Posted by ProPortion Foods Blog on Mar 27, 2018 in Aged Care, Nutrition, Protein
Things are looking up for aged care. Nudging retirement and refusing to eat slop, baby boomers are spurring action.
Celebrity chef Maggie Beer is a recent inspirational voice and champion for healthier food that tastes good. Her foundation is dedicated to training cooks and chefs in aged care to prepare meals driven by “superfoods” like chickpeas, lentils and kale.
Director of Nutrition Professionals Australia, Anne Schneyder, has laid down the gauntlet for Aged Care Accreditation Standards in nutrition and hydration, saying “access to adequate food and nutrition in a form that is enjoyable … is a fundamental right for all residents in our aged care homes.”
Foodservice Australia is holding an aged care summit in May this year to present stakeholders with the “the latest trends and techniques” in meal preparation.
A key issue that needs to be addressed is prioritising food in aged care budgets.
Appalling statistics have revealed more money is spent on food for Australian prisoners than pensioners. Our spend of $6.08 per resident per day puts us behind Europe, the US and Canada, whose food budget has increased as ours decreased. AMA president Michael Gannon described this as a “national disgrace.”
Half the surveyed aged-care residents suffered malnutrition – a major risk factor for sarcopenia and related issues like increased risk of falls, fractures, pressure injuries, poor quality of life and hospitalisation.
The paradox is that malnutrition costs money. So it’s really a no-brainer to invest in good food. Indeed, evidence suggests spending on quality care can improve savings – with improved quality of life a welcome by-product.
Protein and energy are two key essentials for older people with poor appetite, to avoid loss of muscle mass and strength. A good variety of fresh produce from all food groups supplies the nutrients needed for optimal health and immunity.
Various factors need to be considered when providing food in aged care, including dentition, swallowing, dexterity, reduced taste, smell and appetite, personal preferences and providing choice. Some may have allergies or special diets, or need staff member assistance to eat.
These and other considerations need to be factored into Residential Aged Care Accreditation standards. The Dietitian’s Association of Australia identified a need for guidelines to include “robust nursing and food systems to implement care plans,” and assessors involved in accreditation processes with in-depth knowledge of nutrition and food service delivery.
Ultimately, if meals and food choices are appealing, older people are more likely to eat. The environment is also important. Cooking smells, communal eating, pleasant, relaxed surroundings and attractive food presentation can all stimulate appetite.
Former chef Peter Morgan-Jones, Executive Chef and Food Ambassador at HammondCare, challenged himself to whip up a tasty meal for a man suffering early dementia. He had limited swallowing ability and had been restricted to pureed food for 18 months.
He craved baked beans, scrambled eggs and crispy bacon. And he got it – homemade Boston baked beans in a puree batter, pureed scrambled eggs and crispy bacon ground into dust. He was “overjoyed.”
As Maggie Beer says, “It’s all about giving equal measures of pleasure and nutrition. Without pleasure, what is there in life?”
http://onlinelibrary.wiley.com/doi/10.1111/1747-0080.12368/full
https://www.hospitalhealth.com.au/content/aged-allied-health/article/menu-planning-guidelines-for-aged-care-homes-missing-in-action-586703961#axzz58XlKgFko http://www.afr.com/business/retail/fmcg/baby-boomers-to-remake-agedcare-menus-20160809-gqoggn
http://www.foodserviceaustralia.com.au/Content/Aged-Care-Catering-Summit
http://www.hammond.com.au/health-and-aged-care/improving-food-culture-in-aged-care
Posted by ProPortion Foods Blog on Mar 6, 2018 in Bones, Muscle, Nutrition, Protein, Research
Like many confusing nutrition messages, some claim too much protein is bad for bone health. What is the scientific consensus, and what does this mean for people with or wanting to avoid osteoporosis? What other nutrients are important? First, let’s look at osteoporosis.
All living tissues, including bones, are constantly getting rid of old cells and generating new cells. With aging, however, the rate at which bones are replaced slows down.
Osteoporosis, meaning porous bones, happens when too much bone is lost and not enough produced, resulting in reduced bone mineral density and a fragile skeleton easily prone to fractures. It is different to osteoarthritis, which results from degenerated cartilage in the joints.
