title: Multiple morbidity is associated with increased problems of food access in hospital: a cross-sectional survey utilising the Cumulative Illness Rating Scale.
abstract: BACKGROUND
  Problems of undernutrition are common in hospital in-patients. Multiple morbidity increases with age and may contribute to nutritional risks. This research aimed to determine whether increased burden of long-term conditions is associated with patients' difficulties gaining access to food in hospital.
  
  
  METHODS
  A survey was implemented in 29 wards at four hospitals using a questionnaire measure of patients' experiences of food access and the Cumulative Illness Rating Scale (CIRS) to evaluate the burden of long-term illness in each patient. Experiences of food access were evaluated in relation to CIRS score category using random effects logistic regression to adjust for age group, sex and clustering by ward.
  
  
  RESULTS
  Data were analysed for 764/1154 (66%) eligible participants, including 384 women. The median age was 60 years (range 18-96 years). CIRS scores were analysed using the categories 0 (104 patients), 1-3 (197), 4-6 (285), 7-9 (144) and ≥10 (34). When the CIRS was zero, 10% of patients experienced physical problems with food access, whereas, when the CIRS was ≥10, 41% experienced physical barriers to food access, adjusted odds ratio 3.65 (1.14-11.7, P = 0.029). Problems with food quality were experienced by 13% with CIRS = 0 and 32% with CIRS ≥ 10 (adjusted odds ratio 3.97, 1.35-11.6, P = 0.012). Participants with greater morbidity were more likely to report that depression, breathing difficulties or chewing and swallowing difficulties affected the amount of food that they ate at mealtimes.
  
  
  CONCLUSIONS
  Patients with multiple morbidities are more vulnerable to experiencing physical barriers to accessing food and increased concerns with food quality. Assessing barriers to food access is particularly important in multiple morbidity.
authors.affiliation: Department of Public Health Sciences, King's College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Naithani
authors.forename: K
authors.initials: K
authors.lastname: Whelan
authors.forename: J E
authors.initials: JE
authors.lastname: Thomas
authors.forename: M C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001066:Appetite; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders; D003863:Depression; D004435:Eating; D005260:Female; D005502:Food; D005521:Food Service, Hospital; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D009017:Morbidity; D012120:Respiration Disorders; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires