Aims: Malnutrition is common in inpatient older adults with dementia resulting in deleterious consequences including increased length of stay, functional dependence and mortality. Oral Nutritional Supplements (ONS) are well studied to address malnutrition but the uptake amongst inpatient older adults is poor.
Methods: A Quality Improvement Project was conducted in a Singapore tertiary hospital with a pre and post implementation design. Our multi-disciplinary team, consisting of doctors, nurses and dieticians, did a root cause analysis and determined that the lack of awareness as well as poor understanding of ONS importance to be key contributors resulting in suboptimal uptake. A visual poster indicating inpatient older adult’s individualized ONS regime was implemented by bedside to serve as a reminder to both caregiver and care team. Independent variables including dentition status, severity of dysphagia, delirium on admission and polypharmacy were also collected. Qualitative feedback from patients and caregiver were gathered to better understand local taste preference and consumption patterns.
Results: The intervention was implemented between May to July 2024. The average daily ONS consumption increased from 32.1% to 32.9%. There were no associations between variables collected and ONS uptake.
Conclusion: The visual aid garnered positive feedback from nursing staff and caregivers. However, factors affecting ONS uptake are diverse and multifaceted intervention in conjunction with a visual aid is needed to boost its inpatient uptake. Proposed approaches include continued educational engagement of interprofessional care team, active involvement of the caregiver coupled with an individualized approach for persons with dementia.