An educative nutritional intervention supporting older hospital patients to eat sufficiently using eHealth: a mixed methods feasibility and pilot study

Abstract

Background: Insufficient food intake is common in older hospital patients and increases the risk of readmission, mortality, and decline in functional status. To improve food intake in older patients, an eHealth solution (Food'n'Go) enabling them to participate in their own nutritional care was implemented in a hospital unit. We developed an educative nutritional intervention (ENI) to support hospitalized older adults (aged ≥ 65 years) to participate in their own nutritional care using Food'n'Go. In this study, we evaluate the feasibility of the ENI and its potential to improve nutritional intake.

Methods: Feasibility was evaluated using process evaluation, and nutritional intake was examined by using a pre- and post-test design. Assessment of feasibility: Contextual factors (availability of Food'n'Go and prevalence of counseling by a dietitian); Intervention fidelity (whether patients were informed of nutrition and Food'n'Go, and whether their needs for support were assessed); and Mechanism of impact (patients' knowledge and skills related to nutrition and the use of Food'n'Go and their acceptance of the ENI). Assessment of nutritional intake: Patients' intake of protein and energy based on one-day observations before implementation of the ENI (pre-test; n = 65) and after a three-month intervention (post-test; n = 65).

Results: Feasibility: Food'n'Go was available for more patients after the intervention (85 vs. 64%, p = .004). Most patients managed the use of Food'n'Go and were involved in ordering their food, but only a few monitored their food intake. Information on nutrition was not provided sufficiently to all patients. In general, the ENI had high acceptability among the patients. Nutritional intake: Compared to patients in the pre-test, patients in the post-test had a higher daily mean intake of energy (kJ) (6712 (SD: 2964) vs. 5660 (SD: 2432); difference 1052 (95% CI 111-1993)), and of protein (g) (60 (SD: 28) vs. 43 (SD: 19); difference 17 (95% CI 9-26)). Likewise, there was an increase in the mean attainment of protein requirements: 73% (SD: 34) vs. 59% (SD: 29) (p = .013).

Conclusion: The ENI is feasible for supporting hospitalized older adults to participate in their own nutrition using eHealth and preliminary results indicate that it may lead to an increasing energy and protein intake.

Keywords: Educative nutritional intervention; Feasibility and pilot study; Malnutrition; Older patients; Patient participation; Self-management; eHealth.

Fig. 1

Overview and timeline of the assessments and data collection

Fig. 2

Flowchart for inclusion and exclusion of patients for evaluation of nutritional intake

Fig. 3

Flowchart for inclusion and exclusion of patients for evaluation of fidelity and mechanism of impact

Fig. 4

The Educative Nutritional Intervention—ENI* (1) Patient is able to hold and operate the tablet with Food’n’Go without support; (2) Patient is able to hold and operate the tablet with Food’n’Go with verbal and/or technical support; (3) Patient is able to participate in use of Food’n’Go when the tablet is held and operated by another; (4) Patient is not able to participate in use of Food’n’Go. ** Monitoring of food intake was only required for patients at risk of malnutrition (NRS ≥ 3). *** Dietary counselling by dietitian for patients at risk of malnutrition was a part of standard nutritional care and was in this ENI extended to include use of Food’n’Go. Source: Terp et al. Theory-driven development of an educative nutritional intervention (ENI) supporting older hospital patients to eat sufficiently, assisted by an eHealth solution: an intervention mapping approach. BMC Health Serv Res. 2022 Dec 1;22(1):1–15