Developing a Mealtime Assistance Framework for Geriatric Psychiatric Inpatients: A Narrative Review

Malnutrition is highly prevalent amongst psychiatric inpatients, with prevalence reaching up to 42.5%. Geriatric-psychiatric inpatients, in particular, face complex nutritional barriers distinct from typical hospital malnutrition. To date, there is limited guidance on adapting mealtime assistance strategies to the complex needs of geriatric-psychiatric inpatients.

A systematized narrative review aligned with SANRA was conducted to develop a mealtime assistance framework. Personal and institutional challenges in geriatric-psychiatric care were identified, followed by a review of successful mealtime practices from various inpatient settings, and then key elements were modified to fit the unique needs of the target population.

Personal challenges to addressing malnutrition in geriatric psychiatric care include medication-induced appetite and taste changes, apathy, low motivation, and altered circadian rhythm patterns. Institutional barriers include overly rigid organizational approaches, deficits in staff knowledge relating to evidence-based nutrition, competing staff priorities and a predominant focus on pharmacotherapy, which may cause approaches to physical health and nutritional status to be inadequate. Key nutritional interventions from the literature include improving the mealtime environment through protected mealtimes and auditory optimization, enhancing human interaction between staff and patients, implementing a 'train-the-trainer' model, and using oral nutritional supplements and food fortification. Key adaptations to address specific challenges in this population include flexible mealtime scheduling to accommodate disrupted routines, specialized staff training in patient empathy and mutual reciprocity, and the use of sealed packaging for oral nutrition supplements to address paranoia.

Implementing mealtime interventions tailored explicitly to the geriatric psychiatric inpatient population is vital for addressing malnutrition and improving both physical and mental health outcomes. This review provides a novel, setting-specific mealtime assistance framework for this uniquely vulnerable population, making testing and cost-effectiveness analysis an important priority for future research.