While malnutrition is an insidious problem in aged care, simply giving residents more biscuits and cake is not the answer.
Yet that is what many residential facilities are doing, according to research in Melbourne presented at the Royal Commission into Aged Care Quality and Safety.
In fact, the study added to evidence that aged care facilities have been spending less on food, and in the process skimping on high protein sources – critical with aging to prevent disability and malnutrition.
Previous research by the group found that two thirds of residents were malnourished or at risk of malnutrition – and inadequate protein was a major factor.
Essentially, the facilities they researched only provided one serve of high-protein food, such as lean meat, seafood, eggs, poultry and legumes per day – only half of the recommended two serves every day.
Dairy protein only amounted to one serve each day, falling well short of the recommended four servings.
At the same time, the amount of “discretionary foods” high in sugar, refined carbohydrates and unhealthy fats and devoid of nutrients has increased.
So while centres might be trying to save costs, it’s a false economy, lead researcher Dr Sandra Iuliano argues.
Malnutrition results in a host of poor outcomes including bed sores, falls, poor wound healing and general immunity.
This is not only debilitating for sufferers; it also increases hospital stays, estimated to add nearly $1,800 to the cost of each admission.
Some argue that a ban on junk foods in health care facilities is a good start, and research shows it helps shape behaviour and improve diets.
For aged care, where a healthy diet is most critical, mandatory nutrition standards would help lift and standardise the quality of food and nutrition provided – with a particular focus on delivering quality protein.
Beyond protein, poor and medium quality diets have been associated with 92% and 40% greater incidence of frailty, respectively, than a high quality diet.
Lifestyle factors such as diet and exercise can also reduce the risk of dementia.
Enhancing the dining experience would help overcome many obstacles to eating well, such as improving the sensory experience, and making food more appealing through greater choice, communal dining, cooking smells and attractive food presentation.
Some centres have even engaged residents with cooking to help stimulate appetite with foods they are familiar with – an enjoyable, social and stimulating activity with multiple rewards.
As Sandra Iuliano says, “It’s not about adding years to life; it’s about adding quality to the years they have.”
Like all industries in the 21st century, the aged care sector is under increasing pressure to factor sustainability into its business model and long-term planning.
This includes employee satisfaction and social equity, which are necessary for a thriving, successful business and for achieving sustainable solutions and resident wellbeing.
The intimate connection between environmental and economic considerations is becoming harder to ignore as precious resources dwindle and prices go up.
Population growth is driving up demand for food, water, energy and land, while reliance on fossil fuels and excess waste is becoming increasingly untenable.
Add to that an ageing population, with a quarter of Australians expected to be over 65 in just three decades, increasing demand for residential care facilities.
Key pressures to make these sustainable by minimising water and energy use and waste derive from the need to operate more efficiently and to create a good reputation.
Evidence shows that engaging employees through sustainable programs is fundamental to achieving positive outcomes, through their input into generating ideas and carrying them out.
“An investment in sustainability – people, planet and prosperity – is core to how an organisation can succeed and prosper as a business,” writes sustainable business expert, Dr Kaushik Sridhar.
Energy bills in aged care can be reduced by 80%, according to energy efficiency consultancy Conservia, as well as improving resident comfort and staff productivity, and can even achieve net zero energy use.
Their aged care package involves a multipronged approach included solar panels, submetering, a system to manage the building’s mechanical and electrical equipment, reflective window films, thermal paint for cooler roofs, and voltage optimisation.
Educating staff is also a high priority, to teach them how to use central control systems and change behaviours around opening windows and doors.
Some places, like HammondCare, are also getting creative with recycled materials, harvesting grey water, water-efficient gardens and optimised natural light as part of their Environmental Position Statement that aims to reduce energy and waste.
LED lighting and solar installations are key energy saving tools, which Regis Aged Care is focussing on at 35 of its sites across Australia to reduce their energy bills and environmental footprint.
They estimate these steps alone, involving enough solar panels to cover 33 tennis courts and more than 15,000 lights, could reduce annual energy consumption by up to 20% and greenhouse gas emissions by 3,700 tonnes, the equivalent of taking 1,500 cars off the road.
Importantly, their investment is projected to pay itself off in less than four years.
Warrigal aged care has been making impressive inroads in sustainable strategies for more than ten years through university collaborations, winning them several sustainability awards.
As well as energy efficiency initiatives, they have created a ‘sustainability in the home’ guide for independent living residents. They also recycle clothing and buy Greenfleet carbon offsets.
Committed to finding ways to reduce energy and waste and to apply sustainability design standards to new and upgraded buildings, sustainability manager David Rogers also recognises the importance of developing the right staff culture.
“We acknowledge that this is an ongoing journey and until sustainability is ingrained as a habit in all of our 750 staff, I’m not going to consider it successful,” he told Ageing Agenda.
