Malnutrition in hospital inpatients

Leading the way in elderly care research- a study of malnutrition in hospital inpatients

Date: 16 August 2017

Helen Roberts is an associate professor and honorary consultant in geriatric medicine at the University of Southampton. Her research interests focus on the identification and management of sarcopenia, frailty, poor nutrition and low physical activity in older  people and those with Parkinson’s disease. Helen told VISION about her research into the malnutrition of hospital inpatients: 

"In 2011, a national survey, conducted by the British Association of Parenteral and Enteral Nutrition (BAPEN), reported that 28 per cent of patients over the age of 65 years were at risk of malnutrition at the time of their admission to hospital. Malnutrition is associated with increased complications in hospital (such as pressure ulcers and infections), slower recovery from illness, longer hospital stays and even increased mortality. Although poor nutrition starts outside the hospital multi-national studies in developed countries estimate that up to 39 per cent of older in-patients are malnourished.

Patient factors such as acute illness and altered taste due to medication, contribute to poor nutrition. However it is recognised that in a hospital environment, food may be placed out of reach or go cold because of clinical care – and one factor that particularly affects older inpatients is the amount of assistance they receive at mealtimes. With increasing workload and competing priorities at mealtimes, nursing staff often do not have the time they would like to help patients with their meals.

In 2011, I led the Southampton Mealtime Assistance Study, which was supported by the Biomedical Research Centre Nutrition and the MRC Lifecourse Epidemiology Unit. We recruited and trained volunteers to act as mealtime assistants on one female medicine for older people ward at University Hospital Southampton. The volunteers’ remit was to help prepare the tray tables, wipe hands, open packets and remove lids of food and drink items, cut up food and feed patients as required and improve the social setting of meals. Over the course of one year, 29 volunteers assisted 3,911 older female inpatients and the mealtime assistants were highly valued by patients, relatives and nursing staff.

As part of the ageing and dementia theme of the NIHR Wessex CLAHRC, we are building on this in a new study to evaluate the implementation of mealtime assistants in four different hospital departments to help both male and female patients. So far, 65 volunteer mealtime assistants have been recruited and trained to work at the University Hospital Southampton on five medicine for older people wards, the acute medical unit, and two wards each in trauma and orthopaedics and adult medicine. The volunteers range in age from 17-77 years and include students, retired people and those both in and out of employment.

We have also measured food choices and dietary intake on the wards where the volunteers are working and analysis is underway to assess the typical energy and protein intake in each ward area.

Results show that:

  • Volunteers reported that preparing patients
    for their meal was important
  • Volunteers had developed strategies to encourage patients to eat more, which was often challenging
  • Social interaction was an important part of the volunteer role with clear benefit to patients
  • Staff were universally positive about the impact
    of the volunteers especially with reluctant eaters

The volunteers have currently improved the quality of mealtime care for a large number of patients in University Hospital Southampton, which has now taken over the on-going support for the volunteer programme. The volunteers are also very cost-effective, freeing up nursing time for clinical tasks. The research team is developing a set of recommendations for other hospitals and similar organisations on how best to recruit, train and retain volunteers, as well as working with the Academic Health Science Network (AHSN) nutrition team to scale up this intervention to other hospitals.

The NIHR CLAHRC Wessex has supported the research team in this study through organising peer review, regular support and advice and patient & public involvement (PPI). The METHUB has provided support in the form of statistical, qualitative and economic research advice during protocol development and more recently in data analysis."

Read more in VISION magazine.

Read more about Helen's research

  • Summary:
    Helen Roberts is an associate professor and honorary consultant in geriatric medicine at the University of Southampton. Helen told VISION about her research into the malnutrition of hospital inpatients:
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