Sarcopenia – age related muscle loss – is closely related to osteoporosis, and they are impacted by similar factors. Bone health is therefore considered not just a skeletal problem, but a musculoskeletal problem.
Osteoporosis is a significant global concern – one in three women and one in five men over 50 may suffer from a fracture caused by osteoporosis. But there are ways to prevent and even treat it, including physical activity, sunshine and good nutrition.
Calcium is commonly known to be important for bones, and most know vitamin D is important too – it helps bones absorb calcium. Perhaps less well known is that magnesium may also prevent bone turnover and improve bone mineral density.
For good bone health, the National Osteoporosis Foundation recommends dairy products, fish (canned fish like sardines with bones for calcium; oily fish like salmon, mackerel, tuna and sardines for Vitamin D), and a variety of fruit and vegetables for their mineral content (calcium, potassium, magnesium), vitamin C and vitamin K.
Protein is not only a key constituent of muscle, it comprises about 50% of bone volume and around 30% of bone mass. It is also associated with increased production of insulin-like growth factor, which helps make bones, and better intestinal calcium absorption.
Some studies suggest eating too much protein increases calcium excretion in the urine, leading to concerns about high protein intake for bone health. This is thought to occur because protein increases the body’s acidity, so calcium – an alkaline mineral – is released to restore balance.
However numerous studies have refuted this; in fact when calcium intake is adequate, higher protein diets are linked with higher bone mass and less fractures. Any loss may also be offset by increased calcium absorption.
Furthermore, low protein intakes (<0.8g/kg per day) reduce calcium absorption which in turn stimulates the release of parathyroid hormone to tell bones to release calcium and restore its balance in the blood.
What are good protein sources for bone health? Some studies have suggested higher meat consumption increases calcium excretion, but others have refuted that. Soy protein could reduce insulin-like growth factor so may not be a good choice.
Fish, chicken and eggs provide protein. Dairy foods are good protein and calcium sources. Legumes are a good source of protein and other nutrients but should be well soaked then cooked in fresh water to reduce phytates (which could interfere with calcium absorption). Similarly, nuts provide protein along with fibre and other nutrients.
To maintain a healthy acid-alkaline balance, other dietary factors also need consideration. In particular, plant foods like fruit and vegetables abound in potassium and other alkaline minerals, so eating more of these would help prevent bones’ need to release calcium.
https://www.medicalnewstoday.com/articles/319543.php
https://www.nof.org/patients/treatment/nutrition/
https://www.ncbi.nlm.nih.gov/pubmed/26556742
https://www.ncbi.nlm.nih.gov/pubmed/19488681
http://ajcn.nutrition.org/content/87/5/1567S.full
https://www.ncbi.nlm.nih.gov/pubmed/21102327
https://academic.oup.com/jcem/article/89/3/1169/2844205
Posted by ProPortion Foods Blog on Feb 13, 2018 in Diabetes, Muscle, Protein, Research, Sarcopenia
Aging brings rewards and challenges. It can be a fulfilling time of rest and relaxation; enjoying respite from a life of working and raising children. It is also a time when the body starts its graceful decline. Unfortunately, this decline can bring various health problems, for instance loss of muscle mass. Age-related loss of muscle mass and strength is called sarcopenia.
Functional loss of muscle strength with age is not only associated with diminished quality of life and problems with activities of daily living; it can have serious effects including increased risk of falls, fractures, disability, hospitalisation and death. As well as aging, chronic diseases like diabetes factor among sarcopenia causes.
A recent review now suggests sarcopenia could even lead to type 2 diabetes.
Around 1 in 6 Australians over 65 suffer from diabetes, increasing to nearly 1 in 5 adults over 85. Type 2 diabetes makes up 90% of all cases, affecting one million Australians, 90% of whom are over 40. Unlike type 1 diabetes, an autoimmune disease, type 2 is associated with unhealthy lifestyle factors like poor diet, inactivity, smoking and obesity, and is therefore preventable.
Diabetes happens when there is too much glucose in the blood – either because the pancreas stops producing enough insulin (needed by most tissues to take up glucose), and/or because cells lose their capacity to take up glucose (become insulin resistant).
