Interventions to optimise nutrition in older people in hospitals and long-term care: Umbrella review

Background: Inpatients have a high need for protein-energy intake because of increased physical stress metabolism due to illnesses. Protein-energy undernutrition in older patients increases the risk of complications such as falls, pressure ulcers and even death. An overview of effective interventions addressing this complex issue of malnutrition in older people is missing. Aims: To give an overview of effective interventions to optimise nutrition in older people in hospitals and long-term care. Design: An umbrella review, according to the Joanna Briggs Institute and PRISMA statement, was conducted in April 2020. Methods: A systematic search of publications from 2010 until 2020 was conducted in CINAHL, PubMed and Cochrane Database. Included were studies reporting nutrition interventions that involved nurses or the interprofessional team in optimising older hospitalised people's nutrition. Excluded were studies investigating the effects of parenteral nutrition, certain food supplements or tube feeding and research from intensive, community or palliative care. Components of interventions were classified according to the intervention Nutrition management: Patients’ assistance, patients’ instruction, foodservice, environment for meals and nutrient-dense snacks. Findings: Included were 13 reviews from 19 countries of the continents Asia, Australia, Europe and North America from hospitals and long-term care settings. An interprofessional food promoting culture, including staff training as part of a multi-component measure, has shown to be a successful element in implementing activities of Nutrition Management. Conclusion: Several studies synthesised that optimising nutrition in older people in hospitals and long-term care is achievable. Interventions were effective if—on a meta-level—staff training was addressed as part of a multi-component measure to reach an interprofessional food promoting culture. Implications for practice: Interventions to optimise older people's nutrition have to consider an interprofessional food promoting culture, including staff training about the importance of nutrition, patients’ assistance and an appropriate environment for meals.