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Nutrition for Active and Healthy Aging

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Are we missing the point of nutritional supplements?

Posted by ProPortion Foods Blog on Jul 26, 2018 in Aged Care, Nutrition, Research, Supplements

Addressing claims that nutritional supplements can enhance overall health and longevity, a recent review investigated their impact on heart health, stroke and mortality. The researchers report that most supplements did not show evidence of benefit or harm.

 

They investigated 179 randomised controlled trials of vitamins and minerals. Folic acid and B complex vitamins reduced risk of stroke.

 

Multivitamins, vitamins A, 6, D and E, beta carotene, zinc, iron, calcium, magnesium and selenium were not linked to heart disease or mortality. Large dose B3 and antioxidant vitamins had small links with greater risk of all-cause mortality.

 

Limitations of the review include exclusion of cohort studies which are conducted over longer time frames and are more characteristic of the population at large. The researchers also note that antioxidants were lumped together but in reality have different modes of action.

 

 

What does it mean?

 

Available evidence suggests that B vitamins – possibly through their homocysteine-lowering properties – may be a good choice for reducing stroke risk. Other research has shown they might also help prevent dementia.

 

Other nutritional supplements may not impact heart health or lengthen lifespans – which is not to say they don’t have other benefits, for instance to boost immunity when stressed, avoid the flu or address nutritional deficiencies.

 

But the overarching take-home message – that most agree on – is that supplements do not replace a healthy diet.

 

First and foremost, a diet rich in plant foods like fruit, vegetables, legumes, nuts, seeds, wholegrains and healthy fats (e.g. extra virgin olive oil) delivers a kaleidoscope of vitamins, minerals, antioxidants and fibre, with interactive health benefits that supersede supplements alone.

 

Basically, you may eat your cake, but taking a tablet won’t make it healthier for you.

 

 

Supplements and older adults

 

Australians are amongst the world’s highest supplement users per capita. Older Australians – particularly females – are the cohort most likely to take nutrition supplements, according to the latest national survey.

 

Supplement users were also more likely to eat healthier diets, so are likely to be more health conscious. Researchers caution that this combination could result in exceeding recommended daily intakes.

 

In this case fat soluble vitamins like Vitamins D and E are ones to be most aware of because excesses are retained in the body. If water soluble vitamins like the Bs exceed requirements, they are safely excreted.

 

In aged care, a survey revealed that expenditure on nutritional supplements and food replacements had increased by 128 percent. In this scenario older adults may suffer malnutrition, in some cases requiring supplements like concentrated protein powder if appetite is low.

 

For instance, a study in convalescing patients with disabilities found that nutritional supplements combined with resistance training improved muscle mass and activities of daily living.

 

Other nutrients that may be at particular risk in aging, and therefore benefit from supplementation, include B12 and Vitamin D. It is recommended to advise your health care provider of all supplements and medications so they can be aware of potential adverse interactions.

 

And where possible, a healthy diet comes first. Attention to aged care menus, presentation and palatability in aged care can go a long way to support this.

 

 

References

 

https://www.sciencedaily.com/releases/2018/05/180528171511.htm

https://www.ncbi.nlm.nih.gov/pubmed/27431367

https://www.hospitalhealth.com.au/content/clinical-services/news/some-vitamin-supplements-unhealthy-773068962#axzz5HbjF0uEL

http://www.acc.org/about-acc/press-releases/2018/05/29/10/15/most-vitamin-mineral-supplements-not-shown-to-lower-heart-disease-risk

https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/selected-vitamins-and-trace-elements-support-immune-function-by-strengthening-epithelial-barriers-and-cellular-and-humoral-immune-responses/94B772EB747D1E5CD9FAC8F90937AA9F

http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Supplements~400

https://www.medicalnewsbulletin.com/dietary-supplement-use-older-adults/

https://www.cbhs.com.au/health-well-being-blog/blog-article/2014/11/24/multi-vitamins-the-pros-and-cons

https://chicago.suntimes.com/health/older-americans-are-hooked-on-vitamins-despite-scarce-evidence-they-work/

https://academic.oup.com/jn/article-abstract/147/10/1968/4728184?redirectedFrom=fulltext

https://link.springer.com/article/10.1007/s12603-015-0570-4

 

Menu planning in aged care: Q&A with a dietitian

Posted by ProPortion Foods Blog on Jul 20, 2018 in Aged Care, Malnutrition

Recently we highlighted the need for mandatory meal and nutrition standards in aged care, to improve food quality and health of older adults as an important step forward in aged care reform.

