Things are looking up for aged care. Nudging retirement and refusing to eat slop, baby boomers are spurring action.
Celebrity chef Maggie Beer is a recent inspirational voice and champion for healthier food that tastes good. Her foundation is dedicated to training cooks and chefs in aged care to prepare meals driven by “superfoods” like chickpeas, lentils and kale.
Director of Nutrition Professionals Australia, Anne Schneyder, has laid down the gauntlet for Aged Care Accreditation Standards in nutrition and hydration, saying “access to adequate food and nutrition in a form that is enjoyable … is a fundamental right for all residents in our aged care homes.”
Foodservice Australia is holding an aged care summit in May this year to present stakeholders with the “the latest trends and techniques” in meal preparation.
A key issue that needs to be addressed is prioritising food in aged care budgets.
Appalling statistics have revealed more money is spent on food for Australian prisoners than pensioners. Our spend of $6.08 per resident per day puts us behind Europe, the US and Canada, whose food budget has increased as ours decreased. AMA president Michael Gannon described this as a “national disgrace.”
Half the surveyed aged-care residents suffered malnutrition – a major risk factor for sarcopenia and related issues like increased risk of falls, fractures, pressure injuries, poor quality of life and hospitalisation.
The paradox is that malnutrition costs money. So it’s really a no-brainer to invest in good food. Indeed, evidence suggests spending on quality care can improve savings – with improved quality of life a welcome by-product.
Protein and energy are two key essentials for older people with poor appetite, to avoid loss of muscle mass and strength. A good variety of fresh produce from all food groups supplies the nutrients needed for optimal health and immunity.
Various factors need to be considered when providing food in aged care, including dentition, swallowing, dexterity, reduced taste, smell and appetite, personal preferences and providing choice. Some may have allergies or special diets, or need staff member assistance to eat.
These and other considerations need to be factored into Residential Aged Care Accreditation standards. The Dietitian’s Association of Australia identified a need for guidelines to include “robust nursing and food systems to implement care plans,” and assessors involved in accreditation processes with in-depth knowledge of nutrition and food service delivery.
Ultimately, if meals and food choices are appealing, older people are more likely to eat. The environment is also important. Cooking smells, communal eating, pleasant, relaxed surroundings and attractive food presentation can all stimulate appetite.
Former chef Peter Morgan-Jones, Executive Chef and Food Ambassador at HammondCare, challenged himself to whip up a tasty meal for a man suffering early dementia. He had limited swallowing ability and had been restricted to pureed food for 18 months.
He craved baked beans, scrambled eggs and crispy bacon. And he got it – homemade Boston baked beans in a puree batter, pureed scrambled eggs and crispy bacon ground into dust. He was “overjoyed.”
As Maggie Beer says, “It’s all about giving equal measures of pleasure and nutrition. Without pleasure, what is there in life?”
Most of us long ago abandoned our childlike delight of playing with food; watching rapturously as it flowed through our fork, kneading it into a ball, belligerently breaking it up and squishing it through our fingers.
Some lucky adults get to do this for a living. The International Dysphagia Standardisation Initiative (IDDSI) applies such tests to determine if food is safe for people with different stages of dysphagia – including the ‘Fork Drip Test’, ‘Fork Pressure Test’, and the ‘Chopstick Test.’ What fun.
But it’s an important and serious matter for older people who suffer from stroke or other conditions that make swallowing difficult, and may choke or suffocate if food goes down the wrong way.
IDDSI was only recently launched in Australia, with support from Speech Pathology Australia. Proportion Food representatives attended the inaugural IDDSI Australian User and Industry Forum 2018.
Chief support officer for ProPortion Foods, Nikki King, says she was impressed by “the willingness for collaboration between multiple parties – speech therapists, dietitians, food service staff, management and industry.
“There was an overwhelming positivity around the need for standards from a patient safety point of view.”
Following instructions from Peter Lam and Dr Julie Cichero (IDDSI Co-Chairs), delegates and speech pathologists tested a range of foods, including ProPortion Foods’ SmartserveTM which was classified as Level 4 Puree.
