“Supporting the food and drink-related quality of life of older adults living at home from assessment to care delivery: a qualitative study of homecare services in England”.

Research question: How does homecare support the food and drink-related Quality of Life (QoL) of older adults in England? Background Community-dwelling older adults (65+) are at increased risk of malnutrition and dehydration due to multiple and complex factors. These include health conditions (e.g. multimorbidity), psychosocial factors (e.g. social isolation), economic and environmental factors (e.g. income, transport). Unmet food/drink needs contribute to deterioration of overall QoL for older people and their unpaid carers alike. In England, as also internationally, homecare is a pivotal service to support older adults to meet their food/drink needs, addressing both nutritional needs and QoL. However, a recent review of international literature has found a paucity of evidence on (a) how food and drink needs of older adults are identified, assessed and supported by homecare and (b) older adults food/drink-related wellbeing and QoL. This is an important gap as the unmet food/drink needs of community-dwelling older people who use publicly-funded social care have almost doubled in the last ten years in England (1,2). This study will address this gap and produce novel evidence on how the food/drink needs of community-dwelling older people are identified, assessed, and supported in care delivery. Aims and Objectives The study aims to understand how the food/drink needs of older adults who use publicly-funded homecare are identified, assessed, included in care plans and supported in practice. The study s objectives are 1) to investigate how food/drink needs are defined in national guidance, and local statutory assessment and care plan templates; 2) to understand experiences of homecare support for food/drink QoL needs from service users, unpaid carers, social workers and other professionals conducting care needs assessment, homecare workers/managers; 3) to develop actionable recommendations with services users, unpaid carers, homecare and social workers, commissioners and managers to improve homecare support for food/drink needs-related QoL. Methods We will use a qualitative approach to produce in-depth understandings of the complex experiences and processes around food/drink needs and care support. We will use multiple methods of data collection and analysis across three interconnected work packages (WPs) to aid a more complete picture, as detailed below: WP1 - document analysis of (1) national guidelines on identification and assessment of food/drink needs of older people living at home; (2) local providers care plan templates, guidance and policies. WP2 - Semi-structured qualitative interviews with older adults, unpaid carers, social workers/professionals conducting assessment, homecare workers/managers. WP3 - Participatory workshops to co-develop actionable recommendations with service users, unpaid carers, homecare/social workers, managers, and commissioners. Findings from WP1 will inform WP2/WP3; early findings from WP2 will be discussed in WP3. Timelines for delivery: 1 October 2025 – 30 September 2027 (24 months). Anticipated Impact and Dissemination The anticipated impact is actionable recommendations to improve support for older adults food/drink-related QoL. This will be achieved through the involvement of service users, carers, homecare and social workers, managers and commissioners in developing the recommendations. Findings will be disseminated through published articles, conference presentations, and shared with key organisations and networks (e.g. Homecare Association, Local Authorities).