Doctor of Philosophy
School of Medicine
Bell, Alison Fay, Open sesame: exploring the ‘openability’ of hospital food and beverage packaging for the over 65s, Doctor of Philosophy thesis, School of Medicine, University of Wollongong, 2015. https://ro.uow.edu.au/theses/4663
My central hypothesis is that receiving and accessing food in the hospital context is problematic for the older inpatient. ‘Food as medicine’ is an important concept. Many older people enter hospital in a state of malnutrition, or are ‘at risk’ of malnutrition and several studies have found that they leave hospital in a worse state than when they entered . Food in hospitals needs to be nourishing, appealing and accessible to all the patients to encourage them to eat and take in valuable nutrition to aid in their recovery from illness. Access to food must consider the total picture – the environment in which it is served, the posture of the patient and their ability to actually access the food product to harness its nutritional value.
For feasibility reasons, older community dwelling adults participated in the research involving hospital food packs. The thesis used an ergonomics approach to examine the interface of the well, community dwelling older person with hospital food and beverage package and its context of use. As the pilot study  within a hospital environment had established that food and beverage packaging served in hospital presented challenges to older inpatients, it was decided to explore the issue in depth with well older people through a series of three studies. Hand function measured through grip strength, pinch strength, and dexterity and satisfaction with pack performance measured using a questionnaire. Efficiency of pack opening was also measured with time and attempts captured through video recording. Context of use was assessed by measuring hand function and efficiency of pack opening in two postures, sitting in a chair and lying down in a hospital bed. The important nutritional aspect of packaged food and beverages was captured through a comparison of dietary intake when packaging was presented as pre-opened or sealed. The studies were conducted in the community (Study 1) and a simulated hospital laboratory (Studies 2 and 3). The research used an integrated methodology and was iterative and inductive, with each study informing the next. Study 1 assessed the complete range of hospital food and beverage packs with older people in the community setting, measuring grip and pinch strength; time and attempts to open the pack; as well as overall satisfaction with the pack. Study 2 expanded the research to include patient dexterity and the environmental context of the hospital environment, lying in a hospital bed. Study 3 again built upon the research by including grip, pinch strength, dexterity, time and attempts to open packs, satisfaction with packs, measurement of nutritional status and actual dietary intake when packs were served pre-opened and sealed.