The toll of malnutrition on healthcare costs exceeds £7.3 billion per year, half of which is expended on those aged 65+

Four out of 10 people aged 65+ are at risk of becoming malnourished or their situation becoming worse in hospital, increasing hospital stay, risk of complications and risk of mortality (BAPEN 2003). The toll of malnutrition on healthcare costs is estimated to exceed 7.3 billion per year half of which is expended on those aged 65 years and over (Age Concern, 2006).

Age Concern, in their campaign ‘Hungry to be Heard’, set 7 recommendations to tackle malnutrition in older hospital patients, which focus on assistance at mealtimes and identification of patients at nutritional risk. The report also highlighted the problem of impractical eating environments for many older patients. The Better Hospital Food Programme launched in 2001 included guidelines for ward staff to assist with patient meal times (DH 2004). The programme though successful, did not specifically address the older patient’s needs (Age Concern 2006) e.g. reduced sensory perception, smaller appetites and in some instances eating difficulties. The Department of Health (DH) and NHS Joint Action Plan for improving nutritional care in hospitals focused on five priorities for action including raising awareness of the link between good nutrition and health, ensuring accessible guidance, encouraging nutritional screening, nutrition training and improving standards of inspection. The DH Dignity in Care campaign (DH 2006) recognised that delivering adequate food is a fundamental human right and stressed the need for maintaining dignity and providing older people with the assistance they require at mealtimes. The National Service Framework (NSF) for Older People (DH 2001) highlighted the importance of upgrading the patient environment in hospital to ensure it closely fits the older people’s needs. The Council for Europe Alliance (UK) stated that a key characteristic of good nutritional care in hospitals should be that hospital facilities are designed to be flexible and patient centred with the aim of providing and delivering excellent experience of food service and nutritional care. The NSF also recognised that in order to meet the objectives of providing dignity in care and joined up health care for older people there was a need to invest in new technologies. This was re-iterated in the Government White Paper ‘Our Health, Our Care, Our Say’ which concluded ‘it would be wrong to allow a traditional method of delivery to hold back progress’ – a statement which also applies to the provision of food in hospitals for older people.

The solution to hospital malnutrition in older patients has not been found to date by isolated interventions focusing on specific areas of food provision. Despite previous initiatives, guidelines and malnutrition screening tools, a joined up approach to the provision of adequate nutrition to older people in hospital that exploits state of the art technologies with respect to products, people, places and procedures has not previously been considered.

The mappmal project recognised that in order to fully address the problem of malnutrition in older people in hospital, all stages of the food journey, from production to consumption, must be considered concomitantly including: the type of food product and its preparation, the journey of food from production to patient (maintenance of quality), the patient’s eating environment and monitoring food/nutrient intake. The mappmal project addressed these issues by developing a new system prototype for food provision for older people in hospital in a multidisciplinary, user participative, proof of concept study. The project compliments both previous and current initiatives including the NHS/DH Joint Action Plan for Improving Nutritional Care (DH 2007) and the Care Quality Commission nutrition standards.