Older people’s experiences of dignity and nutrition during hospital stays: secondary data analysis using the Adult Inpatient Survey

Abstract

The report uses the Adult Inpatient Survey 2012 to build up an in-depth quantitative evidence base on older people’s experiences of dignity and nutrition during hospital stays in England. We find that just under one-quarter (23%) of inpatients reported that they were not treated with dignity and respect, or were only sometimes treated with dignity and respect during their hospital stay. We estimate that this is equivalent to around 2.8 million people on an annual basis - of whom about 1 million are aged 65 or over. Inconsistent and poor standards of help with eating during hospital stays were also a key concern. In 2012, about a quarter of all survey respondents indicated that they needed support with eating during their hospital stay. This is a substantial proportion and points towards the issue of support with eating being a major issue for significant numbers of inpatients – just under three and a half million each year - rather than being a marginal or specialist issue. Of those who needed help with eating, more than 1 in 3 (38%) reported that they only sometimes received enough help with eating from staff, or did not receive enough help from staff. We estimate that this is equivalent to around 1.3 million people on an annual basis, of whom about 640,000 are aged 65 or over. Logistic regression analysis suggests that, after other factors are controlled for, the risk of not being helped with eating is significantly higher for women rather than men and for individuals who experience a longstanding limiting illness or disability such as deafness or blindness, a physical condition, a mental health condition or a learning difficulty, or a longstanding illness such as heart disease, stroke or cancer. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out as having consistent, large associations with lack of support with eating during hospital stays. Amongst the population aged over 65, risks of inconsistent and poor standards of care were higher for women than for men, and for people aged over 80. We conclude that there was a widespread and systematic pattern of inconsistent or poor standards of dignity and respect, and help with eating, in hospitals in England in 2012. Evidence of poor and inconsistent standards was not limited to isolated “outlier” healthcare providers. Rather, patient experiences of inconsistent or poor standards of dignity and respect, and help with eating, were a significant general problem affecting inpatients in the vast majority of NHS acute hospital trusts. Dignity and nutrition are key markers of quality of care which have been not given sufficient public policy attention in the past. Whilst there has been increasing public policy focus in this area following the Mid-Staffordshire Public Inquiry, ongoing public policy efforts will be required to ensure quality improvement and that the new fundamental standards of care, which cover dignity and respect and help with eating, are implemented and enforce