Smartserve products are “soft-textured dairy desserts and snacks high in protein.” They come in 10 different flavours and are easy to open.
The IDDSI ‘Level 4 Puree’ classification – designated green – places the food in the ‘pureed’ food and ‘extremely thick’ liquid categories, comparable to the National Dysphagia Diet’s ‘Dysphagia Pureed’ category.
As with level 3 (liquidised/moderately thick), the designation overlaps between food and drink categories. Considering feedback from food service professionals, IDDSI retained separate text labels depending on whether the item is required as a food or drink.
Level 4 is measured using the fork drip test; the amount of food or liquid that flows through the fork’s prongs determines its level of thickness. Level 4 puree will remain on the fork, with some forming a “small tail” underneath.
Australia’s implementation of IDDSI, replacing currently approved Australian standards, has three phases: awareness, preparation, adoption.
Stage one, which started December 2016, was an awareness building venture amongst all relevant sectors.
Stage two, now underway as of January 2018, involves preparing and approving processes, protocols, materials and products, and training clinicians, staff and relevant stakeholders.
The recent forum marked an important step forward for Stage 2. The next step, on track for May 2019, will see the new IDDSI system introduced for commercial use, transition and integration.
Like many confusing nutrition messages, some claim too much protein is bad for bone health. What is the scientific consensus, and what does this mean for people with or wanting to avoid osteoporosis? What other nutrients are important? First, let’s look at osteoporosis.
All living tissues, including bones, are constantly getting rid of old cells and generating new cells. With aging, however, the rate at which bones are replaced slows down.
Osteoporosis, meaning porous bones, happens when too much bone is lost and not enough produced, resulting in reduced bone mineral density and a fragile skeleton easily prone to fractures. It is different to osteoarthritis, which results from degenerated cartilage in the joints.
Sarcopenia – age related muscle loss – is closely related to osteoporosis, and they are impacted by similar factors. Bone health is therefore considered not just a skeletal problem, but a musculoskeletal problem.
Osteoporosis is a significant global concern – one in three women and one in five men over 50 may suffer from a fracture caused by osteoporosis. But there are ways to prevent and even treat it, including physical activity, sunshine and good nutrition.
Calcium is commonly known to be important for bones, and most know vitamin D is important too – it helps bones absorb calcium. Perhaps less well known is that magnesium may also prevent bone turnover and improve bone mineral density.
For good bone health, the National Osteoporosis Foundation recommends dairy products, fish (canned fish like sardines with bones for calcium; oily fish like salmon, mackerel, tuna and sardines for Vitamin D), and a variety of fruit and vegetables for their mineral content (calcium, potassium, magnesium), vitamin C and vitamin K.
Protein is not only a key constituent of muscle, it comprises about 50% of bone volume and around 30% of bone mass. It is also associated with increased production of insulin-like growth factor, which helps make bones, and better intestinal calcium absorption.
Some studies suggest eating too much protein increases calcium excretion in the urine, leading to concerns about high protein intake for bone health. This is thought to occur because protein increases the body’s acidity, so calcium – an alkaline mineral – is released to restore balance.
However numerous studies have refuted this; in fact when calcium intake is adequate, higher protein diets are linked with higher bone mass and less fractures. Any loss may also be offset by increased calcium absorption.
Furthermore, low protein intakes (<0.8g/kg per day) reduce calcium absorption which in turn stimulates the release of parathyroid hormone to tell bones to release calcium and restore its balance in the blood.
What are good protein sources for bone health? Some studies have suggested higher meat consumption increases calcium excretion, but others have refuted that. Soy protein could reduce insulin-like growth factor so may not be a good choice.
Fish, chicken and eggs provide protein. Dairy foods are good protein and calcium sources. Legumes are a good source of protein and other nutrients but should be well soaked then cooked in fresh water to reduce phytates (which could interfere with calcium absorption). Similarly, nuts provide protein along with fibre and other nutrients.
To maintain a healthy acid-alkaline balance, other dietary factors also need consideration. In particular, plant foods like fruit and vegetables abound in potassium and other alkaline minerals, so eating more of these would help prevent bones’ need to release calcium.