Mealtime assistance for older adults in hospital settings and rehabilitation units from the perspective of patients, families and healthcare professionals: a mixed methods systematic review

BACKGROUND: The prevalence of malnutrition for older adults (>65 years) in hospital and rehabilitation units has been reported as being as high as 60%; some older patients with good appetites do not receive sufficient nourishment because of inadequate feeding assistance. Mealtime assistance can therefore enhance nutritional intake, clinical outcomes and patient experience. OBJECTIVES: This mixed methods review sought to develop an aggregated synthesis of quantitative and qualitative data on assistance at mealtimes for older adults in hospital settings and rehabilitation units to determine current practices, what practices work, and the perceptions of patients, families, and healthcare professionals of mealtime assistance. INCLUSION CRITERIA: Types of participants: Participants included older adults (65 years and over) in hospital settings, including rehabilitation units. Types of intervention(s)/phenomena of interest: The review focused on interventions for mealtime assistance, observed mealtime assistance, or discussed experiences of mealtime assistance with patients, families and healthcare professionals. Types of studies: The review included qualitative, quantitative and mixed methods studies. Outcomes: The outcomes of interest were the effectiveness of mealtime assistance initiatives and experiences of assistance at mealtimes. SEARCH STRATEGY: The search strategy identified studies from seven databases published between 1998 and 2015. METHODOLOGICAL QUALITY: Methodological quality of studies was independently assessed by two reviewers using standardized Joanna Briggs Institute critical appraisal instruments. DATA EXTRACTION: Standardized Joanna Briggs Institute data extraction tools were used. DATA SYNTHESIS: Synthesis of the findings was reached through discussion. The results of quantitative studies could not be statistically pooled because of heterogeneity and are presented in narrative form. The results are presented as three aggregated mixed methods syntheses. RESULTS: A total of 21 publications (19 studies) were included: 11 quantitative, five qualitative and three mixed method studies. Two studies were conducted in rehabilitation units, and 17 in hospital wards. Eight qualitative studies (nine papers) considered extrinsic and intrinsic factors that influence mealtime support. Evidence for the effectiveness of interventions was limited to eight studies (nine papers); the remaining quantitative studies included two cross-sectional studies, three descriptive evaluations (four papers) and one observational/case study. The following are the aggregated mixed methods syntheses: * Mealtimes should be viewed as high priority, healthcare staff should limit other activities during mealtimes and allow older patients to eat uninterrupted, providing support where required. * Nursing staff, employed mealtime assistants, volunteers or relatives/visitors can help prepare the older patient for meals; this includes opening packages and cutting up food as well as physically feeding patients. * Social interaction at mealtimes for older patients is effective in increasing food, energy and protein intake, and should be encouraged. * Communication between all members of the multi-disciplinary team, staff and volunteers is essential. CONCLUSION: No firm conclusions can be drawn with respect to the most effective initiatives. Initiatives with merit include those that encourage social interaction, either through the use of a dining room, or employed staff or volunteers, relatives or visitors supporting the older patient during mealtimes. Volunteers value training and support and clarification of their roles and responsibilities