 

To dig deeper into menu planning, we spoke with Dr Karen Murphy, accredited practising dietitian and senior research fellow at the University of South Australia.

 

 

Q. What are the most important considerations when planning a menu for older adults?

 

Karen:  Many things need to be considered in menu planning for aged care. Firstly, are they in high level care or independent living facilities?

 

Dining facilities are important. Older adults are at risk of malnutrition because their energy needs drop and so does their appetite. We know that social dining increases food intake, and it’s important to consider the taste and flavour of foods.

 

Available cutlery and ability to eat the food. Can everyone use a knife and fork or are sporks better? People with arthritis and reduced mobility in their hands may need cutlery with curved handles.

 

Can meals and snacks be prepared on-site or does food need to be bought externally and brought in? Consider budgetary restraints.

 

Medical requirements: dysphagia requires different textures to avoid choking; chewing difficulties with dentition; loss of interest/depression; physical immobility.

 

Vegetarian options should be available. Some may need foods with higher protein and fat content to avoid malnutrition.

 

 

Q. What is “menu fatigue” and why is it considered?

 

Karen:  Menu fatigue means getting sick of the same food. It can often be a problem in hospitals or aged care facilities where menus are rotated fortnightly or monthly and can get very boring. This impacts food intake.

 

Sometimes there are budgetary constraints on menu development, kitchen facilities for preparing large amounts of food, or the types of food that can be produced and kept at temperature.

 

 

Q. “Aged care” isn’t just about being in a facility, it could also mean taking care of your mum/dad or partner. How can family help with menu planning?

 

Karen:  Get them involved. Ask them what can I/we do to make it easier for you? What do they like to eat? What can they prepare? Do they prefer smaller regular meals rather than big meals? Can they handle the food packaging?

 

Families can help in several ways. For instance, re-packaging foods if they are hard to open, or helping with bulk preparation of favourite meals and storing them as individual serves.

 

 

Q. What are some snack ideas if their appetite isn’t big enough for a full meal?

 

Karen:  If they are at risk for malnutrition, needing high energy high protein foods, suggest prioritising food to meet the protein RDI.

 

Some ideas: milk drink or Sustagen, smooth peanut butter and banana or ricotta cheese and avocado on crumpets, cheese and crackers, hardboiled egg or omelette, full fat yoghurt, savoury cheese muffins, nuts (if chewing/swallowing isn’t a problem), dried fruit, baked beans, nutritious dips, mini puddings, pikelets with jam and cream.

 

 

Q. What are some aged care menu ideas?

 

Karen:  Meals should focus on high nutrient density, soft textures, fibre and flavour. Milk powder and olive oil can be added for extra protein and calories if needed. Some examples:

 

  • White fish or salmon with a creamy sauce, mashed potato and vegetables
  • Tuna mornay with cheese and vegetables
  • Vegetable cheese frittata with salad
  • Cheesy, vegetable-packed lasagne with béchamel sauce
  • Roast chicken, creamy mash and vegetables with olive oil
  • Moroccan chick pea vegetable casserole
  • White bean soup with vegetables and chorizo
  • Slow cooked beef casserole with gravy and vegetables
  • Pasta with vegetables and creamy sauces

 

 

Q. Where do you see the future for nutrition for aged care menus?

 

Karen: Attention is being given to increasing the social side of dining, improving the whole dining experience. Menus are becoming more creative; texture modified foods are advancing to make them tastier and more visually appealing.

 

The increase in reality cooking shows is drawing attention to the appearance of food to make it more appetising. The nutritional content of meals and using healthy fats like extra virgin olive oil I think will creep into menu planning, and using external meal services might receive more attention.

 

 

We would like to thank Dr Karen Murphy for her time. 

New standards earmarked for aged care

Posted by ProPortion Foods Blog on Jun 12, 2018 in Aged Care

At a life stage of increasing frailty and dependence, older adults deserve to be treated with care and respect. A hallmark of a humane society.

 

However, a recent enquiry into the Oakden Older Person’s Mental Health Facility highlighted continued gaps in the quality of aged care.

