Improving nutrition care and intake for older hospital patients through system-level dietary and mealtime interventions
Abstract
Background & aims Interventions such as oral nutritional supplements (ONS), fortified meals and mid-meals, feeding assistants and Protected Mealtimes have shown some impact on nutritional intake in research studies, but embedding them in practise remains challenging. This study monitored nutritional intake of older medical inpatients as dietary and mealtime interventions were progressively implemented into routine practise. Methods Series of three prospectively evaluated patient cohorts allowed comparison of nutritional intake of 320 consented medical inpatients aged 65 + years: cohort 1 (2007-8), cohort 2 (2009) and cohort 3 (2013-14) as nutrition care interventions were progressively introduced and embedded. Interventions focused on 'assisted mealtimes', fortified meals and mid-meals, and ONS. Energy and protein intake were calculated from visual plate waste of individual meal and mid-meal components on day 5 of admission. Nutrition care processes were evaluated by mealtime audits of diet type, assistance and interruptions on the same day. One-way ANOVA and chi square tests were used for comparison between cohorts. Results Significant, progressive improvements in energy and protein intake were seen between cohorts (energy: cohort 1: 5073 kJ/d; cohort 2: 5403 kJ/d; cohort 3: 5989 kJ/d, p = 0.04; protein: cohort 1: 48 g/d, cohort 2: 50 g/d, cohort 3: 57 g/d, p = 0.02). Greater use of fortified meals and mid-meals and sustained improvements in mealtime assistance likely contri…
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A combination of organizational changes may be sustained over a period of time and culminate in improved dietary intake.
“These three studies suggest that a combination of organizational changes may be sustained over a period of time and culminate in improved dietary intake (Level of Evidence 2þ).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [162]
In Young et al.'s study, there was a significant difference in energy intake between cohorts (cohort 1: 1212 kcal/day, cohort 2: 1291 kcal/day, cohort 3: 1431 kcal/day, p=0.04).
“Results showed a significant difference in energy intake between cohorts (cohort 1: 1212 kcal/ day (SD 442), cohort 2: 1291 kcal/day (SD 538), cohort 3: 1431 kcal/ day (SD 625), p ¼ 0.04).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [162]
In Young et al.'s study, protein intake increased significantly in each successive cohort (+48 g/day, +50 g/day, +57 g/day, p=0.02).
“Protein intake increased significantly in each successive cohort (þ48 g/day (SD 19), þ50 g/day (SD 21) andþ57 g/day (SD 26) respectively, p ¼ 0.02).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [162]
The use of conceptual frameworks to implement changes has been successful in some studies.
“The use of conceptual frameworks to implement changes has been successful in some studies [161,162].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [162]
Cites
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Protein and energy supplementation in elderly people at risk from malnutrition
Milne, A. C., Potter, J., Vivanti, A., & Avenell, A. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003288.pub3 · Cited by 849 · see citing works
Duncan, D. G., Beck, S. J., Hood, K., & Johansen, A. (2006) · Age and Ageing · doi:10.1093/ageing/afj011 · Cited by 202 · see citing works
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ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“Young et al., reported the implementation of nutrition improvement initiatives over a seven-year period on three medical wards [162].”
- Authors
- Young, A. M., Banks, M. D., & Mudge, A. M.
- Affiliations
- Queensland University of Technology (AU)
- Royal Brisbane and Women's Hospital (AU)
- Corresponding author
- Young, Adrienne M.
- Venue
- Clinical Nutrition ESPEN
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 24
- Pages
- 140-147
- ISSN
- 2405-4577 (ISSN-L)
- OpenAlex
- W2782035681
- Cited by
- 50
- References
- 3
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 8 · 2023: 8 · 2022: 4 · 2021: 11 · 2020: 4 · 2019: 2 · 2018: 2 · 2013: 1
- FWCI
- 3.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition ESPEN (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Queensland Health (QH) Strengthening Aged Care
- QH Health Practitioners Funding Scheme
- RBWH Research Foundation
- RBWH
- Queensland University of Technology
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- hospitalized older adults, nutritional intake, oral nutritional supplements, feeding assistance, energy intake, protein intake, hospital nutrition, system-level interventions, medical inpatients
- MeSH terms
- Aged, Aged, 80 and over, Energy Intake, Female, Food Service, Hospital, Food, Fortified, Health Services for the Aged, Humans, Inpatients, Male, Nutritional Requirements, Nutritional Status, Prospective Studies, Protein-Energy Malnutrition, Dietary Supplements, Nutrition Therapy, Quality Improvement, Meals
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