title: Encouraging, assisting and time to EAT: improved nutritional intake for older medical patients receiving Protected Mealtimes and/or additional nursing feeding assistance.
abstract: OBJECTIVE
  Inadequate feeding assistance and mealtime interruptions during hospitalisation may contribute to malnutrition and poor nutritional intake in older people. This study aimed to implement and compare three interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥ 65 years.
  
  
  METHODS
  Pre-post study compared three mealtime assistance interventions: PM: Protected Mealtimes with multidisciplinary education; AIN: additional assistant-in-nursing (AIN) with dedicated meal role; PM + AIN: combined intervention. Dietary intake of 254 patients (pre: n = 115, post: n = 141; mean age 80 ± 8) was visually estimated on a single day in the first week of hospitalisation and compared with estimated energy requirements. Assistance activities were observed and recorded.
  
  
  RESULTS
  Mealtime assistance levels significantly increased in all interventions (p < 0.01). Post-intervention participants were more likely to achieve adequate energy intake (OR = 3.4, p = 0.01), with no difference noted between interventions (p = 0.29). Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions.
  
  
  CONCLUSIONS
  Protected Mealtimes and additional AIN assistance (implemented alone or in combination) may produce modest improvements in nutritional intake. Targeted feeding assistance for certain patient groups holds promise; however, alternative strategies are required to address the complex problem of malnutrition in this population. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY NUMBER: ACTRN12609000525280.
authors.affiliation: Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia. Adrienne_Young@health.qld.gov.au
authors.forename: Adrienne M
authors.initials: AM
authors.lastname: Young
authors.forename: Alison M
authors.initials: AM
authors.lastname: Mudge
authors.forename: Merrilyn D
authors.initials: MD
authors.lastname: Banks
authors.forename: Lynda J
authors.initials: LJ
authors.lastname: Ross
authors.forename: Lynne
authors.initials: L
authors.lastname: Daniels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000150:complications / Q000178:diet therapy; D001315:Australia; D003072:Cognition Disorders / Q000150:complications / Q000178:diet therapy; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D062407:Meals; D009728:Nursing Assistants; D009751:Nutritional Requirements; D009752:Nutritional Status; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000178:diet therapy*; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins