Southampton Mealtime Assistance Study: design and methods

Helen C Roberts, Anna L Pilgrim, Marinos Elia, Alan A Jackson, Cyrus Cooper, Avan Aihie Sayer, Sian M Robinson, Helen C Roberts, Anna L Pilgrim, Marinos Elia, Alan A Jackson, Cyrus Cooper, Avan Aihie Sayer, Sian M Robinson

Abstract

Background: Malnutrition is common in older people in hospital and is associated with adverse clinical outcomes including increased mortality, morbidity and length of stay. This has raised concerns about the nutrition and diet of hospital in-patients. A number of factors may contribute to low dietary intakes in hospital, including acute illness and cognitive impairment among in-patients. The extent to which other factors influence intake such as a lack of help at mealtimes, for patients who require assistance with eating, is uncertain. This study aims to evaluate the effectiveness of using trained volunteer mealtime assistants to help patients on an acute medical ward for older people at mealtimes.

Methods/design: The study design is quasi-experimental with a before (year one) and after (year two) comparison of patients on the intervention ward and parallel comparison with patients on a control ward in the same department. The intervention in the second year was the provision of trained volunteer mealtime assistance to patients in the intervention ward. There were three components of data collection that were repeated in both years on both wards. The first (primary) outcome was patients' dietary intake, collected as individual patient records and as ward-level balance data over 24 hour periods. The second was clinical outcome data assessed on admission and discharge from both wards, and 6 and 12 months after discharge. Finally qualitative data on the views and experience of patients, carers, staff and volunteers was collected through interviews and focus groups in both years to allow a mixed-method evaluation of the intervention.

Discussion: The study will describe the effect of provision of trained volunteer mealtime assistants on the dietary intake of older medical in-patients. The association between dietary intake and clinical outcomes including malnutrition risk, body composition, grip strength, length of hospital stay and mortality will also be determined. An important component of the study is the use of qualitative approaches to determine the views of patients, relatives, staff and volunteers on nutrition in hospital and the impact of mealtime assistance.

Trial registration: Trial registered with ClinicalTrials.gov NCTO1647204.

Trial registration: ClinicalTrials.gov NCT01647204.

Figures

Figure 1
Figure 1
Study outline scheme.

