Some patient groups have specific requirements for the food and drink they are able to and prefer to eat.
Where there is a large proportion of people with certain nutritional or food requirements, the standard menu should reflect these requirements.
Healthcare facilities may also consider whether there are common requirements for some patient groups, e.g. patients admitted due to drug or alcohol disorders and patients admitted due to eating disorders may have similar requirements. This knowledge may assist menu planning if these patient groups are co-located at the facility.
Considerations in practice
The standard menu in a maternity ward should reflect the needs of maternity patients. However, if a maternity patient is admitted to another part of the hospital, then the patient may need to be provided with a maternity therapeutic diet to meet the relevant nutrient and food safety requirements.
Similarly, if the population group within a local health district eats a vegetarian diet, the standard menu should contain a larger number of vegetarian options.
Therapeutic diets
If a patient is not able to eat the food from the standard menu, then it may be appropriate to order them a therapeutic diet, if one is applicable.
The composition and design of these diets are guided by the Diet Specifications. The appropriate diet can be ordered via the facility’s diet ordering system.
See therapeutic diets for more about compliance of these menus with the Nutrition Standards.
Short stay patients
Some short stay patients may have frequent short stay readmissions due to the nature of their illness. Nutritional screening can identify any patients who are at nutritional risk.1
A patient is suitable for a short stay menu if they are:
- not malnourished on admission
- not at risk of developing malnutrition
- not requiring increased nutrient requirements, e.g. maternity patients do have increased nutrient requirements
- expecting to be discharged from hospital in three nights or less.
Modifications for adult patients on short stay menus are outlined in the adult Nutrient Goal Standard and Patient Choice Standard. Changes include different protein requirements and reduced food choices.
For paediatric patients, use patient characteristics to guide the menu design. A reduced number of options and a shorter menu cycle may be appropriate if they meet the short stay criteria listed above.
Long stay and very long stay patients
Long stay patients are those who are in hospital for seven days or more. This cohort may include rehabilitation, spinal injury, respiratory, cardiac and transplant patients.
Very long stay patients are those who are in hospital for four weeks or more.
Menu fatigue is a common risk for long stay and, in particular, very long stay patients. This may lead to patients eating less. Patients with a longer length of stay are more likely to develop malnutrition.2-5
Patients need the opportunity of more choices and to be given additional options when they have been a patient for an extended time. The adult Patient Choice Standard provides strategies to manage this.
If additional nutrition care is required, therapeutic diets should be ordered via the facility’s diet ordering system, as outlined in the Diet Specifications.
Diets to meet religious or cultural needs
Some religious and cultural groups have dietary restrictions and practices.
Healthcare facilities must be familiar with their patient population and their food preferences, so these can be incorporated into the menu design. This enables patients to meet dietary restrictions with choices from the standard menu.
If a patient can’t eat from the standard menu, they can be transitioned to a religious diet within the Diet Specifications.
Vegetarian and vegans
Plant-based diets may be preferred for personal, religious, cultural or sustainability reasons. Vegetarian diets can be nutritious but there are some additional considerations needed when planning a menu.
The standard menu will have a range of plant-based and vegetarian choices each day and will include meat and dairy substitutes.
Nutrients at risk in this patient group include iron, zinc, calcium, omega 3 fats, vitamin B12 and vitamin D.6 Options will be available on the menu to meet these requirements.
To improve iron absorption, the menu should offer a good source of vitamin C at each meal, e.g. fruit juice or salad.
If patients can’t eat from the standard menu, they could be transitioned to the vegetarian or vegan diet within the Diet Specifications. The appropriate diet can be ordered via the facility’s diet ordering system.
Diets supporting patient consumption
These are diets which are modified to help patients eat.
Diets supporting patient consumption, sometimes referred to as operational diets, are appropriate for patients who need:
- modified serving sizes
- modified presentation, e.g. finger food
- modified texture for a non-therapeutic reason, e.g. cut up.
If patients can’t eat from the standard menu, they could be transitioned to one of the diets supporting patient consumption within the Diet Specifications. The appropriate diet can be ordered via the facility’s diet ordering system.
Admission due to drug and alcohol
These patients may require:
- special considerations for the food service delivery model and menu design
- prescribed meal planning
- supplementation with specific foods or nutrients
- management of choice, e.g. use of a non-select menu model.
