A randomised controlled crossover study to assess adherence and palatability of a porridge supplement compared to a drink-based supplement in hospitalised older adults at risk of malnutrition

Oral nutritional supplements (ONS) are essential adjuncts in managing malnutrition in hospitalised older people. This study aimed to explore the adherence and palatability of a new porridge supplement (PS) compared to a standard drink-based supplement (DS) in hospitalised older adults. A single-centre multi-method randomised controlled crossover study was conducted on adults aged ≥65 years at risk of malnutrition (Malnutrition Universal Screening Tool score 1–4). Each participant was prescribed PS (16 g protein; 249 kcal) and DS (18 g protein; 306 kcal) twice per day for 4 days in crossover sequence. ONS leftovers were weighed, and adherence calculated (% consumed). Palatability ratings were assessed with a 7-point Likert scale, and interviews were conducted with 9 older adults and 5 staff to explore product acceptability. Twenty-seven older people (mean age 80 years, 17 female) participated. Median daily PS intake (26.31% [IQR 10.23–48.02]) was significantly lower compared to DS (66.8% [IQR 26.29–75.37]), and texture of PS was significantly disliked compared to DS. There were no significant differences in the absolute volume consumed between products, and supplements did not replace normal dietary intake. Changes in physical ability and appetite, the hospital culture (e.g., staff attitudes), and palatability (e.g., thickness and taste) of products influenced ONS acceptability. To improve patient-centred nutritional care, participants requested a wider in-hospital range of food-based supplementation with natural ingredients and enhanced training for staff in nutritional care.