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Nutrition for Active and Healthy Aging

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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. 

Dispelling myths about nutrition & aging

Posted by ProPortion Foods Blog on May 23, 2018 in Cognition, Malnutrition, Research

 

People may be living longer, but quality of life tends to wane with aging. The burden of disease increases significantly after age 65. As a result, older adults commonly take multiple medications, further exacerbating their risk of frailty and premature death.

 

But it doesn’t have to be like this. Chronic diseases have solid foundations in lifestyle behaviours, including diet. Addressing some common myths around diet and nutrition in older adults can shine some light on healthy aging.

 

 

Myth 1: You need less food

 

People lose muscle mass with aging, resulting in lower energy needs. But it’s important to stay active and maintain strong muscles, which also support good bone density. Even if slower metabolism reduces calorie requirements, more than ever, older adults need a full range of nutrients and fibre from a variety of whole foods to maintain good health.

 

 

Myth 2: It’s okay to skip meals

 

Taste and smell can decline with age, impacting appetite. But skipping meals can cause a downward spiral. It can lower blood glucose levels and increase risk of malnutrition. If appetite is low, eat sweet fruit, add salt and herbs to meals for flavour, and have small portions and regular snacks with high nutrition density – ensuring protein needs are met.

 

 

Myth 3: Nutritional supplements will fix things

 

Nutritional supplements can never replace the full range of vitamins, minerals, protein, healthy fats, polyphenols and fibre provided by a whole food diet. Sometimes they are necessary to supplement a healthy diet though. Vitamins most at risk in aging are B12 and Vitamin D. Protein shakes can provide a concentrated protein source if appetite is low.

 

 

Myth 4: It’s okay to be overweight

 

Although a little extra padding is okay in older years, overweight and obesity increase risk of chronic disease at any age. It is recommended that older people who are overweight shed 5-10% of their body weight over 6 months for improved health. The best approach is to eat whole foods and avoid highly processed foods with refined carbohydrates and unhealthy fats.

 

 

Myth 5: If your weight is okay, you can eat what you like

 

While overweight and underweight bring a host of health problems, poor health can still afflict people in the normal weight range. An unhealthy diet can cause chronic inflammation – associated with a range of physical and mental health problems. A whole food diet low in processed foods is important at any age or weight.

 

 

Myth 6: Let thirst guide your fluid intake

 

Thirst is not generally a reliable indicator of fluid needs, particularly in older years when thirst sensation declines. For this and several other reasons, dehydration is an oft-overlooked problem in older adults. It can lead to poor health, hospitalisation and death. Even mild dehydration can cause weakness, dizziness, low blood pressure and increased falls risk. Ensure plenty of fluids are freely available, particularly water and herbal tea.

 

 

Myth 7: It’s normal to be sick when you age

 

Although body parts endure gradual wear and tear with age, being sick is not normal. Good health can be maintained with good nutrition, regular hydration, healthy weight, physical activity, mental stimulation, social engagement and careful monitoring of any unnecessary medications.

 

 

Myth 8: Senility is unavoidable

 

Dementia risk is associated with several lifestyle factors including low physical activity and poor diet. Research suggests a Mediterranean-style diet – high in plant foods and healthy fats with moderate amounts of fish and dairy and low intakes of red meat and processed food – is protective. B vitamins, antioxidants (abundant in plant foods) and omega-3s may also reduce dementia risk.

 

 

 

 References

https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/health-functioning/burden-of-disease

http://www.health.gov.au/internet/main/publishing.nsf/content/chronic-disease

http://www.abc.net.au/news/2016-02-02/multiple-medications-trigger-frailty-death-polypharmacy-study/7134054

https://academic.oup.com/biomedgerontology/article/56/suppl_2/89/581109

https://www.hospitalhealth.com.au/content/aged-allied-health/article/top-10-myths-regarding-nutrition-for-seniors-467328162#axzz5EJ5WWtlm

https://www.caring.com/articles/senior-nutrition-myths

https://www.globalhealingcenter.com/natural-health/what-are-the-five-myths-of-aging/

https://www.webmd.com/healthy-aging/features/myths-facts-food-nutrition-60#1

https://www.nutrition.org.uk/nutritionscience/life/dehydrationelderly.html

https://academic.oup.com/ije/article/31/2/311/617695

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0012244

https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/effects-of-n3-fatty-acids-epa-v-dha-on-depressive-symptoms-quality-of-life-memory-and-executive-function-in-older-adults-with-mild-cognitive-impairment-a-6month-randomised-controlled-trial/BBBD3D4EC377C47087757CBCE0E42373

