Extra meals for the elderly in hospital cut deaths by half

GIVING elderly patients an extra meal a day halves their chances of dying in hospital, an NHS pilot scheme shows.

Death rates among those admitted with hip fractures have plummeted since the scheme was introduced two years ago, prompting medical chiefs to consider recommending it nationally.

Experts behind the programme say older patients are typically failing to consume enough nutrients while convalescing on geriatric wards.

They believe this contributes to the more than 4,000 elderly people who die within a month of being admitted for a hip fracture each year.

But at five trusts in England and one in Scotland, the introduction of nutritional advisers who personally source the extra meal and sit with patients while it is eaten has coincided with a mortality drop from 11 to 5.5 per cent.

Medics say the extra calories, plus the morale boost afforded by not eating alone, is making the difference between surviving the trauma or not.

“At that point it’s all about getting calories into the patient,” said Mr Dominic Inman, chief orthopaedic surgeon for the National Hip Fracture Database and an architect of the scheme.

“If you look upon food as a very, very cheap drug, that’s extremely powerful.”

Under the HIP QIP programme, nutritional advisers obtain the extra meal from the hospital’s public canteen, and even external shops and restaurants.

Because boosting calorie intake is the priority, a blind eye may be turned when patients ask for less healthy food that would normally be banned.

Visiting family and friends are also encouraged to bring along snacks.

Launched across six trusts in 2016, the scheme has seen the average length of stay among hip fracture patients drop from 25 to 20 days.

This enables managers to save an average of £1,437 per patient, according to Northumbria Healthcare NHS Foundation Trust, which is leading HIP QIP, having traditionally struggled with poor hip fracture mortality rates.

The results are currently being validated by the Royal College of Physicians ahead of possible recommendation that the practice becomes policy.

Prof Mike Reed, a consultant trauma and orthopaedic surgeon at the trust, said: “A hip is a very bad break to have.

“Many patients are already frail and elderly, then the trauma of the fall

and the demands can be very dangerous. It’s clear that the extra food is helping these patients dramatically.”

He added the principal of an extra meal boosting survival would apply across geriatric care, not just for patients with hip fractures.

Mr Inman said overstretched nursing staff did not have time to ensure patients ate their meals, and that clinical targets often distracted staff from the importance of food intake.

He pointed to a randomised controlled trial conducted in NHS hospitals in Wales, which concluded that patients on the standard meal routine were not taking on enough calories.

Along with providing a fourth meal, under the new programme doctors have scaled back the amount of morphine they administer in favour of more locally targeted pain relief.

It follows concerns that strong doses of the opiate exacerbate respiratory problems and reduces mobility in bed, which is crucial for recovering from joint fractures.

Last year a study published in The Lancet suggested thousands of unnecessary hip fractures could be prevented by a nationwide screening programme to test for fragility in older people.

Other trusts taking part in HIP QIP include Great Western Hospital in Swindon, Gloucestershire Hospital, Weston General Hospital in Somerset, James Cook University Hospital in Middlesbrough, and Queen Elizabeth University Hospital in Glasgow.