Can trained volunteers improve the mealtime care of older hospital patients? An implementation study in one English hospital

Fiona F A Howson, Sian M Robinson, Sharon X Lin, Rosanna Orlando, Cyrus Cooper, Avan A P Sayer, Helen C Roberts, Fiona F A Howson, Sian M Robinson, Sharon X Lin, Rosanna Orlando, Cyrus Cooper, Avan A P Sayer, Helen C Roberts

Abstract

Objective: Multinational studies report undernutrition among 39% older inpatients; importantly, malnutrition risk may further increase while in hospital. Contributory factors include insufficient mealtime assistance from time-pressured hospital staff. A pilot study showed trained volunteers could safely improve mealtime care. This study evaluates the wider implementation of a mealtime assistance programme.

Design: Mixed methods prospective quasi-experimental study.

Setting: Nine wards across Medicine for Older People (MOP), Acute Medical Unit, Orthopaedics and Adult Medicine departments in one English hospital.

Participants: Patients, volunteers, ward staff.

Intervention: Volunteers trained to help patients aged ≥70 years at weekday lunchtime and evening meals.

Main outcome measures: The number of volunteers recruited, trained and their activity was recorded. Barriers and enablers to the intervention were explored through interviews and focus groups with patients, ward staff and volunteers. The total cost of the programme was evaluated.

Results: 65 volunteers (52 female) helped at 846 meals (median eight/volunteer, range 2-109). The mix of ages (17-77 years) and employment status enabled lunch and evening mealtimes to be covered. Feeding patients was the most common activity volunteers performed, comprising 56% of volunteer interactions on MOP and 34%-35% in other departments. Patients and nurses universally valued the volunteers, who were skilled at encouraging reluctant eaters. Training was seen as essential by volunteers, patients and staff. The volunteers released potential costs of clinical time equivalent to a saving of £27.04/patient/day of healthcare assistant time or £45.04 of newly qualified nurse time above their training costs during the study.

Conclusions: Patients in all departments had a high level of need for mealtime assistance. Trained volunteers were highly valued by patients and staff. The programme was cost-saving releasing valuable nursing time.

Trial registration number: NCT02229019; Pre-results.

Keywords: hospital; implementation; mealtime assistance; older; volunteer.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Volunteer recruitment and training.

