Hunger and Aversion: Drives That Influence Food Intake of Hospitalized Geriatric Patients

Foodservice systems and mealtime models in rehabilitation: Scoping review

AIMS

To describe current foodservice systems and mealtime care utilized in the rehabilitation setting. A secondary aim was to identify commonly used outcome measures in foodservice research in the rehabilitation setting.

DESIGN

A scoping review.

DATA SOURCES

PubMed, CINAHL, Scopus, Embase, PsycINFO and Cochrane were searched until January 2022.

REVIEW METHODS

The review was conducted according to Joanna Briggs Institute's methodology for scoping reviews. Included studies were conducted in the inpatient rehabilitation setting, adult population ≥18 years old and provided a description of at least one element of the foodservice system, food and menu, waste and/or eating environment.

RESULTS

Of 5882 articles screened, 37 articles were included, reporting 31 unique studies. Most rehabilitation units had cook-fresh production methods (50%), used decentralized bulk delivery methods (67%) had a communal dining room (67%) and had a 3-week menu cycle (71%). Mealtime care was predominantly provided by nursing staff, however few studies reported on specific activities. Nutritional intake was a key outcome measure across included studies (43%), with only six papers reporting on rehabilitation outcomes. Of the intervention studies (n = 9), all were aimed at improving nutritional intake through menu or mealtime care modifications; few (n = 3) studied changes in rehabilitation outcomes.

CONCLUSION

This scoping review identified a considerable lack of reporting of foodservice and mealtime care systems used in rehabilitation settings in the available literature. Further investigation is required to understand what models of mealtime care are provided to patients and to understand the impact of changes to foodservice and mealtime systems on patient outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was necessary for this review.

The accessibility and probability of encountering catastrophic health expenditure by Lao patients in Thai hospitals

It is common for people in Laos to use health services in Thailand and other foreign countries. This study analyzes and compares the probability of using health care services and the financial catastrophe occurring due to health service utilization in both local and Thai hospitals. This study includes 390 respondents from Savannakhet Province, Laos. Households' income levels play an essential role in selected locations of hospital admission. The regression model proves that lower income quintiles were more likely to use local health services, whereas the higher income households preferred Thailand's hospital services. There is a negative relationship between income level and the probability of experiencing catastrophic health expenditure. The National Health Insurance (NHI) is recommended to seek greater cooperation with foreign hospitals, to allow Lao patients to use NHI's coverage as a co-payment system for specific health services not available in Lao hospitals. NHI should have to include proper-nutrition meal services in hospitals for patients to reduce the need for accompanied household members during patients' time at hospitals. It is proven that NHI successfully enhances accessibility to local health services; in the long run, the government should expand national hospitals' capacity, medical equipment availability and quantity of health care personnel.

Patients' evaluation of hospital foodservice quality in Italy: what do patients really value?

OBJECTIVE

Patients often do not eat/drink enough during hospitalization. To enable patients to meet their energy and nutritional requirements, food and catering service quality and staff support are therefore important. We assessed patients' satisfaction with hospital food and investigated aspects influencing it.

DESIGN

We conducted a cross-sectional study collecting patients' preferences using a slightly modified version of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Factor analysis was carried out to reduce the number of food-quality and staff-issue variables. Univariate and multivariate ordinal categorical regression models were used to assess the association between food quality, staff issues, patients' characteristics, hospital recovery aspects and overall foodservice satisfaction (OS).

SETTING

A university hospital in Florence, Italy, in the period November-December 2009.

SUBJECTS

Hospital patients aged 18+ years (n 927).

RESULTS

Of the 1288 questionnaires distributed, 927 were returned completely or partially filled in by patients and 603 were considered eligible for analysis. Four factors (explained variance 64·3 %, Cronbach's alpha α(C) = 0.856), i.e. food quality (FQ; α(C) = 0·74), meal service quality (MSQ; α(C) = 0·73), hunger and quantity (HQ; α(C) = 0·74) and staff/service issues (SI; α(C) = 0·65), were extracted from seventeen items. Items investigating staff/service issues were the most positively rated while certain items investigating food quality were the least positively rated. After ordinal multiple regression analysis, OS was only significantly associated with the four factors: FQ, MSQ, HQ and SI (OR = 17·2, 6·16, 3·09 and 1·75, respectively, P < 0·001), and gender (OR = 1·53, P = 0·024).

CONCLUSIONS

The most positively scored aspects of foodservice concerned staff/service, whereas food quality was considered less positive. The aspects that most influenced patients' satisfaction were those related to food quality.

Avaliação e monitoramento do estado nutricional de pacientes hospitalizados: uma proposta apoiada na opinião da comunidade científica