Food service and dietetic staff should collaborate in menu design planning to best meet the needs of this patient group.
Eating disorder units
The food service model needs to be designed with clinical input and based on guidelines for best practice assessment and treatment of eating disorders in NSW including:
- NSW Eating Disorders Toolkit
- Guidelines for the Inpatient Management of Adult Eating Disorders in General Medical and Psychiatric Settings in NSW
- NSW Service Plan for People with Eating Disorders 2021-2025
Maternity patients
Maternity patients often have a short length of stay and are frequently admitted just prior to giving birth.
This group has increased nutritional needs, e.g. they require additional:7
- energy (an additional 2.0-2.1MJ/day)
- folate (up to 600µg)
- vitamin C (60-85mg)
- calcium (1000-1300mg)
- iodine (220-270µg).
Lactating women also require more fluid.
Other special considerations include:8
- food service models, e.g. flexible meal timing and ease of access to food
- food safety.
If patients can’t eat from the standard menu, they could be transitioned to the maternity diet in the Diet Specifications. A therapeutic diet may also be appropriate for patients with particular clinical needs such as gestational diabetes or hyperemesis gravidarum. The appropriate diet can be ordered via the facility’s diet ordering system.
Older people
Older people can be in hospital for extended periods. These patients often don’t eat or drink enough to meet their nutritional requirements, leading to a higher prevalence of malnutrition.
Ageing is also associated with a decreased intake of energy and micronutrients, while needs for energy and protein increase.2-5
Menu design for older adults should encourage intake of their preferred energy- and protein-dense options.
Strategies may include:
- varying serve sizes
- fortifying energy and protein in small serves
- including familiar meal choices
- having a variety of food presentations, e.g. finger food and plated meals.
Older people admitted to mental health units may present with conditions that impact their ability to eat and drink, e.g. cognitive impairment such as dementia.
Mental health
People admitted to mental health facilities are a diverse population. Mental health diagnoses may include psychotic disorders, major affective disorders, substance misuse, eating disorders and mood disorders.
Additionally, some people may have other coexisting physical health problems, behavioural disturbances, and/or an intellectual disability, and/or have experienced trauma in their life.
Nutritional considerations
People living with mental illness are at increased risk of obesity and chronic disease including cardiovascular disease, type 2 diabetes, and cancer.9, 10 This can be due to the interaction between the mental illness itself, food choices, medications, lifestyle behaviours, alteration in cognitive function, behavioural problems and the social determinants of health.
Menu design for patients in mental health facilities should be modelled on healthy eating principles to minimise nutrition-related risks for chronic disease.
The menu design in mental health facilities should:
- be predominantly less energy dense
- focus on offering higher satiating food choices
- include additional low energy mid-meals.
The principles of a Mediterranean diet should be the basis for menu design. This diet is associated with improvement of cardiovascular parameters and depressive symptoms.11
Offering foods and fluids containing alcohol and caffeine may not be appropriate. Consider based on the requirements of the patients at the facility.
Food service delivery considerations
Base food service delivery in mental health facilities on the needs of patients and an assessment of the site.
Consider aspects of the food service model, for example:
Patients in adolescent units may have increased nutritional needs related to their stage of development.
See the Paediatric Nutrition Standards for adolescent requirements.
Menu planning for patients in mental health parent and baby units needs to accommodate meals for mothers, their partner and babies (generally 0-12 months old).
Lactating mothers will have increased nutritional needs for energy, protein, fats, fibre, fluid and most micronutrients.7, 8 The menu must support the ability to meet these increased requirements.
Menu planning also needs to accommodate the developmental nutritional needs of the baby. See the Paediatric Nutrition Standards for infant requirements.
Design the food service model to provide flexible mealtime access. Allow access to foods and fluids outside of scheduled times, to accommodate the care needs of the baby.
Paediatric
For the paediatric patient population, each stage of development presents different requirements for nutrients, textures and food sources.
For details about how to meet the requirements of each age group refer to:
Paediatric patients might need to shift to a therapeutic diet suited to their needs if the standard hospital menu can't meet them. The Diet Specifications guide the composition and design of these diets. The appropriate diet can be ordered via the facility’s diet ordering system.
In Australia, a high percentage of children are overweight or obese:12
- Around 25% as of 2017-18, are above a healthy weight range.
- As they get older, the chance of being overweight or obesity increases, reaching 31% for adolescents aged 16-17.