References

    1. Russell C, Elia M. Nutrition screening surveys in hospitals in England: BAPEN, 2014..
    1. Kaiser MJ, Bauer JM, Rämsch C, et al. . Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010;58:1734–8. 10.1111/j.1532-5415.2010.03016.x
    1. Stratton RJ, Hackston A, Longmore D, 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. 10.1079/BJN20041258
    1. Elia M. The cost of malnutrition in Engand and potential cost savings from nutritional interventions: BAPEN, Redditch:, 2015.
    1. Guest JF, Panca M, Baeyens JP, et al. . Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK. Clin Nutr 2011;30:422–9. 10.1016/j.clnu.2011.02.002
    1. Patel MD, Martin FC. Why don’t elderly hospital inpatients eat adequately? J Nutr Health Aging 2008;12:227–31. 10.1007/BF02982626
    1. Pilgrim AL, Baylis D, Jameson KA, et al. . Measuring appetite with the simplified nutritional appetite questionnaire identifies hospitalised older people at risk of worse health outcomes. J Nutr Health Aging 2016;20:3–7. 10.1007/s12603-016-0668-3
    1. Walton K, Williams P, Tapsell L, et al. . Observations of mealtimes in hospital aged care rehabilitation wards. Appetite 2013;67:16–21. 10.1016/j.appet.2013.03.006
    1. Roberts HC. Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital. Proc Nutr Soc 2018;77:95–9. 10.1017/S0029665117002804
    1. Hickson M, Connolly A, Whelan K. Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients. J Hum Nutr Diet 2011;24:370–4. 10.1111/j.1365-277X.2011.01167.x
    1. Palmer M, Huxtable S. Aspects of protected mealtimes are associated with improved mealtime energy and protein intakes in hospitalized adult patients on medical and surgical wards over 2 years. Eur J Clin Nutr 2015;69:961–5. 10.1038/ejcn.2015.87
    1. Young A, Allia A, Jolliffe L, et al. . Assisted or protected mealtimes? Exploring the impact of hospital mealtime practices on meal intake. J Adv Nurs 2016;72:1616–25. 10.1111/jan.12940
    1. Tassone EC, Tovey JA, Paciepnik JE, et al. . Should we implement mealtime assistance in the hospital setting? A systematic literature review with meta-analyses. J Clin Nurs 2015;24(19-20):2710–21. 10.1111/jocn.12913
    1. Howson FFA, Sayer AA, Roberts HC. The impact of trainedvolunteer mealtime assistants on dietary intake and satisfaction with mealtime care in adult hospital inpatients: a systematic review. J Nutr Health Aging 2017;21:1038–49. 10.1007/s12603-016-0847-2
    1. Robison J, Pilgrim AL, Rood G, et al. . Can trained volunteers make a difference at mealtimes for older people in hospital? A qualitative study of the views and experience of nurses, patients, relatives and volunteers in the Southampton Mealtime Assistance Study. Int J Older People Nurs 2015;10:136–45. 10.1111/opn.12064
    1. Roberts HC, Pilgrim AL, Jameson KA, et al. . The impact of trained volunteer mealtime assistants on the dietary intake of older female in-patients: The Southampton mealtime assistance study. J Nutr Health Aging 2017;21:320–8. 10.1007/s12603-016-0791-1
    1. Volunteering in health and care: Securing a sustainable future. 2018. .
    1. Okun MA, Yeung EW, Brown S. Volunteering by older adults and risk of mortality: a meta-analysis. Psychol Aging 2013;28:564–77. 10.1037/a0031519
    1. Inouye SK, Bogardus ST, Baker DI, et al. . The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc 2000;48:1697–706.
    1. Craig P, Dieppe P, Macintyre S, et al. . Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655 10.1136/bmj.a1655
    1. Roberts HC, Pilgrim AL, Elia M, et al. . Southampton Mealtime Assistance Study: design and methods. BMC Geriatr 2013;13:5 10.1186/1471-2318-13-5
    1. Moore GF, Audrey S, Barker M, et al. . Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015;350:h1258 10.1136/bmj.h1258
    1. Pinnock H, Barwick M, Carpenter CR, et al. . Standards for Reporting Implementation Studies (StaRI): explanation and elaboration document. BMJ Open 2017;7:e013318 10.1136/bmjopen-2016-013318
    1. Roberts HC, De Wet S, Porter K, et al. . The feasibility and acceptability of training volunteer mealtime assistants to help older acute hospital inpatients: the Southampton Mealtime Assistance Study. J Clin Nurs 2014;23:3240–9. 10.1111/jocn.12573
    1. Team RDC. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2016.
    1. Gale NK, Heath G, Cameron E, et al. . Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013;13:117 10.1186/1471-2288-13-117
    1. Curtis L, Burns A. Unit costs of health and social care 2015. Personal Social Services Research Unit, University of Kent, Canterbury 2015.
    1. Huxtable S, Palmer M. The efficacy of protected mealtimes in reducing mealtime interruptions and improving mealtime assistance in adult inpatients in an Australian hospital. Eur J Clin Nutr 2013;67:904–10. 10.1038/ejcn.2013.126
    1. Buys DR, Flood KL, Real K, et al. . Mealtime assistance for hospitalized older adults: a report on the SPOONS volunteer program. J Gerontol Nurs 2013;39:18–22. 10.3928/00989134-20130614-01
    1. Sneddon J. Using mealtime volunteers to support patients. Nurs Times 2011;107:21–3.
    1. Robinson S, Clump D, Weitzel T, et al. . The Memorial Meal Mates: a program to improve nutrition in hospitalized older adults. Geriatr Nurs 2002;23:332–5. 10.1067/mgn.2002.130279
    1. Wright L, Cotter D, Hickson M. The effectiveness of targeted feeding assistance to improve the nutritional intake of elderly dysphagic patients in hospital. J Hum Nutr Diet 2008;21:555–62. 10.1111/j.1365-277X.2008.00915.x
    1. Gilbert J, Appleton A, Jerrim J, et al. . Assisted feeding for elderly inpatients. Clin Med 2013;13:324 10.7861/clinmedicine.13-3-324
    1. Manning F, Harris K, Duncan R, et al. . Additional feeding assistance improves the energy and protein intakes of hospitalised elderly patients. A health services evaluation. Appetite 2012;59:471–7. 10.1016/j.appet.2012.06.011
    1. Walton K, Williams P, Bracks J, et al. . A volunteer feeding assistance program can improve dietary intakes of elderly patients--a pilot study. Appetite 2008;51:244–8. 10.1016/j.appet.2008.02.012
    1. Huang CS, Dutkowski K, Fuller A, et al. . Evaluation of a pilot volunteer feeding assistance program: influences on the dietary intakes of elderly hospitalised patients and lessons learnt. J Nutr Health Aging 2015;19:206–10. 10.1007/s12603-014-0529-x
    1. Inouye SK, Baker DI, Fugal P, et al. . Dissemination of the hospital elder life program: implementation, adaptation, and successes. J Am Geriatr Soc 2006;54:1492–9. 10.1111/j.1532-5415.2006.00869.x

Source: PubMed

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