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Geriatric medicine
Research
Can trained volunteers improve the mealtime care of older hospital patients? An implementation study in one English hospital
  1. Fiona F A Howson1,
  2. Sian M Robinson2,
  3. Sharon X Lin3,
  4. Rosanna Orlando3,
  5. Cyrus Cooper2,
  6. Avan A P Sayer4,5,
  7. Helen C Roberts1,3,5
  1. 1 Medicine for Older People, University Hospital Southampton NHS FT, Southampton General Hospital, Southampton, UK
  2. 2 MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
  3. 3 NIHR CLAHRC Wessex, University of Southampton, Southampton General Hospital, Southampton, UK
  4. 4 NIHR Newcastle Biomedical Research Centre, Newcastle University Newcastle upon Tyne, UK
  5. 5 Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
  1. Correspondence to Professor Helen C Roberts; hcr{at}soton.ac.uk

Abstract

Objective Multinational studies report undernutrition among 39% older inpatients; importantly, malnutrition risk may further increase while in hospital. Contributory factors include insufficient mealtime assistance from time-pressured hospital staff. A pilot study showed trained volunteers could safely improve mealtime care. This study evaluates the wider implementation of a mealtime assistance programme.

Design Mixed methods prospective quasi-experimental study.

Setting Nine wards across Medicine for Older People (MOP), Acute Medical Unit, Orthopaedics and Adult Medicine departments in one English hospital.

Participants Patients, volunteers, ward staff.

Intervention Volunteers trained to help patients aged ≥70 years at weekday lunchtime and evening meals.

Main outcome measures The number of volunteers recruited, trained and their activity was recorded. Barriers and enablers to the intervention were explored through interviews and focus groups with patients, ward staff and volunteers. The total cost of the programme was evaluated.

Results 65 volunteers (52 female) helped at 846 meals (median eight/volunteer, range 2–109). The mix of ages (17–77 years) and employment status enabled lunch and evening mealtimes to be covered. Feeding patients was the most common activity volunteers performed, comprising 56% of volunteer interactions on MOP and 34%–35% in other departments. Patients and nurses universally valued the volunteers, who were skilled at encouraging reluctant eaters. Training was seen as essential by volunteers, patients and staff. The volunteers released potential costs of clinical time equivalent to a saving of £27.04/patient/day of healthcare assistant time or £45.04 of newly qualified nurse time above their training costs during the study.

Conclusions Patients in all departments had a high level of need for mealtime assistance. Trained volunteers were highly valued by patients and staff. The programme was cost-saving releasing valuable nursing time.

Trial registration number NCT02229019; Pre-results.

  • volunteer
  • older
  • mealtime assistance
  • hospital
  • implementation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022285

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    Footnotes

    • Contributors HCR, FFAH, SMR, CC and AAS designed the study. FFAH led the data collection and volunteer training. SL and RO led on the statistical and economic data analysis, respectively. FFAH and HCR led on the qualitative data analysis. HCR wrote the first draft of the paper. All authors contributed to revised drafts and approved the final paper. HR is guarantor for the study. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex at the University of Southampton. This study was supported by the Faculty of Medicine and the Faculty of Health Sciences at the University of Southampton, and University Hospital Southampton NHS FT. HCR and SMR are supported by the Southampton Biomedical Research Centre. AAS is supported by the NIHR Newcastle Biomedical research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The study funders and sponsor had no role in the design or conduct of this study

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval National Research Ethics Service Committee London, Chelsea (14/LO/1363).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data are available on request by emailing the corresponding author.