When elderly people experience a medical crisis, it can do more than set them back for a few weeks. Without specific care, some can get to the point where they are unable to do the things they did before and are ultimately unable to return to their previous living arrangements.

Saskatoon Health Region’s General Medicine Quality and Safety Committee have been working on ways to keep elderly individuals from losing ground while they are dealing with a medical crisis; recently the committee has been focusing their attention on improving the nutritional status of these elderly hospital patients.

“When elderly individuals are admitted to hospital with a significant illness, they become dependent on others for their day-to-day function,” said RN Donna Flahr, a Clinical Nurse Specialist in General Medicine. “If their basic needs for nutrition, hydration, mobility, bowel or bladder care are not optimized within 48 hours of admission, they can deteriorate to the point of being unable to return to their previous level of function – what we call functional decline.”

A tray of hospital food

Saskatoon Health Region staff are focusing on the nutritional needs of elderly patients in acute care to try and prevent functional decline.

A decrease in mobility can rapidly cause loss of muscle mass and increasing weakness; this, in turn, can increase the risk of falls and potential issues with a person’s management of the activities of daily living.

Adequate food  intake is basic to health, but things can get in the way of elderly patients attaining that  goal – they can be away from their room having tests at meal times, be unable to access their meal tray or open the food containers.  The General Medicine team is focusing on removing those obstacles and increasing food  consumption to ensure elderly patients gain strength during their hospital stay, and are able to return to their pre-hospital living environment.

“The General Medicine Quality and Safety committee is meeting with Food and Nutrition Services on a regular basis and finding ways to optimize our patients’ nutritional intake,” said Flahr. “We have been developing a resource for staff and families summarizing ways that Food and Nutrition Services can support us in providing optimal nutrition intake. For example, the variety of food delivery options available (including six small meals a day, or extended menu options), or allowing for an earlier tray delivery for patients requiring staff assistance to eat.”

So far, the involvement of Food and Nutrition Services with the unit staff is making a difference in their patients’ experience, reported Janice Walker, Clinical manager of the Clinical Teaching Unit at Royal University Hospital.

Feedback from unit staff has been extremely positive – the majority have enjoyed the involvement of Food and Nutrition Services at their meetings, and feel like they have a better understanding of the patient experience, as well as the role of Food and Nutrition Services.

“We are very excited to improve meal times for the patients and we appreciate this team approach,” noted Noella Leydon, Director of Food and Nutrition Services.

An audit on the unit has shown an improvement in documentation of patients’ food intake, and Walker is reporting that she is seeing a change in culture regarding meal set-up on all units. Staff are making rounds at meal time, focusing on the individuals dependent on assistance for food intake, making sure that containers are open and documenting nutritional intake. Patient satisfaction will also be measured.

The next focus for the Quality and Safety committee will be on bowel and bladder care.

“A limitation in mobility can restrict individual patient access to the toilet, increasing the risk of constipation and urinary retention/infection,” noted Flahr. “We are working with Pharmacy to develop a bowel care resource for staff to identify best options to keep patients’ digestive systems moving, and are looking at resources available from Food and Nutrition Services for increasing dietary fibre.”