Paula Moynihan, Newcastle University
Alastair Macdonald, Glasgow School of Art
Lisa Methven, University of Reading
Carl May, Newcastle University
Margot Gosney, University of Reading
Martin Maguire, University of Loughborough
Patrick Olivier, Newcastle University
At the time of the project, it was estimated that 60% of older people are at risk of malnutrition whilst in hospital, increasing complications and reducing quality of life.
The cost of malnutrition to healthcare was estimated to exceed £7.3 billion per year, half of which was expended on those aged 65 years and above.
Despite helpful guidelines to prevent malnutrition and tools to identify those at risk, a broad strategy to address malnutrition in older people that considers all stages of the food journey, from production to consumption and that makes use of novel technologies had not previously been considered.
Aims and objectives
The aim of this project was to address the problem on malnutrition in older patients by exploiting new and existing technologies to rethink and test new ways that food can be produced and delivered to older patients using a ‘a joined-up’ approach that considers all stages of the food journey, from production to consumption (ie, products, people, places and procedures).
The overall research question was therefore ‘Can new products, partnerships, service models and enhanced eating experiences and environments from food production to patient consumption prevent malnutrition in older patients?’
First, current practice with respect to products, people, places and procedures, in the hospital setting for older patients was studied in order to identify opportunities for change.
Next, a prototype for a proposed new food system was devised which considered four key areas:
The sensorial quality of the food product provided.
The food journey from where it is produced to the point of consumption.
The environment in which the older patient eats and drinks.
Monitoring of food and nutrient intake.
Key end users (The ‘Food Family’) within the project include: food providers, caterers, dieticians, nurses, doctors, occupational therapists, speech therapists, carers, older patients/relatives) and other stakeholders (eg, NHS, key professional bodies, charities such as Age UK).
They were engaged in all stages of development of the new prototype. This was achieved by conducting workshops, focus groups and interviews to inform on the feasibility and acceptability of the new system, its workability and potential integration in real life.
The work was conducted in five Work Packages (WP).
WP1: Defining current systems
Observations of current NHS hospital systems and interviews with the Food Family and Stakeholders were conducted to identify areas for change.
WP2: End user engagement
Feedback on the new prototype (from WP3 and 4) was obtained from the Food Family and Stakeholders throughout the project, to assess its practicality and to refine it.
WP3: Developing new food products for older patients
Using state of the art technology, food with improved sensory quality was developed, including new foods for those with swallowing difficulties. The potential use of releasing food aromas at ward level to stimulate patient appetite will be tested.
WP4: Utilising innovative design and technology to optimise the Food Journey and the older patient’s Eating Environment
A new prototype for the ‘food journey’ from production to patient and the environment in which the patient eats was developed. Sketches, physical mock-ups and virtual 3D modelling of ward/patient environments were used to develop scenarios of the new service in operation. A fast and accurate technology-based prototype to monitor food intake of patients will also be developed.
WP5: Potential application to other settings
Interviews and focus groups with the Food Family and Stakeholders collected feedback on the potential application of the new concepts to other settings (eg care homes).
The outcomes of this research, a proof of concept food design, preparation and delivery prototype, is of interest to a broad range of policy makers, professional bodies and charities that work towards reducing the crisis of malnutrition in older people in hospitals.
Policy, practice and product implications relate to reducing malnutrition in older people in hospitals through the development of a new systems prototype for food provision. The prototype aimed to optimise food intake through fresh innovative approaches to food provided, its delivery and the eating environment in hospitals and other care settings.
The project produced general principles that informed policy for the future development and updating of catering facilities in hospitals. It produced specific guidelines that can be taken up by professionals such as dietitians, speech therapists and nurses.
Guidelines for product and equipment design in relation to food production and delivery to the patient was also produced.
This included recommendations for
new food products specifically designed to meet the sensorial preferences and nutritional needs of older patients and the preparation, storage and transport of these products
revised roles of people involved in the provision of food
a system for delivering foods to patients that maximises sensorial quality of food
modifications to the older patients eating environment (furniture, eating implements, ambient environment) to facilitate physical ability to eat and to enhance appetite
a system to facilitate efficient and accurate monitoring of food (and thereby nutrient) intake by older people.
The prototype informed future hospital design, resource allocation, catering requirements and training requirements. The outcomes informed professional bodies concerned with food provision in hospital and care settings of a feasible and acceptable approach for revising practices with respect to roles, places, new food products and the environment in which the older patient eats.
Aspects relating to the actual food product helped dietitians and speech and language therapists in devising patients’ diets especially those with eating difficulties. The outputs also provided opportunities for producers of foods to manufacture special needs products for older people.
For hospital food providers and caterers the prototype informed on means to maximise the sensorial quality of food.
Aspects related to the food journey from production to patient was of interest to those involved in hospital design, caterers and ward staff. It provided opportunities for manufacturers to manufacture new systems for effective delivery of the new food products.
Aspects related to the patients’ eating environments informed those involved in hospital design and was of interest to a broad range of medical staff, in particular occupational therapists and nurses. These outputs also provided a range of manufacturers with the opportunity to manufacture new products for the hospital environment.
Aspects relating to recording of patients’ food intake was of key interest to dietitians, nurses and other members of the care team.
To maximise the impact of the project, a series of launches/exhibitions were planned. In addition, it was planned to promote the findings at conferences of key learned and professional societies and to a wider audience by issuing a series of press releases.