Uncovering Patient-Reported and Observed Barriers and Facilitators to Sufficient Dietary Intake in Acutely Admitted Older Adults: Insights from a Nutritional Trial

Background and Aims: Insufficient dietary intake is common among hospitalized older (≥65 years) adults with or at risk of malnutrition. Identifying barriers and facilitators is essential for improving nutritional care in this population. This study aimed to identify the most frequently reported and observed barriers and facilitators linked to the achievement of estimated dietary requirements during a nutritional intervention. Methods: This descriptive, inductive qualitative content analysis used data from the intervention group (n = 65) of the OptiNAM trial (NCT03741283), a randomized controlled trial evaluating a multidisciplinary nutritional intervention among acutely admitted older adults at Copenhagen University Hospital, Hvidovre. A total of 23 of the 65 participants were hospitalized for ≥24 h, allowing dietary intake to be assessed by a dietitian using validated 24 h dietary records, supplemented by dietitian-conducted 24 h recalls when records were unavailable. Individual energy and protein requirements were estimated, and intake was validated and recorded. Meaning units were derived from free-text data from patient interviews or observations during patient interviews that were linked to dietary intake and categorized as barriers or facilitators depending on whether dietary intake was below or above the estimated requirements. Results: In acutely admitted older adults with malnutrition or malnutrition risk receiving a nutritional intervention during hospitalization, poor appetite was the most frequently reported barrier to sufficient dietary intake (73.9%), followed by disliking the food (39.1%). In contrast, intrinsic motivation (69.6%), good appetite (34.8%), and support from relatives (30.4%) were the most commonly reported facilitators. Conclusions: Appetite, hospital meals, motivation, and support from relatives play central roles in achieving sufficient dietary intake among acutely admitted older adults with or at risk of malnutrition receiving a nutritional intervention.