In hospitals, the standard menu for infants, children or adolescents should be based on healthy eating principles, offering a variety of foods from essential food groups. This will allow patients to choose healthy options, even if they are dealing with weight issues.
Food allergies are on the rise in Australia, especially among children and adolescents:
- About 10% of infants and 5% of children aged 10-14 years have food allergies.13-15
- Cases of severe reactions, known as anaphylaxis, triggered by food allergies have gone up. Hospital admissions increased five-fold between 1993 and 2013.15, 16
- Fatalities from food-induced anaphylaxis are increasing at a rate of about 10% each year.15, 17
Identify patients with an allergy early to allow a safe hospital stay. Follow protocols for dealing with patients with known allergies. Diets must be available that exclude the allergenic food for the patient.
The standard hospital menu for infants, children or adolescents is not designed to be allergen free. An allergen-free menu would not be practical and is not recommended by the National Allergy Strategy.15
Patients may need to shift to a therapeutic diet targeting their identified food allergy/s if the standard menu isn't suitable.
The composition and design of these diets are guided by the Diet Specifications. The appropriate diet can be ordered via the facility’s diet ordering system.
See also:
- Allergy or intolerance diets
- Paediatric allergy diet - milk, egg, soy, wheat, seafood, peanut and tree nut free
References
- NSW Agency for Clinical Innovation. NSW Health Policy - Nutrition Care (PD2017_041). Sydney: NSW Ministry of Health; 2017 [cited 21 Mar 2022].
- Barker L, Gout B, Crowe T. Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. Int J Environ Res Public Health. 2011;8(2):514-527. DOI: 10.3390/ijerph8020514
- Australian Commission on Safety and Quality in Health Care. Hospital Acquired Complication - Malnutrition. Sydney: ACSQHC; 2018 [cited 22 Mar 2022].
- Walton K. Treating malnutrition in hospitals: Dietitians in the driving seat? Nutr Diet. 2009;66(4):202-205. DOI: 10.1111/j.1747-0080.2009.01371.x
- do Rosario V, Walton K. Hospital Food Service. 2019. DOI: 10.1007/978-3-319-75388-1_74-1.
- Dietitians Australia. Diet and nutrition health advice – What is a vegetarian diet? Dietitians Australia; 2022 [cited 23 Aug 2022].
- National Health and Medical Research Council. Australian Government Department of Health and Ageing. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: NHMRC; 2006 [cited 22 Mar 2022; updated Sep 2017].
- Dietitians Australia. Diet and nutrition health advice - Pregnancy and breastfeeding. Dietitians Australia; 2022 [cited 23 Aug 2022].
- NSW Ministry of Health. Physical Health Care for People Living with Mental Health Issues. A Guideline. Sydney: NSW Ministry of Health; 2021 [cited 22 Mar 2022].
- Australian Government Mental Health Commission. Equally Well Consensus Statement: Improving the physical health and wellbeing of people living with mental illness in Australia. Sydney: National Mental Health Commission; 2016 [cited 22 Mar 2022].
- Ventriglio A, Sancassiani F, Contu M, et al. Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clin Pract Epidemiol Ment Health. 2020;16(1):156-164. DOI: 10.2174/1745017902016010156.
- Australian Government Institute of Health and Welfare. Overweight and obesity among Australian children and adolescents. Canberra: AIHW; 2020 [cited 23 Mar 2022].
- Osborne N, Koplin J, Martin P, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011;127(3):668-676.e2. DOI: 10.1016/j.jaci.2011.01.039
- Sasaki M, Koplin J, Dharmage S, et al. Prevalence of clinic-defined food allergy in early adolescence: The SchoolNuts study. J Allergy Clin Immunol. 2018;141(1):391-8. DOI: 10.1016/j.jaci.2017.05.041
- National Allergy Strategy. New allergy guidelines to protect children from severe allergic reactions in schools and childcare. Australia: NAS; 7 Oct 2021 [cited 22 Mar 2022].
- Parliament of Australia. Overview of allergies and anaphylaxis in Australia. Canberra: Parliament of Australia; 2020 [cited 23 Mar 2022].
- Mullins R, Liew W, Wainstein B, et al. Anaphylaxis Fatalities in Australia 1997 to 2013. J Allergy Clin Immunol. 2016;137(2):AB57. DOI: 10.1016/j.jaci.2015.12.189