The health of many older patients is being jeopardised through lack of attention at meal times. Jennifer Taylor looks at how you can make sure they eat properly

Despite recognition that it is preventable, malnutrition of older people continues to be a huge problem for hospitals across the country, says Michelle Mitchell, charity director for Age Concern and Help the Aged. “Food is one of the basic human needs for healthy wellbeing and survival, yet too many hospitals are still failing to give nutritional care enough priority in their day to day practice.”

With 40 per cent of older people malnourished on admission to hospital, the charity’s Hungry to be Heard campaign says patients should have their weight and height taken on admission and at regular intervals.

An accredited tool should be used for the assessment, says Debbie Dzik-Jurasz, learning and development facilitator at the Royal College of Nursing. One example is the British Association for Parenteral and Enteral Nutrition malnutrition universal screening tool.

But surveys from the National Patient Safety Agency highlight that one of the main reasons people do not get weighed in hospital is that wards do not have scales that work, so clinical leaders first need to know the appropriate equipment is in place before they can bring in an assessment tool.

While training on how to use the chosen screening tool is not mandatory, senior members within a trust need to ensure people are released for that training, or the consequences could be dire. “If you do not give someone the appropriate food and drink, the end result could be that they will die,” explains Ms Dzik-Jurasz.

Hospitals need protocols in place so that action is taken when a patient is identified as malnourished or at risk of malnutrition - that is, what steps will be taken and how that will be monitored.

Happy meals

Protected meal times are one positive step towards improving patient nourishment in which non urgent activity stops to give staff the time to support people who need help to eat and drink, while also ensuring that patients do not feel rushed.

A system to identify which older people need help eating can be as simple as putting their meal on a red tray.

But protected meal times are challenging to implement, says Ms Dzik-Jurasz, because patients may need to leave the ward during these times to have x-rays and other procedures. She adds: “Surgical ward areas seem to have the most challenges, because the surgeons may be in theatre in the morning and [then] they want to come and see their patients, which is often around lunchtime.”

In cases where there are too few appropriately qualified nurses to help patients with their eating or drinking, ward leaders or registered members of the ward team should report it as a clinical incident, says Ms Dzik-Jurasz.

“They are putting people at risk if they have not got enough people. We need to get nutrition at the same [priority] level as a hospital acquired infection and we are not there yet.”


British Association for Parenteral and Enteral Nutrition malnutrition universal screening tool

The Essence of Care: patient-focused benchmarking for health care practitioners, DH 2001

Age Concern and Help the Aged nutritional care training videos

Royal College of Nursing Nutrition Now campaign

Top tips

  • Screen patients on admission for risk of malnutrition using an accredited tool
  • Ensure wards have scales for weighing patients and that staff are trained to use the screening tool
  • Use red trays to identify patients who need help to eat or drink
  • Implement protected meal times
  • Where appropriate, use trained volunteers to help with meal times
  • Monitor impact using the Essence of Care benchmarks

Case study: Darlington Memorial Hospital

Six months ago, Age Concern Darlington identified the need for 200 volunteers to work three hour slots each week to assist with meal times at Darlington Memorial Hospital. They help ensure patients are calm and comfortable, put food trays within easy reach, remove packaging, encourage patients who do not feel like eating, and provide observational feedback to nursing staff.

The volunteers help any patient who needs it, but Geoffrey Crute, chief executive of the charity, says: “About 70-75 per cent of the patients who need the sort of assistance we are talking about are older people.”

Recruitment started in January and there are now around 15-20 volunteers on the wards, with a further 53 going through Criminal Records Bureau checks, reference checks and training. The hospital has immovable rules on these procedures so it is a slow process, says Mr Crute. “There is a balance to be achieved between keeping on building awareness, but not having too many people saying ‘yes please’.”