As we face a burgeoning aging population, food quality in aged care has entered the limelight. After all, nutrition is pivotal for good health and healthy aging. Food also enhances quality of life through the joy of eating and the social interaction that it fosters.
Yet more than half of Australian aged care residents suffer or are at risk for malnutrition.
Malnutrition carries a host of negative outcomes like increased risk of falls, osteoporosis, arthritis, poor recovery from illness, delayed wound healing, depression and mortality. It lowers quality of life. And it is preventable.
It’s not just a matter of ensuring all nutritional needs are met, which include protein, energy and a variety of foods from each food group. Several other considerations factor in.
Improving older people’s nutrition status would need a multifactorial approach to address problems with swallowing, dentition, food packaging, eating support, appetite, food preferences, taste and environment.
Fundamentally, quality food needs higher priority in aged care budgets.
Even though people and organisations like Maggie Beer, Nutrition Australia, The Lantern Project and others are tackling this issue, systemic change may only come with mandatory guidelines.
Services provided at residential aged care facilities are regulated under the Aged Care Act, through the Aged Care Standards and Accreditation Agency. The standards include general nutrition information, but no mandatory guidelines for nutrition and menu planning. Hospitals have standards, so why doesn’t aged care?
To rectify this situation, mandatory nutrition standards would need to be created, implemented and enforced for all Australian aged care facilities.
The new standards could contain the following recommendations:
The residential aged care landscape is fragmented. Cooperation among all stakeholders would be imperative for the successful creation, acceptance, adoption, rollout and continuation of new mandatory standards.
Stakeholders include the government’s Australian Aged Care Quality Agency, My Aged Care program, Residential Aged Care Facilities (RACFs), Leading Aged Services Australia, Dietitians Association of Australia, and Speech Pathology Australia.
Challenges would need to be ironed out. Thousands of aged care workers complain about cost cutting, understaffing and rationing in RACFs, resulting in “struggle to provide the most basic level of care and dignity for elderly people.”
Clearly, a cultural overhaul in aged care facilities would be essential for a new mandatory policy to succeed. This could be achieved through collaboration with stakeholders, priority budgeting, and a directive issued from above: the government body responsible for aged care quality.
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.