 

An independent report exposed inadequate resources, medication overdosing, inappropriate restraining and a toxic culture – finally leading to its closure in 2017 following complaints extending as far back as 2007.

 

The report led to a Review of National Aged Care Quality Regulatory Processes, now completed. It’s been a long time coming, but the government has announced a new national Aged Care Quality and Safety Commission in an effort to seal the gaps.

 

 

Overview of the new commission

 

Through the new commission, to be implemented on 1 January 2019, the government promises to “ensure Australians in the aged care system are better cared for, through raising the quality benchmarks that homes must meet.”

 

It aims to provide an independent body to guarantee quality standards of care are upheld. “The unified new Commission will be a responsive, one-stop shop to prevent failures, highlight quality concerns and have them quickly rectified,” says Ken Wyatt, Minister for Aged Care.

 

Mr Wyatt acknowledges that most facilities provide quality care, but says, “We must ensure that disasters like Oakden are never repeated.”

 

This includes the development of a Serious Incident Response Scheme for reporting and investigating complaints regarding aged care.

 

The new commission will merge departments regulating aged care and dealing with compliance and complaints to ensure that risks and substandard care are identified and rectified faster. Older Australians and their families will have one point of contact for getting help with poor quality care.

 

This extends recent plans to undertake impromptu audits in all residential aged care facilities. A new performance rating will be introduced to compare sites with quality standards, and consumers will be able to access a comparison tool on the My Aged Care website.

 

 

Nutrition in aged care

 

This welcome reform is a step forward in the gradual rehabilitation of aged and mental health care services.

 

As Mr Wyatt said in a press release, “Our senior Australians have built the nation that we enjoy today. They have rightly earned the respect of the community and must be cared for with the dignity they deserve.”

 

This includes food quality – critical in aging to prevent risk of malnutrition, sarcopenia, falls, wound healing, and even Alzheimer’s disease. Not to mention enhanced quality of life through improved wellbeing and enjoying good food.

 

Currently, despite growing attempts by isolated individuals and organisations to address this issue, aged care has no mandatory meal and nutrition standards – which are needed to ensure any systemic change.

 

Malnutrition is already rife in residential care. Hopefully it won’t take so long to address that issue as it has to enforce quality standards for safety and clinical care.

 

 

 

 References 

 

http://www.agedrights.asn.au/rights/history.html

http://www.abc.net.au/news/2017-04-20/makk-and-mcleay-nursing-home-history-of-problems/8454856

http://www.abc.net.au/news/2017-02-27/sa-mental-health-facility-overrun-with-problems-report-shows/8307680

http://www.abc.net.au/news/2017-04-20/controversial-oakden-mental-health-facility-to-be-shut-down/8457928

http://www.sahealth.sa.gov.au/wps/wcm/connect/4ae57e8040d7d0d58d52af3ee9bece4b/Oakden+Report+Final+Email+Version.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-4ae57e8040d7d0d58d52af3ee9bece4b-mbuk16f

https://agedcare.health.gov.au/quality/review-of-national-aged-care-quality-regulatory-processes

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2018-wyatt048.htm

https://www.australianageingagenda.com.au/2018/04/18/risk-profiling-star-ratings-among-new-quality-reforms/

https://www.theweeklysource.com.au/ken-wyatt-launches-new-single-set-of-quality-standards-for-aged-care/

https://www.agedcareguide.com.au/talking-aged-care/quest-for-quality-in-aged-care-results-in-new-quality-and-safety-commission

https://www.dementia.org.au/media-releases/2018/new-aged-care-quality-and-safety-commission-welcomed-by-dementia-australia

 

Medicinal applications of the cannabis plant

Posted by ProPortion Foods Blog on Jun 4, 2018 in Aged Care, Hemp, Nutrition, Research

Cannabis is popularly known for its mind-altering properties. But this controversial plant boasts abundant secret delights that are now (re)emerging following its prohibition.

 

The Australia China Nutrition and Health Association recently showcased medicinal cannabis and hemp products in a forum with professional guest speakers at the Pullman Hotel in Melbourne.

 

 

‘Tsunami of change’

 

Attendee Nikki was impressed that cannabis had so many different uses, including clothing, textiles, construction and a “myriad of health benefits.”

 

Presenter John Easterling, founder and president of Amazon Herb Company USA (and husband to Olivia Newton-John), says cannabis has been used for food, medicine and shelter for at least 10,000 years.

