No longer hungry in hospital : improving the hospital mealtime experience for older people through Action Research

‘The definitive version is available at www.blackwell-synergy.com.’ Copyright Blackwell Publishing DOI: 10.1111/j.1365-2702.2007.02063.xAims and objectives.  This study aimed to improve the mealtime experience of older people in a hospital setting through helping staff to make changes to their clinical practice and the ward environment. Background.  Poor nutritional care has been a persistent and seemingly intractable problem for many years. Methods.  We used an action research design for the study, drawing on techniques from practice development to support the action phase of the work, including action learning, role modelling good practice and reflection. The ward context was explored at the beginning and end of the study using focus groups, interviews, observation and benchmarking. Results.  Ward staff made a number of changes to their nursing practice. The most significant was that all staff became engaged with, prioritized and were involved in the mealtime, ensuring that there was sufficient time and expertise available to assist patients with eating. Conclusions.  This study demonstrates that it is possible to change nursing practice at mealtimes and that this change leads to improvements in patients’ experience through ensuring they receive the help they need. Relevance to clinical practice.  Although hospital mealtimes are frequently viewed as problematic, we have shown that nurses can be enabled to make changes to their practice that have a positive impact on both the mealtime experience and wider patient care.Peer reviewe

The voice of experience: the unmet needs of older people in Barnet.

Between February and July 2008 six focus groups of older people were conducted in six locations across Barnet. The participants in the focus groups were either regular attendees at day centres or older people groups which met regularly. The aim of the study was to identify the unmet needs of older people across the Borough. The focus groups identified that need was felt across many domains of older peoples’ lives, including health and access to health care, exercise and responsibility for one’s own well-being, access to information, companionship, transport and the home environment

Growing old in England: economic and social issues

This paper examines the economic and social impact of changes in the duration of working life for the 80 per cent of older adults living in urban England. While some people are experiencing extended retirement because of moving out of paid work in their fifties, a growing minority of those beyond the state retirement age continue in paid employment. This paper highlights the considerable challenges for urban policy makers in addressing the economic and social inclusion of all older adults

Novel flavours paired with glutamate condition increased intake in older adults in the absence of changes in liking

Previous research on the repeat exposure to a novel flavour combined with monosodium glutamate (MSG) has shown an increase in liking and consumption for the particular flavour. The aim of the current work was to investigate whether this could also be observed in the case of older people, since they are most affected by undernutrition in the developed world and ways to increase consumption of food are of significant importance for this particular age group. For this study, 40 older adults (age 65-88) repeatedly consumed potato soup with two novel flavours (lemongrass and cumin) which were either with or without a high level of MSG (5%w/w). A randomized single blind within-subject design was implemented, where each participant was exposed to both soup flavours three times over 6 days, with one of the soup flavours containing MSG. After three repeat exposures, consumption increased significantly for the soups where the flavours had contained MSG during the repeated exposure (mean weight consumed increased from 123 to 164 g, p=0.017), implying that glutamate conditioned for increased wanting and consumption, despite the fact that the liking for the soup had not increased

Enhancing the quality of oral nutrition support for hospitalised patients: a mixed-methods knowledge translation study. (The EQONS study)

Aim - To report a multi-faceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. Background - Malnutrition among hospitalised patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. Design - A mixed-method integrated knowledge translation study. Methods - The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. Findings - Statistically significant differences (Chi Square) were observed in self-reported confidence of nurses a) to assess patients using the Malnutrition Universal Screening Tool, b) to teach colleagues how to use the Malnutrition Universal Screening Tool and c) to ensure that patients were assessed within 24 hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organisation) and macro (healthcare system) levels acted as barriers and enablers for change. Conclusion - Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition

Inter-professional perspectives of dementia services and care in England: Outcomes of a focus group study

© The Author(s) 2014. Many people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings

The use of finger foods in care settings: An integrative review

Background: Reduced food intake is prevalent in people in residential and hospital care settings. Little is known about the use of finger-foods, (foods eaten without cutlery), to increase feeding independence and food intake. The Social Care Institute for Excellence (1) recommends the use of finger foods to enable mealtime independence and to prevent loss of dignity and embarrassment when eating in front of others. The aim of this review is to identify and evaluate existing literature regarding the use and effectiveness of finger foods among adults in health and social care settings. Methods: An integrative review methodology was used. A systematic search of electronic databases for published empirical research was undertaken in October 2018. Following screening of titles and abstracts, the full text of publications, which investigated outcomes associated with the provision of finger foods in adult care settings, were retrieved and assessed for inclusion. Two independent investigators conducted data extraction and quality assessment using Critical Appraisal Skills Programme checklists. Thematic analysis was used to summarise the findings. Results: Six studies met the inclusion criteria. Four themes were identified: Finger food menu implementation; Importance of a team approach; Effect on nutrition and Influence on wellbeing. Study designs were poorly reported, with small sample sizes. Conclusions: There is some evidence that provision of finger foods may positively affect patient outcomes in long-term care settings. There is a paucity of research evaluating the use of a finger food menu in acute care settings, including economic evaluation. Future high quality trials are required

Experiences of drug use and ageing: health, quality of life, relationship and service implications

roe b., beynon c., pickering l. & duffy p. (2010)Experiences of drug use and ageing: health, quality of life, relationship and service implications. Journal of Advanced Nursing66(9), 1968–1979

Psychosocial factors and ageing in older lesbian, gay and bisexual people: a systematic review of the literature

Aims and objectives: To synthesise and evaluate the extant literature investigating the psychosocial influences on ageing as a lesbian, gay or bisexual person, in order to develop understanding about these influences and guide future research in the area. Background: Research suggests there may be specific psychological and social factors relevant to ageing for individuals with a non-heterosexual identity. Design: A systematic review was conducted on empirical research involving lesbian, gay and bisexual individuals aged 60 or above. Methods: The Cochrane Database, PsychINFO, MEDLINE, Web of Science and Google Scholar were searched and 41 studies met inclusion criteria. The majority had not been reviewed in earlier review articles. Results: Findings were within two domains: psychological, consisting of sub-themes relating to identity, mental health and body image; and social, consisting of relationships, social support, discrimination, caregiving and receiving, community, accessing services and housing. The results suggest lesbian, gay and bisexual individuals mostly adjust well to ageing identities, with mediating influences including self-acceptance and connection with peers. Challenges experienced included ageism and heteronormative health and social care services; intimate friendships, social support and respectful professionals mitigated such threats and facilitated successful ageing. Methodological issues related to sampling procedures, such as purposive sampling through the gay community and limited generalisability due to the homogeneity of participants. Additionally, there was a widespread lack of heterosexual control groups. However, most studies used appropriate measures and acknowledged inherent limitations. Conclusion: Psychosocial influences included the challenge of societal stigma, but also resilience individuals demonstrate through a positive attitude. These factors must continue to be investigated for services to best meet the needs of this population. Relevance to clinical practice: Clinicians are well placed to assist individuals draw on resilience when facing ageing challenges. Also, clinicians should be aware older people may have prior negative experiences of accessing services and try to involve ‘families of choice’ in care planning