Abstract
The study was designed to investigate the effectiveness of dietetic advice to a hospital's catering management, in improving the nutritional status of elderly patients living in a psychiatric hospital in south London. Three lines of investigation have been pursued: i) the nutritional content of the menu, before and after the implementation of dietetic advice in menu planning, ii) the evidence of malnutrition amongst the patients before and after the change of menu, iii) observations of meal times on the wards, and the calculation of the nutrient content of the bulk food served, the portion sizes and amount of food wasted. Meal service and other practical issues affecting the food intakes of the patients, It was found that: i) implementation of the dietitian's recommendations did not have all the expected effects on the nutritional content of the menu, ii) evidence of vitamin C, vitamin D, folate deficiency and inadequate energy nutrition was found in December 1986, iii) the patients' nutritional status had not improved in December 1987 after a year's intake of the new menu. The relationships between mental illness and nutritional status are reviewed. The effect of dementia on food habits and intake are considered with recommendations for practical approaches to maximise nutritional intake. The reasons for 'hospital starvation', are found to be complex and to involve all aspects of the institution's organisation. The effect of government policies and the response of the hospital to the study findings is discussed.