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.”
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.