Roberts H C, Pilgrim A L, Jameson K A, Cooper C, Sayer A A, Robinson S
Dr Helen Roberts, Academic Geriatric Medicine Mailpoint 807, Southampton General Hospital, Southampton SO16 6YD, Tel: 023 8120 4354 Email :
J Nutr Health Aging. 2017;21(3):320-328. doi: 10.1007/s12603-016-0791-1.
Malnutrition among older hospital inpatients is common and is associated with poor clinical outcomes. Time-pressured staff may struggle to provide mealtime assistance. This study aimed to evaluate the impact of trained volunteer mealtime assistants on the dietary intake of older inpatients.
Quasi-experimental two year pre and post- test study of the introduction of volunteer mealtime assistants to one acute medical female ward, with contemporaneous comparison with a control ward.
Two acute medical female wards in a university hospital in England.
Female acute medical inpatients aged 70 years and over who were not tube fed, nil by mouth, terminally ill or being nursed in a side room.
The introduction of volunteer mealtime assistants to one ward to help patients during weekday lunchtimes in the intervention year.
Patients' background and clinical characteristics were assessed; 24-hour records were completed for individual patients to document dietary intake in both years on the two wards.
A total of 407 patients, mean (SD) age 87.5 (5.4) years, were studied over the two-year period; the majority (57%) needed mealtime assistance and up to 50% were confused. Patients' clinical characteristics did not differ between wards in the observational or intervention years. Throughout the intervention year volunteers provided mealtime assistance on weekday lunchtimes on the intervention ward only. Daily energy (median 1039 kcal; IQR 709, 1414) and protein (median 38.9 g: IQR 26.6, 54.0) intakes were very low (n=407). No differences in dietary intake were found between the wards in the observational or intervention years, or in a pre-post-test comparison of patients on the intervention ward. Data were therefore combined for further analysis to explore influences on dietary intake. In a multivariate model, the only independent predictor of energy intake was the feeding assistance required by patients; greater need for help was associated with lower energy intake (P<0.001). Independent predictors of protein intake were the feeding assistance given (P<0.001) and use of sip feeds; sip feed users had slightly higher protein intakes (P=0.014).
Trained volunteers were able to deliver mealtime assistance on a large scale in an effective and sustainable manner, with the potential to release time for nursing staff to complete other clinical tasks. The study participants had a low median intake of energy and protein highlighting the importance of patient factors associated with acute illness; a stratified approach including oral and parenteral nutritional supplementation may be required for some acutely unwell patients. The level of mealtime assistance required was the factor most strongly associated with patients' poor intake of energy and protein and may be a useful simple indicator of patients at risk of poor nutrition.
老年住院患者营养不良情况常见，且与不良临床结局相关。时间紧迫的工作人员可能难以提供用餐协助。本研究旨在评估训练有素的志愿者用餐助理对老年住院患者饮食摄入量的影响。
对一个急性内科女性病房引入志愿者用餐助理进行为期两年的准实验前后测试研究，并与对照病房进行同期比较。
英国一家大学医院的两个急性内科女性病房。
70岁及以上非鼻饲、非禁食、非绝症且不在侧室护理的急性内科女性住院患者。
在干预年的工作日午餐时间，在一个病房引入志愿者用餐助理以帮助患者。
评估患者的背景和临床特征；为每个患者完成24小时记录，以记录两个病房两年内的饮食摄入量。
在两年期间共研究了407名患者，平均（标准差）年龄87.5（5.4）岁；大多数（57%）患者需要用餐协助，高达50%的患者存在认知障碍。在观察年或干预年，各病房患者的临床特征无差异。在整个干预年，志愿者仅在干预病房的工作日午餐时间提供用餐协助。每日能量摄入量（中位数1039千卡；四分位数间距709，1414）和蛋白质摄入量（中位数38.9克：四分位数间距26.6，54.0）非常低（n = 407）。在观察年或干预年，各病房之间的饮食摄入量无差异，干预病房患者的前后测试比较也无差异。因此，将数据合并进行进一步分析以探讨对饮食摄入量的影响。在多变量模型中，能量摄入的唯一独立预测因素是患者所需的喂食协助；对帮助的需求越大，能量摄入越低（P < 0.001）。蛋白质摄入的独立预测因素是给予的喂食协助（P < 0.001）和使用流食；流食使用者的蛋白质摄入量略高（P = 0.014）。
训练有素的志愿者能够以有效且可持续的方式大规模提供用餐协助，有可能为护理人员腾出时间来完成其他临床任务。研究参与者的能量和蛋白质摄入量中位数较低，凸显了与急性疾病相关的患者因素的重要性；对于一些急性不适的患者，可能需要采取包括口服和肠内营养补充在内的分层方法。所需的用餐协助水平是与患者能量和蛋白质摄入不足最密切相关的因素，可能是营养不良风险患者的一个有用的简单指标。
