While multitudes of people around the world face food insecurity, a whopping third of food is lost or wasted. This equates to more than a billion tonnes of food valued at nearly $940 billion every year.
Australia is a part of the problem: five million tonnes of food reach landfill annually, which would fill 9,000 Olympic sized swimming pools, according to OzHarvest. This comes at no small cost – wasted food costs the Australian economy around $20 billion a year.
Apart from the financial cost, food waste impacts the environment. Precious resources such as water and energy are used to grow, transport and sell food. And every tonne of food that ends up in landfill results in 750kg of carbon dioxide being released into an already overloaded atmosphere.
Every business, school and household needs to pull their weight to address the problem. But health care facilities face unique challenges in dealing with their contribution.
Food surplus accounts for half of all waste generated by the health system, squandering resources, labour and finances.
In 2015, an Australian audit found that 200 grams of food was wasted, on average, per bed each day in hospitals and aged care facilities. Most of this came from uneaten food on patient trays. Other sources are hospital kitchens and cafeterias, according to a US survey.
In hospitals, food service revolves around health care procedures, generating several different routes for food waste. These include bulk cooking, long delays between ordering and serving, and missed meals due to hospital procedures, fasting, test scheduling, and patients being checked out.
Patients and older adults are more likely to have poor appetite and treatments and conditions that limit eating through symptoms like pain and nausea.
Palatability of hospital food is a key issue, as well as packaged food that is unopened and thrown away or half-eaten – which also contributes to plastic pollution.
These issues not only have implications for food waste, but also for patients’ nutrition intake.
Methods for serving patient meals have not changed in 30 years. Improved technologies offer several ways in which the issue of food waste – and associated problems like surplus food costs and malnutrition – can be addressed.
A study by HealthShare NSW reformed hospital food delivery using improved workflow processes and menus, staff training and technology. The project aimed to decrease the time lag between ordering and getting meals to four hours or less, improve food quality and nutrition and increase patient choice.
As a result, improvements were made at various stages of the process, reducing patient food waste by half. Patients’ food intake also increased considerably.
Other health care facilities have switched to a room service model for feeding patients. This personalised approach results in better patient satisfaction, in turn improving nutrition intake and reducing food waste.
Melbourne’s health department joined other organisations to trial recycling organics, finding it a viable way to divert wasted food from landfill.
In all, combining streamlined technologies and procedures for storing, ordering, delivering and disposing of food with improved patient choice, food quality and dining environments can improve nutrition intake and reduce food waste – a win-win on all counts.
This month saw the launch of the Healthy Ageing APAC Summit in Singapore on 12-13 June, covering a smorgasbord of topics related to nutrition and healthy ageing throughout the Asia-Pacific region.
Currently more than half of the world’s over-60s live in the Asia-Pacific. And the region’s number of older adults is expected to double from 547 million in 2016 to nearly 1.3 billion by 2050.
The summit was launched to explore how the nutrition and food industry “can meet the needs of the rapidly ageing populations of today, and more crucially, tomorrow.”
Nikki attended the summit. “There was just so much information and networking, it really was a fabulous couple of days! I’m very lucky to have been able to attend and learn a lot.” Here are some highlights.
Presenter Chin Juen Seow from Euromonitor pointed out that healthy living has become a major trend – and not just in ageing.
He suggests this is driven by an array of social and cultural influences spanning economics, population change, technological advancement, concerns about the environment and sustainability, and changing values: “Health is the new wealth.”
As a result, 37 percent of packaged food sales in Asia are presented with a health focus, and this is predicted to increase.
Dr Lesley Braun from Blackmores presented new research suggesting that omega-3s may benefit sarcopenia. Bolstered by animal studies that show increased stimulation of muscle protein synthesis, human trials provide some evidence of improved muscle-related biomarkers in older adults after taking omega-3 supplements.
Dementia is now the second highest cause of Australian deaths. It is risky and expensive for pharmaceutical companies to develop drugs for Alzheimer’s disease – the most common form of dementia – according to Dr Shawn Watson from Senescence Life Science, with a 99.6% failure rate of clinical trials. Their focus on amyloids could be the limiting factor.
Increasing research shows that nutrition and sleep can support healthy brain function with ageing, preventing risk of Alzheimer’s via several biological mechanisms including reduced inflammation and oxidative stress. Watson reported positive results from supplementation with turmeric and ginseng.
Alzheimer’s disease has also been nicknamed “diabetes type 3.” When people eat too much sugar, cells are bombarded with insulin, which tells them to take in the glucose for energy. Over time the cells become insulin resistant, leading to diabetes and a host of related health problems. Research has linked a lack of insulin to the formation of plaques associated with Alzheimer’s – one more reason to avoid excess sugar and refined carbohydrates.
Accordingly, the glycemic index (GI) was developed to rank foods by how quickly sugar is released into the blood stream. Kathy Usic from the Glycaemic Index Foundation told the audience about an impending global roll-out of the Low GI Symbol on food packaging to help address the soaring epidemic of chronic disease.
Amidst a wave of related research on low carbohydrate/high protein diets, a study is currently underway to investigate the effects of a low-GI high-protein diet on pre-diabetes/type 2 diabetes prevention. Watch this space!
Swallowing. Most of us perform this apparently simple act many times every day without a second thought.