This can happen when the body is bombarded with too much sugar or refined carbohydrates, and the glucose receptors that let sugar into cells go on strike. The pancreas keeps producing insulin to try and lower blood sugar, and eventually wears itself out.
The body then goes into overdrive trying to keep blood sugar levels down, and the strain can cause a plethora of serious problems include heart attack, stroke, kidney damage, vision loss, nerve damage and poor wound healing – which can also result in amputation of limbs.
Sarcopenia research has been dominated by functional outcomes. But a recent review drew attention to possible metabolic consequences, focussing on various pathways that could lead to diabetes:
Therefore, the importance of preventing or reducing muscle loss and chronic disease with age cannot be understated. Prime targets are diet quality – particularly protein and vitamin D for muscle and generally a healthy diet to prevent chronic disease – and appropriately tailored physical activity.
https://www.sciencedirect.com/science/article/pii/S2213858714700348
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507610/
https://www.mja.com.au/system/files/issues/205_07/10.5694mja16.00446.pdf
Posted by ProPortion Foods Blog on Feb 6, 2018 in Dysphagia, Food Science, Nutrition, Protein, Research
Swallowing. Most of us perform this apparently simple act many times every day without a second thought.
Yet eating and swallowing is an extremely complex procedure that recruits over thirty different nerves and muscles to move food and liquid down the correct channels from mouth to stomach.
Malfunction in any aspect of this intricate operation can result in swallowing difficulties, or dysphagia, afflicting up to one in five older community-dwelling adults and around half of those living in aged care facilities.
It’s easy to lose heart when eating and drinking can’t be enjoyed as before, which can result in a vicious cycle of unintentional weight loss, malnutrition, and further despondency.
However, there are ways to keep the nutritional side of things on the bright side to avoid complications like pneumonia, dehydration and infection, and optimise health and recovery.
A team of health professionals helps manage dysphagia and navigate individuals through the act of safe swallowing and recovery, with speech pathologists at the helm and dietitians on board to carefully monitor a patient’s ability, progress and nutrition status.
In some cases, tube feeding through the nose or stomach (enteral nutrition) or directly into the blood (parenteral nutrition) is the best option to deliver or supplement with life-giving nutrients and fluid. But patients should be supported to eat and drink orally wherever possible.
Strategies for eating can include postural adjustments, swallow manoeuvres, trained feeding assistance, adaptive feeding equipment, distraction-free environment, swallow rehabilitation and texture-modified food and liquid.
Mildly to extremely thickened liquid or nectar is most commonly used for dysphagia. Thin fluids are avoided for fear of choking – therefore it is important to maintain good hydration, and watch out for dark-coloured urine, skin turgor and dry membranes.
Texture-modified foods, ranked according to their viscosity, have four levels of consistency depending on the patient’s swallowing and chewing ability.
Smooth pureed food is the easiest option. Much trial and error has been invested in getting this right – which would be obvious, for instance, if you’ve ever tried to puree green beans (hint: they’re stringy…).
The pureed food must have consistent thickness, be free from lumps and require no chewing. Examples include smooth, pureed cereals, meats, mashed potato, avocado, custard, and fruit-free yoghurt.
The next level is moist, semi-solid food that requires some chewing ability but is easily mashed with a fork. These foods can have a little texture and soft, smooth lumps, like cooked cereals, ground or cooked meat, and soft, canned fruit and vegetables.
Soft foods are allowed for more advanced swallowing and chewing ability, including well cooked vegetables, baked beans, soft or canned fruit, moist breads and rice, and tender, thinly sliced meat, fish or chicken.
Level four requires no texture modification – all foods are on the menu.
Some simple tricks can boost food’s nutrition density, like pureeing with milk or cream for extra protein and energy, and adding butter or milk powder.
And for those repelled by colourless, unidentifiable slop, advanced food manufacturing techniques now use thickeners and food moulds to enhance pureed food’s appeal while improving the nutrition profile.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426263/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597750/
https://www.dietetics.co.uk/nutrition-in-dysphagia.aspx
https://emedicine.medscape.com/article/2212409-treatment#d11
https://emedicine.medscape.com/article/2212409-treatment#d12
https://emedicine.medscape.com/article/2212409-treatment#d17