While malnutrition is an insidious problem in aged care, simply giving residents more biscuits and cake is not the answer.
Yet that is what many residential facilities are doing, according to research in Melbourne presented at the Royal Commission into Aged Care Quality and Safety.
In fact, the study added to evidence that aged care facilities have been spending less on food, and in the process skimping on high protein sources – critical with aging to prevent disability and malnutrition.
Previous research by the group found that two thirds of residents were malnourished or at risk of malnutrition – and inadequate protein was a major factor.
Essentially, the facilities they researched only provided one serve of high-protein food, such as lean meat, seafood, eggs, poultry and legumes per day – only half of the recommended two serves every day.
Dairy protein only amounted to one serve each day, falling well short of the recommended four servings.
At the same time, the amount of “discretionary foods” high in sugar, refined carbohydrates and unhealthy fats and devoid of nutrients has increased.
So while centres might be trying to save costs, it’s a false economy, lead researcher Dr Sandra Iuliano argues.
Malnutrition results in a host of poor outcomes including bed sores, falls, poor wound healing and general immunity.
This is not only debilitating for sufferers; it also increases hospital stays, estimated to add nearly $1,800 to the cost of each admission.
Some argue that a ban on junk foods in health care facilities is a good start, and research shows it helps shape behaviour and improve diets.
For aged care, where a healthy diet is most critical, mandatory nutrition standards would help lift and standardise the quality of food and nutrition provided – with a particular focus on delivering quality protein.
Beyond protein, poor and medium quality diets have been associated with 92% and 40% greater incidence of frailty, respectively, than a high quality diet.
Lifestyle factors such as diet and exercise can also reduce the risk of dementia.
Enhancing the dining experience would help overcome many obstacles to eating well, such as improving the sensory experience, and making food more appealing through greater choice, communal dining, cooking smells and attractive food presentation.
Some centres have even engaged residents with cooking to help stimulate appetite with foods they are familiar with – an enjoyable, social and stimulating activity with multiple rewards.
As Sandra Iuliano says, “It’s not about adding years to life; it’s about adding quality to the years they have.”
Prescribing food could be as cost-effective – if not more so – than common drug treatments while delivering significant health benefits, according to research published in PLOS Medicine.
The study rides on a wave of interest in food as medicine – “farmacy” rather than pharmacy – by doctors, hospitals and insurers as drug treatments for food-related illnesses like diabetes, heart disease and cancer fail to fulfill their promise.
The researchers modelled the economic and health benefits of subsidising 30 percent of fruit and vegetable and 30 percent of wholegrains, nuts/seeds, seafood and plant-based oils.
Results showed that fruit and vegetable subsidies could avert nearly two million cases of heart disease while the wider incentive could prevent more than three million people from developing heart disease and 120,000 from getting diabetes.
The cost savings were also staggering – the resulting reduced use of health care services saved nearly US$40 billion and more than US$100 billion, respectively, confirming the cost-effectiveness of such an intervention.
“These new findings support the concept of Food is Medicine,” says lead author Dariush Mozaffarian; “that innovative programs to encourage and reimburse healthy eating can and should be integrated into the healthcare system.”
In reality, how likely are people to eat healthier food if it were subsidised?
One of the biggest barriers is access, and that’s where prescribing and subsidising food can make a difference.
Nutrition and cooking education might help as well – and is effective, as shown by research such as Australian studies Helfimed and SMILE.
These two interventions gave people suffering major depression food hampers and nutrition education, and in Helfimed they received cooking workshops. Both studies showed significantly improved diets in the treatment arm.
Depression symptoms decreased as well, suggesting that even psychiatrists could start prescribing diet.
Other research has found health benefits from food prescription programs, including lower blood sugar levels in people with diabetes, weight loss and increased intake of fruit and vegetables.
Having a GP validate and promote diet as a treatment could also be powerful.
“People may be more likely to make a behaviour change if the recommendation comes from their healthcare provider,” says Associate Professor Heidi Wengreen, “as part of a treatment plan for conditions such as diabetes, heart disease, high blood pressure, or obesity.”
Already, some doctors have started prescribing diet in the US, such as the Food Farmacy program at Nunnalee Pediatric Specialty Clinics in North Carolina.
Older adults, who often can’t afford healthy food, could derive even greater benefits from diet prescriptions. Poor diet has been linked to frailty with aging, associated with spiralling loss of strength, mobility and quality of life.
Even one extra meal a day could save lives.
Added to that, a healthy diet could displace the multiple medicines that are being prescribed to older adults, with many negative consequences.
Changing the culture of drug prescriptions could require an overhaul of the insidious and far-reaching influence that pharmaceutical companies have on clinical practice.
And although nutritional supplements might be a welcome alternative in some cases, nothing can replace a wholesome diet.
Our Cost of Malnutrition report outlines the problem of malnutrition and its various costs – both financial and physical – and offers a guide to its identification and management.
Download your free report HERE.
In 2008 the Australian government released its Closing the Gap Strategy, which laid out plans to achieve health equality for Aboriginal and Torres Strait Islander people by 2030.
