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Nutrition for Active and Healthy Aging

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The silent killer: 1 in 3 patients at risk of malnutrition

Posted by ProPortion Foods Blog on Feb 22, 2019 in Aged Care, Malnutrition, Research

One in three hospitalised adults in the US is at risk for malnutrition, a major analysis has found. And patients’ poor food intake is having a significant impact on their healing and recovery, compounding their risk of death.

 

“Nutrition is easily overlooked as healthcare professionals often focus on a patient’s primary diagnosis,” lead author Abby Sauer told NutritionInsight.

 

“It may come as a surprise to some that when patients don’t get proper nutrition, it can significantly put their health and lives at risk,” she adds, explaining that nutrition is more important than ever when someone is sick or injured.

 

 

The invisible malady

 

The researchers screened around 10,000 patients from 2009 to 2015 to assess malnutrition risk and links with mortality.

 

They found around one in two patients were eating half or less of their meals. This low food intake was linked to higher risk of mortality, and those who ate none of their food had a nearly six-fold higher risk of dying than those who ate at least some.

 

The findings support previous studies that have identified hospital malnutrition as a global public health problem, including Australian research which also found that this “silent epidemic” affects one in three hospitalised patients.

 

Despite this growing awareness, it is still not given the attention it deserves.

 

“Malnutrition can be invisible to the eye and is rampant in US hospitals because it’s not always top of mind,” said Gail Gerwitz, president of nutritionDay, an organisation which was involved in the study.

 

Loss of muscle mass and strength takes the brunt of poor nutrition, leading to sarcopenia, an age-related disease of accelerated muscle wasting that results in a downward spiral of poor health and mortality.

 

 

Taking action

 

Some Australian hospitals are taking action by implementing basic malnutrition and sarcopenia screening tools. Relatives can also look for key signs of malnutrition.

 

These include unexpected weight loss, tiredness, low mood, poor appetite, unhealthy teeth and gums, listless hair and brittle nails, constipation and poor wound healing.

 

Hospitals and aged care facilities can take several measures to boost patients’ food intake, by using patient-centred service models, introducing mandatory nutrition standards, addressing obstacles to eating like poor dentition, and providing a choice of meals that are tasty and appealing.

 

High protein, high energy meals are the first line of defence to prevent or address malnutrition and promote healing. This can be achieved by adding extra cream or butter to food. Where necessary – especially with poor appetite – supplements can be used between meals to boost protein and calorie intake.

 

 

 

 References

 

https://www.nutritioninsight.com/news/one-in-three-us-hospitalized-patients-at-risk-of-malnutrition-study-discovers.html

https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.1499?referrer_access_token=YpyQjt0dEdDplln3sncQT04keas67K9QMdWULTWMo8NpaDOJGsSXE-fFRqzg6qmp4mwZgNSU9OHo5UV-WX36sAF2PuESP4p8o6p9TexcSSzwdzG5kvFYGDFA6MWvDsOp&

One more meal a day could save lives

Posted by ProPortion Foods Blog on Feb 14, 2019 in Aged Care, Malnutrition, Nutrition

Many older adults don’t eat enough to meet their nutritional needs, and this can impact their healing and recovery from injury.

 

In support of this, a 2-year pilot study has shown that giving one extra meal a day to older adults who were hospitalised with hip fractures halved their risk of dying.

 

The study, conducted by the NHS in the UK, was instigated after staff noticed that patients with hip fractures struggled to get enough nutrients. In the program, nutrition advisors across six sites brought food from the hospital’s canteen and sat with patients as they ate their extra meal.

 

As a result, mortality rates fell from 11 to 5.5 percent, and medical authorities are considering whether it should be introduced countrywide.

 

Often, busy staff overlook patients’ food intake, noted chief orthopaedic surgeon Dominic Inman. Commenting on the findings to The Telegraph, he said, “If you look upon food as a very, very cheap drug, that’s extremely powerful.”

 

 

A downward spiral

 

Hip fractures are the most common, and most serious type of fracture in Australia, with new fractures resulting in 50,900 hospitalisations and 579,000 bed days throughout 2015-16.

 

The health of adults over 50 often rapidly declines after a hip fracture, exacerbating poor outcomes. For three months after fracturing a hip, older adults are at five to eight times greater risk of dying, and one in three adults over 50 dies within 12 months.

 

Aside from that, a hip fracture can sorely impact mobility, independence and quality of life, and many patients are transferred to another facility for ongoing care.

 

 

On the bright side

 

Falls can be prevented by maintaining good muscle mass and strength. Failing that, patient outcomes after a fall can be improved with rehabilitation aimed at getting them moving as soon as possible, and with good nutrition.

 

Malnutrition, although widespread, is often overlooked, so it is important to be aware of the signs.

 

Addressing this, Queensland researchers have tested a patient-centred food service model in a public hospital setting and showed that it increased patients’ energy and protein intake – key requirements for healing and preventing malnourishment.

 

The model has been used in private acute care settings for 15 years. It revolves around providing room service to patients on demand – so they get to choose what they eat and when. (Who wants dinner at 5pm if you’re not ready for it?)

 

This food revolution was led by Sally McCray, who says, “This innovate model demonstrates the importance of patients being able to order flexibly, both in terms of the type of food items that patients feel like eating, as well as ordering food at a time of day that they feel like eating.”

 

The researchers showed that, not only can it improve nutrition intake, it also results in happier patients and reduced food waste.

 

 

References

 

https://www.sciencedirect.com/science/article/pii/S2212267217305191

https://www.materonline.org.au/getattachment/Whats-On/News/July-2018/Mater-s-Dietetics-and-Food-Services-team-are-kicki/Public-hospital-research-paper.pdf

https://dietitianconnection.com/news/a-revolution-in-food-service-the-mater-room-service-model-part-1-of-2/

https://www.dailymail.co.uk/news/article-6586215/Giving-elderly-patients-extra-meal-day-halve-chances-dying-hospital.html

https://www.aihw.gov.au/reports/injury/hip-fracture-incidence-in-australia-2015-16/contents/summary

https://theconversation.com/why-hip-fractures-in-the-elderly-are-often-a-death-sentence-95784

 

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

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