Yet eating and swallowing is an extremely complex procedure that recruits over thirty different nerves and muscles to move food and liquid down the correct channels from mouth to stomach.
Malfunction in any aspect of this intricate operation can result in swallowing difficulties, or dysphagia, afflicting up to one in five older community-dwelling adults and around half of those living in aged care facilities.
It’s easy to lose heart when eating and drinking can’t be enjoyed as before, which can result in a vicious cycle of unintentional weight loss, malnutrition, and further despondency.
However, there are ways to keep the nutritional side of things on the bright side to avoid complications like pneumonia, dehydration and infection, and optimise health and recovery.
A team of health professionals helps manage dysphagia and navigate individuals through the act of safe swallowing and recovery, with speech pathologists at the helm and dietitians on board to carefully monitor a patient’s ability, progress and nutrition status.
In some cases, tube feeding through the nose or stomach (enteral nutrition) or directly into the blood (parenteral nutrition) is the best option to deliver or supplement with life-giving nutrients and fluid. But patients should be supported to eat and drink orally wherever possible.
Strategies for eating can include postural adjustments, swallow manoeuvres, trained feeding assistance, adaptive feeding equipment, distraction-free environment, swallow rehabilitation and texture-modified food and liquid.
Mildly to extremely thickened liquid or nectar is most commonly used for dysphagia. Thin fluids are avoided for fear of choking – therefore it is important to maintain good hydration, and watch out for dark-coloured urine, skin turgor and dry membranes.
Texture-modified foods, ranked according to their viscosity, have four levels of consistency depending on the patient’s swallowing and chewing ability.
Smooth pureed food is the easiest option. Much trial and error has been invested in getting this right – which would be obvious, for instance, if you’ve ever tried to puree green beans (hint: they’re stringy…).
The pureed food must have consistent thickness, be free from lumps and require no chewing. Examples include smooth, pureed cereals, meats, mashed potato, avocado, custard, and fruit-free yoghurt.
The next level is moist, semi-solid food that requires some chewing ability but is easily mashed with a fork. These foods can have a little texture and soft, smooth lumps, like cooked cereals, ground or cooked meat, and soft, canned fruit and vegetables.
Soft foods are allowed for more advanced swallowing and chewing ability, including well cooked vegetables, baked beans, soft or canned fruit, moist breads and rice, and tender, thinly sliced meat, fish or chicken.
Level four requires no texture modification – all foods are on the menu.
Some simple tricks can boost food’s nutrition density, like pureeing with milk or cream for extra protein and energy, and adding butter or milk powder.
And for those repelled by colourless, unidentifiable slop, advanced food manufacturing techniques now use thickeners and food moulds to enhance pureed food’s appeal while improving the nutrition profile.
When people think about causes of malnutrition, they might consider poor appetite, chewing difficulties or illness as likely candidates. Yet many health professionals would know that even something seemingly trivial, like not being able to open food packaging, can be a major obstacle to eating well.
Opening food packaging can require strength, dexterity and fine motor skills that many vulnerable people don’t have—especially older adults.
Inaccessible food packaging is often an issue in hospitals, particularly when there is no-one to help patients open single serve and portion-controlled food items. The NSW Special Commission of Inquiry into Acute Care Services found that many patients need help to open food packaging, and reported that this can be a significant barrier to nutrition.
A Canadian study of 132 cognitively healthy nursing home residents found that 37.4% of residents were at risk of malnutrition—and food packaging was identified as one of the primary contributing factors.
Disabilities like arthritis can present a major obstacle to opening food packaging for people of all ages.
Arthritis Australia’s Consumer Director, Wendy Favorito suffers from arthritis herself and has experienced the resulting emotional struggles, like public embarrassment and lack of independence by having to rely on other people, and physical obstacles to basic daily tasks like cooking simple meals for her family.
If her husband weren’t there to help her, Favorito writes that it would just mean going without. “It is unacceptable that common items are so difficult to open for a large portion of people in our community when some simple packaging solutions exist.”
As Fergal Barry, Partnerships Manager of Arthritis Australia, stressed in a CHOICE interview, this problem will keep growing along with our aging population if it is not addressed.
Even in the general population, food packaging is not a trivial issue. Researchers at Nottingham University in the UK reported that over 60,000 people needed hospital treatment for injuries from trying to open difficult packaging, often resorting to using scissors or knives. Other injuries include wrist strain from trying to loosen jam jar lids. According to CHOICE interviews, experts believed Australians would face a similar problem.
This phenomenon has a name. ‘Wrap Rage’ is defined by Wikipedia as “the common name for heightened levels of anger or frustration resulting from the inability to open packaging’.
A healthy 30-year old male expressed frustration trying to open the plastic wrapping on crumpets, according to a more recent UK report which claimed that “Millions suffer ‘wrap rage’ battling to open modern-day packaging.”
For vulnerable people, accessible design is even more vital. The Nottingham University inquiry’s main finding was that packaging is easier to open when there is a larger surface area to grab onto. But there is much more complexity to making packaging accessible. Guidelines published by Arthritis Australia further include ease of grip and control, avoiding sharp edges, adequate grasping points on seals, texture, and salient, legible fonts.
For organisations seeking user-friendly products for vulnerable populations, Arthritis Australia set up an Initial Scientific Review (IRS) which rates products according to their accessibility. A database of these ratings is available for various pre-packaged and portion-controlled foods used by the food service industry.