"Busy nurses 'leave elderly to starve'"

August 29, 2006 -- Today the Telegraph (U.K.) site posted a piece by Celia Hall reporting that a charity had claimed some elderly hospital patients in the U.K. are starving because nurses do not have time to help them eat. Age Concern's report said that most older hospital patients were at risk of malnutrition, and that 90% of nurses said they sometimes did not have time to help patients eat. To its credit, the Telegraph includes reaction from a Royal College of Nursing advisor, who says the report underlines how serious nurse short-staffing has become. Indeed, recent U.S. research suggests that such care is just one type of activity nurses may feel forced to omit in a desperately understaffed environment. Even more difficult issues the piece does not explore include the correct priorities of nurses who must choose between helping an elderly patient eat and other vital care.

The piece reports that Age Concern said that six of 10 "older" U.K. hospital patients were "at risk of malnutrition." Nine in 10 nurses said they "did not always have time to help patients who needed assistance to eat." The charity estimated that malnutrition was costing the health service £7.3 billion a year--compared to an estimated £500 million cost of treating obesity--because of longer hospital stays and far greater risks of complications. The piece notes that the "death rate is also higher." The charity's report, "Hungry to Be Heard," gives specific examples of the problem, including food left out of patients' reach. Age Concern's director, Gordon Lishman, argued that help eating should be considered "an essential part of care." He also said it was "shocking...that Age Concern has to run a campaign to fight for the implementation of such simple measures." The group's ideas include assessing all patients for malnutrition and using a "red tray" system to identify patients with special food needs, including help eating.

Of course, nurses do not need to be told that adequate nutrition is a basic patient need, and the piece quotes the Royal College of Nursing's "advisor for older people" Pauline Ford as saying that the survey

highlights just how serious the problem of understaffing on many hospital wards has become. It is unacceptable if patients are not getting the help they need to eat or drink. Nurses desperately want to be able to give the standards of care they were trained to give but they need the support and resources to do so. Most importantly, they need to be given the time to care.

Sadly, it is not really surprising that eating assistance might be one of the tasks nurses feel forced to jettison in a short-staffed environment. Recent research by Center board member Beatrice Kalisch has suggested that this type of patient care is one of the many that may be put aside when a nurse is rushing desperately to provide other life-saving care. In fact, it appears that nurses (like other humans) without sufficient time are likely to focus on tasks that, if left undone, will likely result in strong and quick negative feedback. Such tasks may include giving medications and running tests envisioned by physician care plans. By contrast, assistance with eating may engender no such feedback and may seem less urgent. As the Age Concern report suggests, it may also be something that nurses hope patient families can help do.

The piece does not discuss even more fundamental (and potentially controversial) end-of-life issues implicated by some of these situations. In some cases, an elderly person cannot feed herself or even ask to be fed, and has no realistic hope of regaining those abilities. In such a case, it is not clear that feeding assistance is a higher nursing priority than vital care for patients who may recover. And even if the resources existed for all such care, some would argue that families, caregivers, and society as a whole should consider carefully whether such feeding assistance is ultimately in a patient's best interests. The recent Terry Schiavo situation is one in which these issues arose. In this regard, living wills may be useful tools for patients to define situations in which they would and would not wish to be kept alive.

We thank Ms. Hall and the Telegraph for this piece.

See the article "Busy nurses 'leave elderly to starve'" by Celia Hall from the August 29, 2006 edition of the Telegraph.

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