Should we implement mealtime assistance in the hospital setting? A systematic literature review with meta-analyses

Aims and objectives. This review aimed to determine the effect of mealtime assistance provided to hospitalised patients (>= 65 years) by nurses, trained staff or volunteers on nutritional and anthropometric outcomes. Background. Malnutrition is a critical issue in hospitals with a reported prevalence of 20-50%. Nutritional supplementation has been associated with increased weight gain, improved function and decreased mortality; however, other system approaches including mealtime assistance may also contribute to improving nutritional intake. Design. A systematic literature review. Methods. Six electronic databases (CINAHL Plus, Cochrane Library, ProQuest Nursing and Allied Health Source, Scopus, PsycINFO and MEDLINE) were searched from their inception to August 2014. Inclusion criteria were hospitalised patients >= 65 years, provided mealtime assistance by nurses, volunteers or trained staff. Studies were examined for quality and risk of bias. Outcome data were combined narratively and by meta-analyses. Results. From 5458 publications, five studies met the inclusion criteria. Studies were rated neutral and positive according to the Academy of Nutrition and Dietetics Quality Checklist. Adherence to study protocols was not always reported. Meta-analyses demonstrated significantly greater daily energy and protein intake where mealtime assistance was provided. Anthropometric outcomes generally did not differ significantly with mealtime assistance. Observation and sampling bias were noted in several studies. Conclusions. There is evidence that mealtime assistance increases daily energy and protein intake in hospitalised patients (>= 65 years). More robust research is needed to elucidate whether this strategy may be an effective means of addressing the high prevalence of malnutrition in hospitals. Relevance to clinical practice. The evidence identified suggests that mealtime assistance provided to hospitalised older patients (>= 65 years) leads to a statistically significant increase in energy and protein intake. For many patients, this increase in both energy and protein intake will be clinically significant, reducing the gap between requirements and actual intake.