Joining in the spirit, enterprising residents at Emmaus Village have been teaming up to recycle plastic bottles through Scouts Recycling Centre and have raised funds that go back into organising activities for the residents.
Others are putting on their gardening gloves, which not only reduces the need for food packaging and transport, but also has established benefits for physical and mental health and wellbeing.
Food waste is another pressing environmental and economic issue, especially pertinent to health care facilities. Solutions are also at hand here, such as the Love Food Hate Waste Program.
Anglican Care trialled it and reduced food waste by 6,000 kg per year on average per residential aged care, diverting it from landfill to local farms as mulch and compost – a win-win all round.
Posted by ProPortion Foods Blog on Sep 5, 2019 in Aged Care
Few of life’s pleasures match the gratification and connection that comes with crafting a meal for loved ones, sending mouth-watering aromas wafting through the house and sitting down to eat, drink, chat and share stories.
This is one of the activities that older adults lose when they move to aged care. But one retirement village has brought it back.
Scalibrini Village is a group of aged care facilities that specialise in dementia and palliative care in NSW. They have employed Italian-speaking staff and Italian food to not only engage residents in cooking but reconnect them to their culture – which is much more than just food.
To embed the experience, they produced the Scalabrini Village Cookbook “Cibo é vita” (cooking is life), featuring Italian recipes that are well-known and loved by the residents.
“Most of Scalabrini’s Italian residents come from a background where food isn’t purely a source of human nourishment; it’s a way of life,” says Daz Smith, advisor at the village.
Traditional Mediterranean diets have received much attention for their health benefits. They also bring people together through cooking and eating together and promoting social interactions which are another important aspect of healthy aging.
Familiarity is something else that people miss in aged care, according to a report by the MBF, including familiar food, eating environment and people from assorted cultures.
There is an urgent need to enhance nutrition and flavour in aged care food. Enjoying home-cooked food in a warm, convivial environment also motivates people to eat more, addressing the prevalent issue of malnutrition in older adults.
And cooking has its own unique benefits. A large review found that mental stimulation can help improve cognition and mood in people with dementia – that includes baking.
At Scalabrini, Smith witnessed this himself, saying that he saw residents’ moods pick up when they were in the kitchen. Engaging in familiar tasks can stimulate memories at a time when they are slipping away.
“In the early stages of dementia,” he explains, “people find great satisfaction in assisting with preparing foods like they may have done for years in their family home.”
“In the later stages of dementia, the taste, colour, aroma, feel and presentation of the food becomes an important part of a sensory experience.” Indeed, stimulating all the senses not only stirs memories but can also improve appetite.
While aged care is long overdue for a desperately overhaul to improve conditions across the board, the village demonstrates that cooking and eating home cooked food is a pleasurable and achievable target that ticks several boxes at once.
Nearly one million Australians over 70 are taking five or more medicines every day, and this number is continuing to grow, researchers from the Universities of Western Australia and New South Wales have revealed in the Medical Journal of Australia.
Using multiple drugs together, especially five or more, can produce several adverse outcomes including side effects, dysphagia, nutritional deficiencies, impaired cognition, falls, hospital admissions and mortality.
In fact, the World Health Organisation has set a target to halve polypharmacy and other unsafe prescription practices as part of its third global patient safety challenge to reduce medication-related harm.
Older adults tend to have several chronic conditions and often take different drugs to reduce the symptoms and risk of complications. People with higher needs, hospital inpatients and aged care residents tend to take the most meds.
Drawing from a nationally representative sample of people eligible for PBS-listed drugs between 2006 and 2017, Dr Amy Page and co-authors found that the prevalence of polypharmacy grew by nine percent.
And because of population growth, there was a 52 percent increase in the number of people taking five or more medicines a day over that period. In community care, the number of older adults receiving medications has grown rapidly, doubling over the past 20 years.
The researchers say these estimates may be conservative, because they don’t factor in medicines and supplements obtained without a prescription.
Some medicines stopped being subsidised and would also have not been recorded; this may account for the fact that medication use started to decline again after 2016 – although it was close to one million in 2017.
It must also be noted that some drugs are being combined to reduce pill burden, and this should be factored into future investigations.
The researchers report that Australia’s polypharmacy rates are higher than the US or the UK and have been for some time.
While some medications may be necessary for older adults, there is widespread concern about inappropriate polypharmacy and its detrimental outcomes.
Professor Sarah Hilmer from the University of Sydney is one advocate for “deprescribing” unnecessary drugs – noting that some are used as preventative measures and are not even addressing an existing condition.
Sometimes people continue taking drugs into old age when they no longer need them. “Compounding this,” says Hilmer, “is the issue of the prescribing cascade – doctors prescribing a drug to treat the effects of another drug to treat the effects of another drug, without realising they are doing so.”
Her team is working on written resources for consumers as well as doctors.
Dr Page agrees, saying that strategies to improve people’s awareness about the potential risks in taking several medications should target both the public and health professionals.