Posted by ProPortion Foods Blog on Oct 3, 2018 in Aged Care
Welcome news for the aged care sector – the Australian government has announced that a long sought-after royal commission will investigate an “industry in crisis” amidst harrowing reports of older adults being subjected to substandard care.
This follows revelations of horrific conditions at the Oakden facility last year, resulting in a national Aged Care Quality and Safety Commission, streamlining of complaints and crackdown on departures from quality care.
Since then, the Department of Health has reportedly closed one aged-care facility nearly every month, and another 17 centres have sanctions enforced.
Complaints to the Aged Care Complaints Commissioner increased to 4,300 for residential aged care in the last financial year, while 5,780 complaints were lodged for home and community care.
In a time-honoured example of ordinary people spurring action, the commission was announced as courageous aged care workers spoke to Four Corners last month.
They were just some of the 1300 aged care workers and more than 4,000 family, industry and staff members who contacted the show from across Australia for its crowd-sourced initiative.
It’s not just the stories that have grabbed media attention, like the 70-year old resident who died after being assaulted by another patient or the 99-year old female patient who was sexually assaulted by a male carer.
More broadly, it’s “the everyday stories of neglect and inattention, poor quality food, lack of personal care, boredom and heart-breaking loneliness,” according to presenter Sarah Ferguson.
Stories include residents – who have complex care needs – getting a quick face wipe in lieu of a shower, being left in bed all day, overmedicated for easier management, left in a hot room with no fan, and having a commode full of faeces left next to their bed.
Not only that, but malnutrition is a pervasive issue in older adults and particularly those in aged care.
“There were people that were in bed that needed to be fully fed, they couldn’t feed themselves at all,” said one worker.
“And you’d see staff members just quickly go in, offer the resident a bit of food, and if they didn’t take it immediately, just go out and ditch the lunch. You can see these people are so hungry.”
Even if they had time and support to eat, the food quality leaves much to be desired. With a reported spend of $6 per day per resident, the food was “very ordinary,” according to a worker.
“Dinner time was like a couple of patty pies and a scoop of mashed potato,” she said.
“We would get sausage rolls, curry puffs, and marshmallows for dessert,” said another.
The program revealed that the growing ageing industry is currently worth more than $22 billion each year.
Glossy advertisements promote residential facilities like luxury hotels. But, a personal care assistant said, “They’re being sugar coated. They’re being fed a picture, a story that in reality is very untrue.”
“Often it’s the quality of the building, the amenity of the grounds, that’s what’s being sold,” reported an aged care consultant. Often what’s not clear is the quality of the people in the building.”
Low staff numbers are a fundamental issue. One enrolled nurse reported that between her and a registered nurse, they had to look after 72 residents.
And 70 percent of personal care attendants have had only six weeks’ training.
Hopefully, now that the heat is on, the royal commission will act quickly – not only to prevent further neglect but to enhance quality of life. That includes putting mandatory nutrition standards in place.
Posted by ProPortion Foods Blog on Sep 12, 2018 in Aged Care
What better way to breathe life into aged care than with young children. That’s what intergenerational programs are starting to do in Australia.
In an era of dissolving extended families, the new model of bridging generations is testament to their multiple psychological, social and economic benefits.
Dr Catrin Hedd Jones, from Bangor University in the UK, took part in a documentary about six nursery children who were introduced to an adult day care facility for three days.
She said she witnessed some “life affirming interactions” that benefited both the older people and the children, who flourished with the extra attention and opportunity to grow their social and emotional skills.
Increasing numbers of shared care centres have sprung up over the past 20 years in the US. They include a nursing home called ‘The Mount’ in West Seattle, which joins 125 children with 400 residents five days a week.
“We wanted to create a place for people to come to live, not a place for people to come to die,” administrator Charlene Boyd told PBS news hour. Footage shows young children dancing and interacting with the residents, whose faces light up in delight.
Staff and family members say that residents suffering dementia become engaged and lucid during their interactions with the children. They’ve seen some “incredible moments”, as well as enhanced learning for the children.
Over in Japan, a study reported that intergenerational programs with preschool children brought smiles and conversation to older adults.
In New South Wales an association holds intergenerational playgroups to support families and strengthen local communities, bringing meaningful engagement and enhanced self-esteem for participants.
But programs that bring together young and old are relatively new in Australia. And they need to be more structured with consistent monitoring and evaluation of outcomes, according to Professor Anneke Fitzgerald from Griffith University.
Her team is trialling two models in older adults living with dementia and 3-5-year-old children – one with aged care and childcare in the same location and one in which the groups take trips to visit each other.
The two generations meet for an hour each week over 16 weeks and engage with each other through shared activities.
Preliminary results are positive, with the children and adults expressing “excitement and joy at being able to interact with each other,” according to Fitzgerald.
Fostering appropriate interactions between young and old takes careful planning and facilitation from trained care staff to help build relationships.
But the possibilities are endless, writes Hedd Jones.
They can range from reading a book to craft activities or dancing together. Musicians aged between 6 and 90 years old in New Jersey play together in an orchestra, while in Massachusetts children and older adults work together on environmental projects.
There’s no doubt about the psychological and social benefits of intergenerational connections.
Older adults feel valued with an enriched life purpose; young children benefit from increased knowledge and social interaction, and in the process develop positive perceptions of older people.
The programs could also help alleviate the burgeoning costs of an increasingly older population by lowering running costs and sharing resources.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.