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

Increased peptide YY blood concentrations, not decreased acyl-ghrelin, are associated with reduced hunger and food intake in healthy older women: Preliminary evidence.

With ageing there is frequently a loss of appetite, termed anorexia of ageing, which can result in under-nutrition. We do not know how appetite control alters with ageing. The objective of this study was to investigate whether differences in the release of, and response to, gastrointestinal appetite hormones is altered in young compared to old healthy volunteers. We hypothesised that an increase in PYY and GLP-1 or a decrease ghrelin may result in a decreased appetite. A comparative experimental design, using a cross-sectional sample of ages from a healthy population, matched for sex and BMI was used. The study compared total ghrelin, acyl-ghrelin, PYY, GLP-1 and subjective appetite responses to ingestion of a standardised 2781kj (660 kcal) test meal. 31 female volunteers aged between 21 and 92yrs took part. Multiple linear regression showed that both age and sex had an independent effect on energy intake. Subjective appetite scores showed that hunger, pleasantness to eat, and prospective food intake were significantly lower in the older age groups. PYY incremental area under the curve (IAUC) was greater in the oldest old compared to younger ages (f(3,27) = 2.9, p = 0.05. No differences in GLP-1, ghrelin or acyl-ghrelin were observed in the older compared to younger age groups. Our data suggest that there may be increases in postprandial PYY(3-36) levels in female octogenarians, potentially resulting in reduced appetite. There does not appear to be any change in ghrelin or acyl-ghrelin concentrations with ageing