How is it tracking?
Not well, according to a 10-year review by the Australian Human Rights Commission – if anything, the gap has grown.
Of all Australian population groups, Aboriginal and Torres Strait Islander people still suffer the worst health outcomes, and their lives are about 10 years shorter than the rest of the populace.
According to Robert Tickner from the Australian Red Cross, “It is a national disgrace that, despite our reputation as one of the world’s most bountiful food producers, so many Australians cannot get adequate, nutritious and affordable food.”
Poor nutrition is a key contributor to the overburden of health issues faced by Indigenous Australians, which include overweight and obesity, malnutrition, heart disease, type 2 diabetes, chronic kidney disease and tooth decay.
These diseases contribute to at least three-quarters of their mortality gap.
Food insecurity is a big part of the problem. Much of this is due to poverty. Many Indigenous Australians also live in remote communities where healthy food is hard to come by. What is available is expensive because of transport costs.
As a result, fresh fruit and vegetable intake is very low, and “discretionary foods” make up 41 percent of their daily energy intake. Sugar consumption – largely from sweetened drinks – is nearly 50 percent more than the World Health Organisation’s recommendations.
Combined with easy access to unhealthy food and drinks, poor education and nutrition literacy is also part of the problem.
Many community-based programs have helped, the most successful being those with multi-level strategies that encourage community involvement at every stage of their development and implementation to make sure they are culturally appropriate and address local needs.
Some programs have focussed on improving the food supply through local retail outlets, school and community gardens, food provision by community organisations, and community store nutrition policies.
Nutrition education can also help, if delivered in conjunction with making healthy food accessible through cooking education, budgeting advice, and group-based lifestyle programs.
But these are band aid solutions to the overarching problem: there have been no nationally coordinated nutrition ventures since the National Aboriginal and Torres Strait Islander nutrition strategy and action plan expired in 2010.
The situation can be traced to many historical factors; indeed, all the evidence suggests that before European settlement Indigenous Australians enjoyed good health and a varied diet of nutritious fresh plant and animal foods.
Now they suffer socioeconomic disadvantage with low income and unemployment, institutional racism, low access to primary health care and poor quality, overcrowded housing, all of which contribute to ill-health and mortality.
Health equality is a basic human right. Treating diseases and improving nutrition and food security are important, but the review argues that underlying structural factors also need to be tackled before Australia can close the gap.
Posted by ProPortion Foods Blog on Jun 28, 2019 in Nutrition
If you visit a psychiatrist one day in the not-too-distant future, you may be surprised to find that you are given dietary advice.
That doesn’t mean you won’t be given counselling, and medication where necessary, but it reflects a growing awareness about the importance of nutrition for good mental health.
In fact, some psychiatrists are already doing this, like Dr Drew Ramsey in the US, who regularly prescribes his clients a diet high in fresh, nutritious food and low in highly processed food.
Research on links between diet or nutrition and mental health has steadily grown over the past decade or so. This comes from a combination of studies investigating single nutrients and whole diets.
A whole array of nutrients is essential for brain function. Accordingly, research has found that supplementing with nutrients such as vitamins B and D, omega-3, zinc, and magnesium can improve symptoms of depression and anxiety.
Vitamin B and omega-3 may also help alleviate cognitive decline and dementia with aging.
But, although nutritional supplements may be necessary at times, we don’t eat nutrients, we eat whole food. Importantly, interactions between nutrients play important roles in brain function.
Fibre is also critical as it helps to facilitate healthy gut bacteria. This is increasingly recognised as being critical for reducing systemic inflammation and maintaining healthy brain function.
Population studies have consistently shown links between unhealthy diets and higher levels of depression and anxiety, and conversely between healthy diets and better mental health.
It might be said that people who are anxious or depressed eat more poorly, but longitudinal studies also found that people who ate poorly were more likely to develop mental health problems over time.
Other research has shown that people who have higher inflammatory markers in their blood – which underlie a range of chronic diseases – are more likely to become mentally ill.
And diet is a key contributor to low-lying inflammation.
More recently, two randomised controlled trials have confirmed what population research has found. Both were conducted in Australia independently finding that diet substantially reduced depressive symptoms in people suffering major depression.
The quick answer: a diet high in fresh food and low in processed food. Like Michael Pollan famously said: “Eat food. Not too much. Mostly plants.”
The traditional Mediterranean diet is high in plant foods – including fruit, vegetables, legumes, nuts, seeds, and whole grains, and includes generous amounts of extra virgin olive oil for salads and cooking (it has a high smoke point so is safe for cooking over moderate heat).
It contains moderate amounts of fish, dairy, and red wine with meals, and little or no meat, highly processed foods and confectionary.
There is endless scope to experiment with this type of diet, which is deceptively simple, tasty, and cheap.
And you never know, healthy food prescriptions might be subsidised by Medicare one day – US researchers have predicted that subsidising 30% of the cost of healthy foods could prevent nearly two million heart attacks, prevent 350,000 deaths and save $100 billion in health care costs.
Given that physical health and mental wellbeing are intimately related, this remedy be just what the psychiatrist ordered.