40% of hospital population malnourished
Malnourishment is not a feature of modern Irish life that we hear much about. And although deficits in hospital care are regularly highlighted, the food you eat or don’t eat while in hospitals is not one of them. A new Dept of Health report ‘Food and Nutritional Care in Hospitals, Guidelines for Preventing Under Nutrition in Hospitals’ was published last week. It outlines how this is a very serious issue which is much neglected.
What you eat in hospital is central to your recovery yet it is very far down the list of hospital management priorities. Hospital managers are much more concerned with managing beds, hygiene, standards of medical care, juggling budgets than food and yet food is central to recovery process and also important to quality of life.
There are some outstanding statistics in this report.
11% of people who arrive in hospital are malnourished and between 63% and 84% of them are at nutritional risk.
It also says that recent Irish research shows that the nutritional status of another 29% of patients deteriorates while in hospital.
International research backs up these findings eg similar research in England shows 40% of NHS patients are malnourished.
And malnourishment in hospital is bad news because it hampers patients’ recovery but it also lengthens time of stay in hospital and increases the cost of care.
So, why do people become malnourished in hospitals?
People are sick and therefore are less likely to have an appetite for food. But there is lots of research that shows that if you have the right type of food, good food choices and are supported to make the right choices then malnutrition in hospital is totally unnecessary.
So some of it is caused by bad food. But there are also other considerations like
- when you get your meals – the timing of it
- how it is served – hot or cold, nice appearance or ‘slop’
- whether you are able to eat it or not and get the right assistance if you need it eg special cutlery or may need to be fed.
- the nutritional value of the food.
Interestingly it is recommended that people in hospital eat different diets to what the rest of us are told to eat – high fibre, low fat, low sugar and salt. In hospital one needs much higher fat and sugar – basically one needs high energy food, in fact the report says that if hospitals follow healthy eating guidelines it is likely to increase malnutrition in patients!
And what does the research say?
There is no comprehensive research on this in Ireland carried out by the HSE or the Dept of Health. But there is a v comprehensive irishhealth.com rate my hospital survey from September 2009 which has over 17,000 patients’ votes. And I did my own straw poll of people I know who have spent time in hospital and my findings are reiterated in the irishhealth.com poll.
People who have spent time in hospital are utterly divided on their food experience, some were very positive others utterly damning.
My sisters said ‘The only hospital where I ever ate vaguely edible food was Holles St – food in 3 other hospitals would kill a perfectly health human being!’
She recommends ‘bring sandwiches! And ask for a lot of toast!’
There was also a distinction between public and private hospitals.
Overall private hospitals come out much better on food front – much better choice and quality of food – very little criticism of private hospitals apart from one who complained about high salt levels in hotel like food. In the rate my hospital poll, just one out of top ten was a pubic hospital. Aut Even in Kilkenny was voted the best for food and St Lukes in Rathgar the second best. Interestingly, many of the best known teaching hospitals were bottom of the league.
Private hospitals the food is ‘posh’, with hotel like menus which you choose the day before. While in public hospitals there tends just to be a choice of two things, if that.
A cousin of mine who has had five stays in hospital this year in both public and private facilities was v positive about both, especially the healthy nature of the food and the kindness of the staff eg she could not believe it was possible to eat mashed potatoes with butter and salt but she found she got on fine with just pepper.
Another friend spoke about the flexibility of the staff and if you asked for something off the menu then they would get it for you.
He said private definitely better than public but public was quite good too but he never ate an actual meal he just ate sandwiches and survived on deliveries from visitors. He said ‘only a fool would order an omelette in a hospital, better off ordering a plain chicken sandwich’.
He also noticed that there is much more slop like food in public hospitals, and lots of fried foods, lots of chips but then again Irish people like their chips!
In relation to serving and presentation, everyone said this was very important. Pretty much everyone I spoke to was positive about the people who deliver their food, how kind they are, how they remember your special idiosyncrasies v quickly.
But also everyone was v critical of the timing, how early the food comes in the morning and the last thing you can get in the day is at 5.30 when most people have not started thinking of their dinner. Also meals can clash when people are out of wards and not always possible to get meal later.
So what can be done to improve people’s nutrition in hospital?
These guidelines are about putting the issue on the agenda, increasing awareness. And they say that
- Food needs to be seen as part of medical treatment not as hotel facilities.
- That food is central to quality of life but also crucial to recovery, length of stay and cost of care.
- This needs to be led from the top. And incorporated in patient management and clinical care.
- It recommends a nutritional assessment when people arrive in hospitals to identify the 11% who are malnourished but also ongoing assessment for those who are staying in hospital to prevent deterioration.
- It specifies how all stages are important, it is not just nutritional content of the food but also about giving patients choice, timing, having access to meals at different times, when you want to eat not when you have to
- It talks about good nutrition being central to effective medical treatment but also a good indicator of quality of care,
- need for energy dense meals, for smaller portions, multi cultural options.
- for 24 hour ‘room service’ options for hospitals
- International research shows that people eat more and better when at a table and that this should be incorporated into hospital planning and design. Currently majority of people have to eat in bed and how it is much preferable to eat at a table.
However, the guidelines are not compulsory and nor are they audited. Until they are in a way like hygiene is by HIQA, its hard to see how food quality and nourishment will improve…. especially when budgets are tight.