How to identify malnutrition in older adults

Posted by ProPortion Foods Blog on Apr 24, 2018 in Aged Care, Malnutrition, Muscle, Nutrition, Sarcopenia

Thinking of malnutrition tends to generate images of starving people in third world countries. But malnutrition is silently affecting aging people at home. It afflicts a third of older adults admitted to hospital and over half of aged care residents – and it is often overlooked.

 

Malnutrition in aging can have serious consequences for physical and mental health, recovery from illness and quality of life. Prevention is best, so it is important to detect malnutrition early.

 

How can you tell if your loved one – whether it be partner, parent, grandparent or someone you care for – is malnourished or at risk for malnutrition? Here are some clues to be aware of.

 

 

Signs of malnutrition

 

  1. Weight loss

    The primary, most obvious symptom is weight loss. Technically malnutrition is defined as unintentionally losing 5-10% body weight over 3-6 months. Other indicators include baggy clothes and belts. Even loose jewellery (e.g. rings) and dentures are tell-tale signs.

 

  1. Feeling tired, weak or dizzy

Food provides calories and essential nutrients needed to produce energy. Not meeting nutritional needs through diet can result in tiredness, weakness and dizziness. A clue here could be reduced levels of mobility. Look out for diminished muscle mass – a risk factor for sarcopenia.

 

  1. Depression, low mood

It’s commonly recognised that depression can affect people’s appetite. But nutrients from food – carbohydrates, protein, healthy fats, vitamins and minerals – are also vital for healthy brain function. Not getting enough can impact mood and even lead to major depression.

 

  1. Poor appetite

Aging and some medications can alter taste and appetite. Eating less can, in turn, reduce appetite. Strategies to provide tasty, nutrient-rich food, small meals and regular snacks can help mitigate this.

 

  1. Teeth and gums

You can’t fool your dentist. Teeth and gums are a key indicator of nutrition and health status. Swollen or bleeding gums are early oral symptoms of malnutrition. If malnutrition progresses, it can cause irreversible tooth decay.

 

  1. Hair & nails

Check brushes and clothes for excess hair. Hair loss and lack lustre hair can reflect poor nutrition status, particularly insufficient protein and iron. Nails also become dry, brittle and discoloured if essential nutrients are lacking. When iron levels drop too low, nails can start curling upwards, signalling possible iron-deficiency anaemia.

 

  1. Infections and wound healing

Our immune system needs nutrients to prevent and ward off disease. Frequent illness and infections can reveal poor nutrition status. Also be on the watch for easy bruising and wounds that don’t heal easily.

 

  1. Bowel habits

Chronic constipation can signal insufficient food intake to mobilise the digestive tract; it can also reflect inadequate fibre and/or dehydration – common in older adults. Conversely, watch out for persistent diarrhoea because this can decrease nutrient absorption and exacerbate malnutrition.

 

 

Addressing malnutrition

 

Several strategies can prevent and alleviate malnutrition. Most important are regular meals and snacks containing protein and energy, a variety of food from the key food groups, and regular drinks to avoid dehydration.

 

Barriers and catalysts of eating need to be identified and addressed, and every effort made to help older people enjoy food and the enhanced wellbeing that it delivers.

 

 

 

References

https://www.webmd.boots.com/healthy-eating/guide/malnutrition

https://www.nhs.uk/conditions/malnutrition/symptoms/

http://www.thenacc.co.uk/assets/downloads/169/NACC%20Spotting%20the%20Signs%20of%20Malnutrition%20-%20Use.pdf

http://rmhealthy.com/10-signs-symptoms-malnutrition/

https://www.tandfonline.com/doi/full/10.1080/1028415X.2017.1411320

https://www.webmd.boots.com/healthy-ageing/features/signs-of-malnourishment-in-older-people?page=3

https://www.livestrong.com/article/18046-signs-symptoms-malnutrition/

https://www.webmd.boots.com/healthy-ageing/features/signs-of-malnourishment-in-older-people?page=2