22% of hospitalised older adults are estimated to be in a state of malnutrition.
Malnutrition, also known as undernutrition, is a lack of nutritional intake leading to
decreased fat free mass and diminished physiological functioning. Malnutrition impairs
patient recovery, increasing hospital length of stay and escalating healthcare costs.
Therefore, the identification and management of malnutrition is a vital patient-centred
outcome to enhance older adult's health and quality of life and to enable cost-effective
treatment and care.
A key method to support individualised nutritional care of hospital in-patients is the
use of oral nutritional supplementation (ONS). ONS are energy and nutrient dense products
designed to increase dietary intake when diet alone is insufficient to meet daily
nutritional requirements. Overall, research suggests favourable impacts of ONS on
nutritional status and healthcare costs, while the impact on functional outcomes and
mortality are more controversial. A burgeoning evidence base attests to the importance of
considering acceptability and compliance of ONS on adequate intake and thus effectiveness
of ONS in practice.
Patient compliance to ONS considers the relationship between the amount of ONS prescribed
and the amount of ONS ingested and is important to maximise clinical and
cost-effectiveness. Palatability refers to the hedonic (i.e., pleasantness) evaluation of
sensory factors, such as taste and smell, leading to alterations in food or fluid
consumption. Supplemental preference may be affected by a multitude of factors such as
taste, colour, smell, after taste and texture. Typically, hospital patients are offered
liquid based ONS (sip feeds). However, previous research has pinpointed that 56% of older
adults on geriatric wards did not like sip feeds. Hence, exploration of compliance to
different ONS formats is an important research direction to maximise malnourished older
adult's nutritional intake.
Malnourished hospitalised older adults should be offered an improved range and provision
of ONS to suit patient preferences and maximise intake. For instance, an attractive
alternative strategy is the use of energy and protein-dense meals (via fortification) or
snacks (supplementation), including fortified bread, protein-enriched main meals and
between meal snacks, such as biscuits, yoghurt and ice cream. Yet this is an understudied
area, with limited data investigating compliance to alternative ONS products compared to
ready-made drinks in hospital, such as powdered ONS and snacks, or their clinical
effectiveness. Therefore, the current study aimed to investigate the compliance and
palatability of novel fortified porridge compared to traditional sip-feeds in
malnourished hospitalised older adults.
Research questions include:
What are the compliance rates (% intake) of fortified porridge compared to standard
liquid based ONS in malnourished hospitalised older adults?
What are the palatability ratings (e.g., taste) of fortified porridge compared to
standard liquid based ONS in malnourished hospitalised older adults?
What is the acceptability of fortified porridge compared to standard liquid based
ONS in malnourished hospitalised older adults, including facilitators and barriers
to their use on medical wards?
A mixed methods randomised controlled crossover design will be conducted to determine
compliance and palatability of fortified porridge in malnourished hospitalised older
adults compared to a liquid-based control ONS. The acceptability of products will be
assessed through qualitative interviews to explore patients and healthcare professionals'
experiences and views of using the nutritional supplements. Participants will be
prescribed ONS twice per day for 4 days, in addition to normal meals, in a crossover
design. The products will be offered in-between breakfast and lunch, and after dinner to
reduce the detrimental long period of calorie absence experienced overnight.