 

Easterling forecasts that after 17 years of battling to legalise hemp in food products, we are facing a “tsunami of change in the world of cannabis and hemp.”

 

 

Unravelling cannabis

 

Oil derived from the nutritious hemp seed is rich in healthy fats including omega-3. The trichomes (oils) at the end of the cannabis flowers contain the plant’s active properties: at least 113 cannabinoids – compounds that have receptors in the body and brain.

 

Two primary cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is responsible for the ‘high’ and other side effects that are induced by smoking or ingesting marijuana cooked in foods.

 

Marijuana is grown to produce high quantities of THC. But industrial hemp varieties of cannabis contain CBD and very little, if any, of the psychoactive THC.

 

Importantly, CBD does not produce a high – in fact it dampens it. In 2017 the World Health Organisation announced that CBD is safe for humans, with no adverse health effects.

 

 

Health and medicinal benefits

 

There are reports of CBD’s anticonvulsive, anti-epileptic and antimicrobial properties.

 

While THC has been associated with anxiety and risk of schizophrenia in susceptible individuals, CBD could help reduce anxiety and symptoms associated with neuropsychiatric disorders like epilepsy and schizophrenia.

 

It has even been studied for potential applications in cancer, type 1 diabetes, acne and Alzheimer’s disease.

 

Speaker Professor Ian Brighthope referred to a case in which a NSW father, out of desperation, treated his two daughters’ Crohn’s disease with juice from the hemp plant. Despite their vastly improved symptoms, he is currently facing imprisonment.

 

One of Brighthope’s friends tried cannabis for Parkinson’s. He reported that after four days she regained her sense of smell. Travelling overseas, she forgot her medication and used medicinal cannabis. Over nine days she noticed reduced tremors.

 

In January 2017, The National Academies of Sciences, Engineering and Medicine released a review of the evidence for cannabis’s health benefits. The report concluded that “There is conclusive or substantial evidence that cannabis or cannabinoids are effective:

 

  • For the treatment for chronic pain in adults
  • Antiemetics in the treatment of chemotherapy-induced nausea and vomiting
  • For improving patient-reported multiple sclerosis spasticity symptoms”

 

They reported moderate evidence for its ability to improve short-term sleep in people with sleep disturbance related to chronic conditions like fibromyalgia and multiple sclerosis. More evidence is needed to support other medical applications.

 

 

Chronic pain in aged care

 

An estimated five million Australians suffer chronic pain. And older adults are most afflicted.

 

Estimates of chronic pain prevalence in community-dwelling older adults are 25-50%, and up to 70% for nursing home residents. It is typically managed using opiates and other painkillers, all of which can have serious side effects and adverse interactions with other medications.

 

Dementia and aged care consultant Leah Bisiani says 73% of people in aged care facilities are not having their pain managed effectively, and will continue to deteriorate on opioids. Baby boomers are demanding alternative approaches like medical cannabis with less unwanted side effects.

 

Bisiani contends that we “need to look at medicinal cannabis as a humane philosophy of care.” She argued that access to effective pain relief is “a basic human right” that “cannot be ignored.”

 

 

References

 

https://en.wikipedia.org/wiki/Cannabidiol

https://www.vice.com/en_au/article/bnp4bv/how-and-why-your-brian-makes-its-own-cannabinoids

https://www.sciencedirect.com/science/article/pii/S0367326X09002780

https://www.tandfonline.com/doi/abs/10.1300/J133v02n04_04

https://onlinelibrary.wiley.com/doi/full/10.1111/epi.12631

http://www.abc.net.au/news/2018-03-07/father-faces-jail-for-medicating-daughters-with-cannabis-juice/9523898

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546472/

https://www.nap.edu/resource/24625/Cannabis-conclusions.pdf

https://en.wikipedia.org/wiki/Hempcrete

https://onlinelibrary.wiley.com/doi/full/10.1002/jppr.1419

https://www.medicalnewstoday.com/articles/317221.php

https://www.healthline.com/nutrition/cbd-oil-benefits

https://www.forbes.com/sites/janetwburns/2018/03/18/who-report-finds-no-public-health-risks-abuse-potential-for-cbd/#54a5efd52347

https://www.smh.com.au/lifestyle/health-and-wellness/beyond-codeine–more-risks-identified-with-other-painkillers-20180208-h0vs1l.html

 

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