Dr Adrienne Young1,2, Dr Merrilyn Banks1, Dr Alison Mudge3, Ms Prue McRae3
1Nutrition and Dietetics, Royal Brisbane And Women’s Hospital, Herston, Australia, 2School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia, 3Internal Medicine, Royal Brisbane and Women’s Hospital, Herston, Australia
Malnutrition and poor dietary intake remains a significant problem for older hospital patients. The complexity of hospital mealtimes and nutrition care necessitates an interdisciplinary approach to improvement. This study monitored nutritional intake of older inpatients (65+ years) over a ten-year period as foodservice and mealtime interventions were progressively implemented into routine practice in a large metropolitan Queensland hospital. Hospital and ward-level interventions were implemented from 2009-2014. These included facilitated implementation of ‘assisted mealtimes’ (by nursing, allied health, and medical, as part of the Eat Walk Engage program), and proactive provision of high protein/energy (HPHE) meals and mid-meals. Allied health assistants supported these interventions. Data were collected on 386 medical inpatients admitted in 2007-08 (n=129, 80±8y, 49% male), 2009 (n=139, 80±8y, 45% male), 2013-14 (n=52, 82±8y, 44% male) and 2017 (n=66, 82±8y, 50% male). Energy and protein intake were calculated from visual plate waste of all meals and mid-meals on Day 4-7 of admission; these were compared to patient requirements. One-way ANOVA and χ2 tests were used to compare cohorts. Nutritional intakes of participants have significantly increased over time (energy: 5073±1850kJ, 5403±2252kJ, 5989±2614kJ, 5954± 2179kJ, p=0.014; protein: 48±19g, 50±21g, 57±26g, 58±24g, p=0.002). The proportion of patients with inadequate energy and protein intakes has also decreased (intake<resting energy expenditure: 59.7%, 53.2%, 44.2%, 34.8%, p<0.001; intake<1g/kg protein: 85.3%, 75.5%, 73.1%, 63.6%, p=0.007). Provision of HPHE diets and mealtime assistance have improved (HPHE: 20.2%, 56.1%, 84.6%, 89.4%, p<0.001; assistance where required: 58.1%, 86.4%, 100%, 85.7%, p<0.001). This ten-year study highlights the importance of continuous quality improvement and interdisciplinary and system-level nutrition care strategies such as mealtime assistance and foodservice improvements to achieve improved intakes of older inpatients. Factors important in creating sustainable change included use of implementation frameworks, multidisciplinary implementation team, assistant workforce, and making small, sequential changes.
Dr Adrienne Young is an Accredited Practicing Dietitian, and is currently Principal Research Fellow, Allied Health Professions at the Royal Brisbane and Women’s Hospital. Her PhD research on improving nutritional intake of older medical inpatients has been of interest nationally and internationally, with Adrienne awarded the Health Practitioner Researcher of the Year at the Royal Brisbane and Women’s Hospital research symposium in 2018, and New Researcher Award at the International Congress of Dietetics in 2012. Adrienne has continued to research in the area of malnutrition in older people, with recent work also focused on workforce development to prepare allied health professionals to translate research into their practice.