title: Mealtime assistance for older adults in hospital settings and rehabilitation units from the perspective of patients, families and healthcare professionals: a mixed methods systematic review.
abstract: The prevalence of malnutrition for older adults (>65 years) in hospital and rehabilitation units has been reported as being as high as 60%; some older patients with good appetites do not receive sufficient nourishment because of inadequate feeding assistance. Mealtime assistance can therefore enhance nutritional intake, clinical outcomes and patient experience.
  
  
  
  This mixed methods review sought to develop an aggregated synthesis of quantitative and qualitative data on assistance at mealtimes for older adults in hospital settings and rehabilitation units to determine current practices, what practices work, and the perceptions of patients, families, and healthcare professionals of mealtime assistance.
  
  
  
  TYPES OF PARTICIPANTS: Participants included older adults (65 years and over) in hospital settings, including rehabilitation units.
  
  
  
  The review focused on interventions for mealtime assistance, observed mealtime assistance, or discussed experiences of mealtime assistance with patients, families and healthcare professionals.
  
  
  
  The review included qualitative, quantitative and mixed methods studies.
  
  
  
  The outcomes of interest were the effectiveness of mealtime assistance initiatives and experiences of assistance at mealtimes.
  
  
  
  The search strategy identified studies from seven databases published between 1998 and 2015.
  
  
  
  Methodological quality of studies was independently assessed by two reviewers using standardized Joanna Briggs Institute critical appraisal instruments.
  
  
  
  Standardized Joanna Briggs Institute data extraction tools were used.
  
  
  
  Synthesis of the findings was reached through discussion. The results of quantitative studies could not be statistically pooled because of heterogeneity and are presented in narrative form. The results are presented as three aggregated mixed methods syntheses.
  
  
  
  A total of 21 publications (19 studies) were included: 11 quantitative, five qualitative and three mixed method studies. Two studies were conducted in rehabilitation units, and 17 in hospital wards. Eight qualitative studies (nine papers) considered extrinsic and intrinsic factors that influence mealtime support. Evidence for the effectiveness of interventions was limited to eight studies (nine papers); the remaining quantitative studies included two cross-sectional studies, three descriptive evaluations (four papers) and one observational/case study. The following are the aggregated mixed methods syntheses: CONCLUSION: No firm conclusions can be drawn with respect to the most effective initiatives. Initiatives with merit include those that encourage social interaction, either through the use of a dining room, or employed staff or volunteers, relatives or visitors supporting the older patient during mealtimes. Volunteers value training and support and clarification of their roles and responsibilities.
authors.affiliation: 1The Wales Centre for Evidence-based Care, a Joanna Briggs Institute Centre of Excellence 2School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Edwards
authors.forename: Judith
authors.initials: J
authors.lastname: Carrier
authors.forename: Jane
authors.initials: J
authors.lastname: Hopkinson
mesh_terms: D000368:Aged; D005190:Family / Q000523:psychology; D005248:Feeding Methods; D005521:Food Service, Hospital; D006299:Health Services for the Aged; D006801:Humans; D007297:Inpatients / Q000523:psychology; D010564:Personnel, Hospital / Q000523:psychology