Everyone becomes more forgetful with age. People start misplacing their keys and worry that they’re losing their marbles. But that’s quite normal. When you forget what to use your keys for, that’s when you might consider a dementia test.
Seventy per cent of people suffering dementia have Alzheimer’s disease, the second major cause of death in Australians. Most common in older age, dementia affects three in ten people over 85 years old. It destroys neurons, causing brain shrinkage and declines in memory, thinking, emotional control and behaviour.
Slipping into dementia can be scary for sufferers, while they are aware of what’s happening. Family members find it distressing when the person they know and love switches personality, forgets their name or no longer even recognises them.
The good news is that like most modern diseases, lifestyle choices can help to prevent dementia and prolong quality of life.
A landmark study by Cambridge university researchers identified seven lifestyle factors that could prevent one in three cases of Alzheimer’s disease. Most striking was regular physical activity. Education and reducing smoking and diet-related conditions like obesity, diabetes and hypertension were also protective.
Other research has shown that B vitamins can slow the rate of brain shrinkage by lowering homocysteine in people with mild cognitive impairment – an Alzheimer’s disease precursor. Some evidence suggests a Mediterranean diet rich in plant foods may prevent dementia onset.
New Australian research, published by researchers at Edith Cowan University, Western Australia, suggests that eating foods high in protein could reduce the risk of developing Alzheimer’s disease.
The study showed that people who ate the most protein had lowest levels of amyloid beta – clumps of protein in the brain that are the hallmark of Alzheimer’s disease.
The researchers investigated the diets of 541 cognitively normal adults and found that people who consumed around 118g of protein per day were twelve times less likely to have high amyloid beta levels than those who ate only 54g per day.
Lead author, Dr Binosha Fernando, said it’s not clear how protein might reduce Alzheimer’s disease risk. He speculated that a high protein diet may exert its effects by lowering blood pressure. High blood pressure increases risk of heart disease, stroke and dementia.
Dr Fernando suggests that eating 120g of protein per day could give people the protective effect their study showed. For instance, he says, you could have a mixed bean salad with tuna for lunch, a serve of chicken with salad for dinner and a handful of peanuts in between.
Good protein sources include animal foods like eggs, dairy, chicken, fish and meat, and plant foods like legumes (e.g. chickpeas, lentils, red kidney beans) and nuts.
Protein intake is one of several confusing nutrition messages. This study supports other research suggesting we need more protein than is currently recommended. Particularly in aging, protein can also help prevent other conditions like sarcopenia and osteoporosis.
One of our staff recently spoke with someone whose father is in an aged care facility. They discovered he had a hairline fracture in his hip – about a week after it happened. The nurse accidentally dropped him when she was helping him out of bed, and it wasn’t reported.
Around one in three older adults suffer from falls, and up to 60 percent will suffer an injury. Three times more people tumble in long-term aged care.
Most injuries are superficial cuts, grazes, bruises and sprains. Some are more serious. Falls cause 40 percent of injury-related deaths in older adults. Hip fractures are the most serious and costly fall-related injuries, resulting in 19,000 hospital admissions for older Australians from 2011 to 2012.
More broadly, falls – and fear of falling – can impact independence and quality of life. But it’s not a cross lotto. Older people can reduce their risk of falls with nutrition and exercise.
Assessment tools can predict risk of falls, to help tailor prevention strategies. These tend to assess physical capacity like mobility, balance, strength and gait. But nutrition status is also a key predictor for likelihood of falling and the gravity of injuries.
Malnutrition and low body weight result from depleted protein and energy stores. This carries multiple adverse outcomes including bone loss and fragility, poorer movement coordination, slower reaction time and diminished muscle strength – all of which increase risk of falling.
Low calcium and vitamin D impact bone health and risk of falls. Low vitamin K also increases bone fragility. Poor eyesight can compound propensity to fall, also impacted by nutrition status. Low levels of vitamins A, C and E contribute to weak vision.
Insufficient vitamin B12 and folic acid can reduce nerve function in extremities, and in the brain lead to confusion. Dehydration, a common problem in older adults, can also cause delirium, as well as constipation and low blood pressure; all increasing fall risk.
Providing a healthy, tasty diet high in protein from eggs, dairy, fish, chicken, nuts and legumes and a variety of foods from the core food groups is an important step towards preventing nutrient depletion and associated risk of falling.
Regular physical activity is important to reduce age-related loss in muscle mass and bone density. Recently, the SUNBEAM trial (Strength and Balance Exercise in Aged Care), tested a program of individually tailored physical activity in aged care.
The program reduced falls by 55 percent, larger than any other study to date according to lead investigator Jennie Hewitt, physiotherapist from Feros Care and PhD candidate at the University of Sydney.
Over 200 aged care residents from 16 facilities in New South Wales and Queensland took part – half of them were randomised to do the program and the other half continued normal activities.
Participants in the program engaged in 50 hours of group-based resistance (strength) training and balance activities over 25 weeks, then a six-month maintenance period.
Not only did falls decrease dramatically in the exercise program group, but participants had considerably better balance and mobility. Some found the enhanced independence life-changing, and rejoiced at being able to go out with their families.
It’s not just about falls; healthier lifestyles and greater mobility have positive ripple effects for happy aging.
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, 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.