OBJETIVO: A desnutrição pode afetar adversamente a evolução clínica de pacientes hospitalizados e aumentar o tempo de permanência hospitalar. O objetivo deste estudo foi certificar critérios para avaliação e acompanhamento do estado nutricional de pacientes hospitalizados aceitos pela comunidade de pesquisadores, docentes e profissionais da área de nutrição clínica. MÉTODOS: Com este propósito aplicou-se um questionário via Internet, à comunidade científica, cadastrada na Plataforma Lattes - sistema nacional de cadastro curricular unificado on-line -, para apoiar atividades de fomento de agencias federais e estaduais. O questionário é composto de recomendações acompanhadas por uma escala Likert e espaços para justificativas dos participantes em relação à opção de aceitação parcial ou discordância do procedimento proposto. Foi considerado aprovado o procedimento que teve concordância total ou parcial maior ou igual a 70,0%. RESULTADOS: Responderam ao questionário 35,2% dos profissionais contatados. A maioria (84,0%) era professor universitário, sendo 62,0% de universidade pública; 67,0% eram doutores; 63,0% tinha mais de 20 anos de formado; 74,0% eram nutricionistas e 25,0% médicos. Os procedimentos propostos versam sobre as seguintes necessidades: triagem para definição de complexidade da atenção nutricional, indicadores de avaliação e monitoramento nutricional durante a internação e equipamentos e protocolos para o atendimento nutricional. Todos os procedimentos foram aceitos pelos entrevistados. Foi proposto pelos autores um modelo de triagem para definição da complexidade do atendimento nutricional, considerando os procedimentos aceitos. CONCLUSÃO: A aceitação dos procedimentos propostos fortalece o reconhecimento da necessidade de implantação de padrões para a avaliação e monitoramento nutricional nas instituições hospitalares.

Nutritional problems in the elderly

Despite the high prevalence of malnutrition among elderly patients, nutritional problems are still not recognized as a priority forthem by health professionals. The need for nutritional assessment and intervention is particularly crucial in this age group, in whom the incidence of chronic illness is high and a myriad of socio-economic factors enhance the likelihood of malnutrition. Malnutrition could be considered as an element of frailty among the old, leading to increased risk of many geriatric syndromes such as falls, delirium, functional decline, depressed immunity, etcetera. However, detection of nutritional risk and nutritional intervention are effective in frail patients. Nutritional assessment should be part of routine clinical practice in elderly hospitalized patients. A comprehensive screening tool for assessment of nutritional status that is clinically relevant and cost effective to perform is therefore needed. If malnutrition is suggested by such screening tests, then a supplemental conventional nutritional assessment should be performed before treatment is planned.

The evolution of nutritional status of geriatric patients without cachexia is associated with food intake in sub-acute care

OBJECTIVES

To determine if changes in patients' nutritional status during hospitalization are related to daily energy and protein intakes when cachectic/inflammatory conditions are controlled for.

DESIGN

Prospective study.

SUBJECTS

A total of 32 non-cachectic patients (21 women; 65-92 y).

METHODS

Nutritional status was evaluated at admission and discharge using the Protein-Energy Malnutrition Index which includes BMI, %IBW, TS, MAC, albumin, hemoglobin and lymphocyte count. Food intake was assessed 3 meals/day every other day for an average of 46.2 +/- 14.6 meals/participant.

RESULTS

In all, 47% of the study sample was malnourished at admission. Nutritional status improved in 73% of patients who had been identified as malnourished and in 30 % of non-malnourished patients at admission. Total energy intake correlated with improvements in BMI, %IBW and total lymphocyte count (all p < 0.04). Improvement in PEMI score for the whole group was associated with functional status (p < 0.05). Controlling for this variable, energy (kj/kg body weight) and protein (g/kg body weight) intakes correlated positively with improvements in BMI, %IBW and MAC (Energy: partial r = 0.644, 0.624, 0.466 respectively; Protein: partial r = 0.582, 0.554, 0.433 respectively; all p < 0.05).

CONCLUSIONS

Results from this study offer strong evidence that when cachectic/inflammatory conditions are controlled for, standard nutrition care is compatible with the maintenance or improvement of nutritional status during the hospital stay.

How to Try This

Fulmer SPICES is a framework for assessing older adults that focuses on six common "marker conditions": sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown. These conditions provide a snapshot of a patient's overall health and the quality of care. The SPICES assessment, done regularly, can signal the need for more specific assessment and lead to the prevention and treatment of these common conditions. For a free online video demonstrating the use of SPICES, go to http://links.lww.com/A100.

The role of everyday emotion regulation on pain in hospitalized elderly: insights from a prospective within-day assessment

Pain management is still an unresolved issue among the general elderly patient population in institutions. It is proposed that everyday emotion regulation (i.e. self-supporting maintenance or change in positive and negative emotions) performed by hospitalized elderly can help reduce pain intensity. This argument is based on (1) robust evidence in life span research of elderly's high ability for emotion regulation in the midst of everyday life and (2) experimental evidence from pain research that simple strategies to regulate emotions impact pain intensity. A prospective within-day study was designed to (1) empirically trace the occurrence of emotion regulation over specific sampling episodes, (2) assess the impact of this regulation on end-of-episode pain intensity, and (3) consider the effects of socio-demographic, psychological, and clinical factors on emotion regulation and its relationship to pain intensity. Thirty patients (mean age 78.8) of a geriatric facility provided ratings of emotional states and pain intensity. Emotion regulation was defined as maintenance/recovery of desirable emotional states and computed for individual emotions (positive feelings, anger, anxiety, and mild depressed feelings) and globally to reflect the number of emotions successfully regulated. Multilevel analyses found emotion regulation to be prospectively related to pain intensity, for both global and anxiety regulation. While this relationship held across the sample, lower emotion regulation was found for old-old (vs. young-old), males (vs. females), and patients living alone (vs. with others). Results suggest the possibility that promoting emotion regulation as self-management strategy could contribute to cost-effective pain management in general or targeted elderly populations.