Eating (or Not Eating!) in Hospital

Irene Berman-Levine, PhD, RD
November 26, 2004

This is another extract from Dr Irene Berman-Levine's book, "Dr Irene's Nutrition Tidbits". You can order the book, which is packed with easily digested research news, tips, menus, and recipes, for US$16 by clicking here
Robert Griffith, Editor.

I am writing this from a room in a rehabilitation center. A family member had a knee replacement 4 days ago. I am still here because if I left, I know she would not eat.

Most people have experienced the hospital environment and realize it is a HUGE challenge to eat. First, you are there because you are sick or need surgery. Both conditions contribute to lack of appetite. On top of that, you are not used to eating while sitting in bed (or next to your bed) with strange roommates and people going in and out all times of day and night. Even the most carefully prepared foods have little appeal when you are ill. On the hospital side, imagine the challenge of trying to deliver hot/cold appetizing foods to hundreds of people, many with special dietary needs.

Her hospital experience was actually incredible. She received the best of care and every effort was made to help her eat. In fact, the first night she was allowed to eat after surgery, her appetite was still poor and she only wanted chicken soup with a touch of noodles. A nice piece of baked chicken arrived but her stomach was not ready. The anesthesia and pain killers delay intestinal movement and decrease appetite. I went to the cafeteria but they only had heavier soups that evening. When the person delivering the tray saw she had not eaten, he found her some chicken soup. We felt very fortunate.

The rehab experience is not as pleasant. She was admitted on Saturday and it's now Sunday evening. We are hoping that it is just a weekend staffing shortage but if things don't change by Monday morning we are out of here! First, this is a rehab facility but it turns out she only gets 30 minutes of actual physical therapy the entire weekend! The doctor in charge indicated it is only going to get worse. In 2006 when new Medicare regulations go into effect, there won't even be inpatient rehab for joint replacements! The second reason bothers me from a dietitian's standpoint . . . the food setup.

Most rehabs encourage patients to go down to a central cafeteria to promote independence and practice life skills. That would be fine if you knew exactly what time meals were and you were prepared for the environment. She was admitted at 9:30 Saturday morning and I did not arrive until visiting hours around 3:0. She had received a tray for lunch but wasn't really hungry and just ate a small amount. A staff member indicated she should go to the second floor cafeteria for the rest of her stay. If we were not there, I'm sure she would not have bothered with dinner but since we were present, my sister took her down while I was taking care of other details. The family member lasted two minutes because she was not prepared to see the contraptions and serious conditions of many patients. This could have been avoided if a staff member had described the eating environment, explained some of the contraptions she would see in the cafeteria and perhaps even described how to get your food. The first time in any new cafeteria can be confusing, especially if there are different lines for patients and guests.

We got permission to go down and get her food so she would eat. If we were not there, I am sure she would have chosen to go without. I also met with the dietitian, who was wonderful. She understood the family member's poor appetite and let me complete a menu for trays in her room until she adjusted to the environment. The physician in charge also indicated he could write an order, if necessary, for family to come during meal times (which were outside of visiting hours).

Why am I so bothered? The trays never came and, if family members had not been present, she would not have gone for meals. Fortunately, her drive for her morning cup of coffee was strong enough to get her to breakfast on her own. While there, she had a bowl of oatmeal.

If she had not gone to the cafeteria, no one would have noticed that she had not eaten. At lunch I was there so she went down to eat. Having no appetite she would have easily skipped it again and no one would have probably noticed. With pending cuts in Medicare and healthcare budgets, things are only going to get worse.

My conclusion is that a family member or patient advocate needs to evaluate if nutritional care would be optimized by their involvement. In my relative's situation, having a family member there improved both nutrition and medical care.

Here are tips to help family members eat if they are in a healthcare facility:

1. Join them for meals. If possible eat with them so they feel comfortable eating.
2. Join them for meals.
3. Join them for meals (I put this down 3 times on purpose as my relative felt this is important).
4. Make the room as pleasant as possible. If the individual requires portable toilet devices and anything else that is not conducive to dining, remove or hide them.
   When it's near mealtime, clear their tray area. If allowed, encourage them to sit in a chair rather than eating in bed.
5. If they are not eating well but indicate willingness to try specific foods, write them down and pass them on to the dietary department. These foods may be available.
6. If special homemade food would make a difference in food intake, request permission to bring it in. Permission is important as the individual may have special dietary restrictions that need to be considered. Make sure the food is nourishing and not going to add a gall bladder attack to their problems.
7. Providing there are no fluid restrictions, provide bottled water at bedside. Even though the water in water pitchers is refreshed, some people may find it more appealing to have bottled water. This is particularly true if they are from another area and not used to the taste of the water.
8. If you do bring food in, make sure it is not going to make the patient sick! A perishable food should not be at room temperature for more than two hours. Throw it out if the individual is not going to eat it. Don't let it sit on their windowsill for later.

Doing whatever you can (without breaking any facility rules) to encourage good nutrition will make a difference in their recovery.

Dr Irene is the author of a free newsletter which helps you understand the confusing world of nutrition and motivates you to choose healthy foods. You can sign up for the newsletter by clicking here.

Source

• I Berman-Levine PhD, RD. "Dr Irene's Nutrition Tidbits" Newsletter published by HealthandAge.com. Volume IV Issue No 51, December 2003.

Related Links
Poor Diet Hinders Recovery of Hospitalized Seniors
Light, Digestible, and Nutritious!
Dining Ambiance Spurs Appetite in Seniors
Tasteful Considerations

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