"Someone to Remember I Need Help": Multi-Site Mixed-Method Study of Older Inpatients' Experiences of Eating and...

Hospital mealtimes are complex, and older adults are at high risk of inadequate food and fluid intake, which contributes to poorer hospital outcomes. Interventions to improve mealtimes and mealtime care should consider patient perspectives. This multi-site study aims to describe the eating and drinking experiences and perceptions of older adults admitted to 12 hospitals across Queensland, Australia.

Mixed-method study analyzing structured interviews with older inpatients (aged 65 years and older) collected within the Eat Walk Engage quality improvement program in 20 acute medical and surgical wards in 12 publicly funded hospitals (2019-20). Interviews were undertaken by trained staff and included patient perspectives, barriers, enablers, and suggestions related to eating and drinking in hospital. Qualitative data were coded using the Theoretical Domains Framework (TDF) and synthesized to create overarching belief statements.

Two hundred interviews were analyzed. Nearly all (98%) patients described eating and drinking in hospital as important. Eighteen belief statements were generated across the seven most indexed TDF domains. Patients recognized eating and drinking as important to their strength and recovery and generally appreciated the quality and options in hospital food. However, they experienced multi-level challenges: at a personal level (e.g., reduced appetite, symptoms, and physical impairments); with mealtime care (e.g., lack of assistance and uncomfortable positioning); and from the broader hospital system (e.g., inflexible meal timing and meal sizes). Several enabling factors were identified, including self-motivation, encouragement and assistance from staff and family, greater choice around food, and familiar and simple foods.

Eating and drinking in hospital is complex for older patients. Improvement solutions should be multi-faceted and multi-disciplinary to provide effective person-centered nutrition care.