References

    1. Margetts BM, Thompson RL, Elia M, Jackson AA. Prevalence of risk of undernutrition is associated with poor health status in older people in the UK. Eur J Clin Nutr. 2003;57:69–74. doi: 10.1038/sj.ejcn.1601499.
    1. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T. et al.Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58:1734–1738. doi: 10.1111/j.1532-5415.2010.03016.x.
    1. Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M. 'Malnutrition Universal Screening Tool' predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr. 2006;95:325–330. doi: 10.1079/BJN20051622.
    1. Kerr A, Syddall HE, Cooper C, Turner GF, Briggs RS, Sayer AA. Does admission grip strength predict length of stay in hospitalised older patients? Age Ageing. 2006;35:82–84. doi: 10.1093/ageing/afj010.
    1. Elia M, Russell CA, Stratton RJ. Malnutrition in the UK: policies to address the problem. Proc Nutr Soc. 2010;69:470–476. doi: 10.1017/S0029665110001746.
    1. McDougall T, Williams H, Fairbrother J. Food consumption on medical elderly wards. Proc Nutr Soc. 2010;69:E222.
    1. Audit commission. Acute hospital portfolio, catering - review of national findings. London, UK: Audit commission; 2001.
    1. Patel MD, Martin FC. Why don't elderly hospital inpatients eat adequately? J Nutr Health Aging. 2008;12:227–231. doi: 10.1007/BF02982626.
    1. Vanderwee K, Clays E, Bocquaert I, Gobert M, Folens B, Defloor T. Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multi-centre study. Clin Nutr. 2010;29:469–476. doi: 10.1016/j.clnu.2009.12.013.
    1. Russell CA, Elia M. Malnutrition in the UK: where does it begin? Proc Nutr Soc. 2010;69:465–469. doi: 10.1017/S0029665110001850.
    1. Elia M, Russell CA. The advisory group on malnutrition1B. Combating malnutrition: recommendations for action. 2008;12:6.
    1. Amaral TF, Matos LC, Teixeira MA, Tavares MM, Alvares L, Antunes A. Undernutrition and associated factors among hospitalized patients. Clin Nutr. 2010;29:580–585. doi: 10.1016/j.clnu.2010.02.004.
    1. Healthcare Commission. State of healthcare. London: Healthcare Commission; 2008.
    1. Care Quality Commission. Dignity and nutrition inspection programme: national overview. London, UK: Care Quality Commission; 2011.
    1. Xia C, McCutcheon H. Mealtimes in hospital–who does what? J Clin Nurs. 2006;15:1221–1227. doi: 10.1111/j.1365-2702.2006.01425.x.
    1. Simmons SF, Bertrand R, Shier V, Sweetland R, Moore TJ, Hurd DT. et al.A preliminary evaluation of the paid feeding assistant regulation: impact on feeding assistance care process quality in nursing homes. Gerontologist. 2007;47:184–192. doi: 10.1093/geront/47.2.184.
    1. Westergren A, Unosson M, Ohlsson O, Lorefalt B, Hallberg IR. Eating difficulties, assisted eating and nutritional status in elderly (> or = 65 years) patients in hospital rehabilitation. Int J Nurs Stud. 2002;39:341–351. doi: 10.1016/S0020-7489(01)00025-6.
    1. Tsang MF. Is there adequate feeding assistance for the hospitalised elderly who are unable to feed themselves? Nutr Diet. 2007;65:222–228.
    1. Green SM, Martin HJ, Roberts HC, Sayer AA. A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings. J Clin Nurs. 2011;20:1810–1823. doi: 10.1111/j.1365-2702.2010.03624.x.
    1. Duncan DG, Beck SJ, Hood K, Johansen A. Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Age Ageing. 2006;35:148–153. doi: 10.1093/ageing/afj011.
    1. Hickson M, Bulpitt C, Nunes M, Peters R, Cooke J, Nicholl C. et al.Does additional feeding support provided by health care assistants improve nutritional status and outcome in acutely ill older in-patients?–a randomised control trial. Clin Nutr. 2004;23:69–77. doi: 10.1016/S0261-5614(03)00090-6.
    1. Young JB, Robinson M, Chell S, Sanderson D, Chaplin S, Burns E. et al.A whole system study of intermediate care services for older people. Age Ageing. 2005;34:577–583. doi: 10.1093/ageing/afi179.
    1. Robson C. Real world research. Oxford: Blackwell Publishers; 1995. Quasi-experimentation; pp. 98–108.
    1. Morgan JC, Konrad TR. A mixed-method evaluation of a workforce development intervention for nursing assistants in nursing homes: the case of WIN A STEP UP. Gerontologist. 2008;48(Spec No 1):71–79.
    1. Mills A, Patel S. Food Portion Sizes. 2. Norwich: The Stationery Office; 1998.
    1. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M. et al.Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults. Br J Nutr. 2004;92:799–808. doi: 10.1079/BJN20041258.
    1. Haboubi NY, Hudson PR, Pathy MS. Measurement of height in the elderly. J Am Geriatr Soc. 1990;38:1008–1010.
    1. Qureshi KN, Hodkinson HM. Evaluation of a ten-question mental test in the institutionalized elderly. Age Ageing. 1974;3:152–157. doi: 10.1093/ageing/3.3.152.
    1. Pennington CR. Disease and malnutrition in British hospitals. Proc Nutr Soc. 1997;56:393–407. doi: 10.1079/PNS19970041.
    1. Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C. et al.A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40:423–429. doi: 10.1093/ageing/afr051.
    1. Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14:61–65.
    1. Roberts HC, Haslam SC, Mashod NIHA, Burnett ME, Aihie Sayer A. Measuring activity in older in-patients -time standing or step count? Age Ageing. 2012;41:111. doi: 10.1093/ageing/afr075.
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S. et al.The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual Life Outcomes. 2007;5:63. doi: 10.1186/1477-7525-5-63.
    1. Ritchie J, Lewis J, editor. Qualitative research practice. London: Sage; 2003.

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