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.
One in three hospitalised adults in the US is at risk for malnutrition, a major analysis has found. And patients’ poor food intake is having a significant impact on their healing and recovery, compounding their risk of death.
“Nutrition is easily overlooked as healthcare professionals often focus on a patient’s primary diagnosis,” lead author Abby Sauer told NutritionInsight.
“It may come as a surprise to some that when patients don’t get proper nutrition, it can significantly put their health and lives at risk,” she adds, explaining that nutrition is more important than ever when someone is sick or injured.
The researchers screened around 10,000 patients from 2009 to 2015 to assess malnutrition risk and links with mortality.
They found around one in two patients were eating half or less of their meals. This low food intake was linked to higher risk of mortality, and those who ate none of their food had a nearly six-fold higher risk of dying than those who ate at least some.
The findings support previous studies that have identified hospital malnutrition as a global public health problem, including Australian research which also found that this “silent epidemic” affects one in three hospitalised patients.
Despite this growing awareness, it is still not given the attention it deserves.
“Malnutrition can be invisible to the eye and is rampant in US hospitals because it’s not always top of mind,” said Gail Gerwitz, president of nutritionDay, an organisation which was involved in the study.
Loss of muscle mass and strength takes the brunt of poor nutrition, leading to sarcopenia, an age-related disease of accelerated muscle wasting that results in a downward spiral of poor health and mortality.
Some Australian hospitals are taking action by implementing basic malnutrition and sarcopenia screening tools. Relatives can also look for key signs of malnutrition.
These include unexpected weight loss, tiredness, low mood, poor appetite, unhealthy teeth and gums, listless hair and brittle nails, constipation and poor wound healing.
Hospitals and aged care facilities can take several measures to boost patients’ food intake, by using patient-centred service models, introducing mandatory nutrition standards, addressing obstacles to eating like poor dentition, and providing a choice of meals that are tasty and appealing.
High protein, high energy meals are the first line of defence to prevent or address malnutrition and promote healing. This can be achieved by adding extra cream or butter to food. Where necessary – especially with poor appetite – supplements can be used between meals to boost protein and calorie intake.
Many older adults don’t eat enough to meet their nutritional needs, and this can impact their healing and recovery from injury.
In support of this, a 2-year pilot study has shown that giving one extra meal a day to older adults who were hospitalised with hip fractures halved their risk of dying.
The study, conducted by the NHS in the UK, was instigated after staff noticed that patients with hip fractures struggled to get enough nutrients. In the program, nutrition advisors across six sites brought food from the hospital’s canteen and sat with patients as they ate their extra meal.
As a result, mortality rates fell from 11 to 5.5 percent, and medical authorities are considering whether it should be introduced countrywide.
Often, busy staff overlook patients’ food intake, noted chief orthopaedic surgeon Dominic Inman. Commenting on the findings to The Telegraph, he said, “If you look upon food as a very, very cheap drug, that’s extremely powerful.”
Hip fractures are the most common, and most serious type of fracture in Australia, with new fractures resulting in 50,900 hospitalisations and 579,000 bed days throughout 2015-16.
The health of adults over 50 often rapidly declines after a hip fracture, exacerbating poor outcomes. For three months after fracturing a hip, older adults are at five to eight times greater risk of dying, and one in three adults over 50 dies within 12 months.
Aside from that, a hip fracture can sorely impact mobility, independence and quality of life, and many patients are transferred to another facility for ongoing care.
Falls can be prevented by maintaining good muscle mass and strength. Failing that, patient outcomes after a fall can be improved with rehabilitation aimed at getting them moving as soon as possible, and with good nutrition.
Malnutrition, although widespread, is often overlooked, so it is important to be aware of the signs.
Addressing this, Queensland researchers have tested a patient-centred food service model in a public hospital setting and showed that it increased patients’ energy and protein intake – key requirements for healing and preventing malnourishment.
The model has been used in private acute care settings for 15 years. It revolves around providing room service to patients on demand – so they get to choose what they eat and when. (Who wants dinner at 5pm if you’re not ready for it?)
This food revolution was led by Sally McCray, who says, “This innovate model demonstrates the importance of patients being able to order flexibly, both in terms of the type of food items that patients feel like eating, as well as ordering food at a time of day that they feel like eating.”
The researchers showed that, not only can it improve nutrition intake, it also results in happier patients and reduced food waste.