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.”
Addressing claims that nutritional supplements can enhance overall health and longevity, a recent review investigated their impact on heart health, stroke and mortality. The researchers report that most supplements did not show evidence of benefit or harm.
They investigated 179 randomised controlled trials of vitamins and minerals. Folic acid and B complex vitamins reduced risk of stroke.
Multivitamins, vitamins A, 6, D and E, beta carotene, zinc, iron, calcium, magnesium and selenium were not linked to heart disease or mortality. Large dose B3 and antioxidant vitamins had small links with greater risk of all-cause mortality.
Limitations of the review include exclusion of cohort studies which are conducted over longer time frames and are more characteristic of the population at large. The researchers also note that antioxidants were lumped together but in reality have different modes of action.
Available evidence suggests that B vitamins – possibly through their homocysteine-lowering properties – may be a good choice for reducing stroke risk. Other research has shown they might also help prevent dementia.
Other nutritional supplements may not impact heart health or lengthen lifespans – which is not to say they don’t have other benefits, for instance to boost immunity when stressed, avoid the flu or address nutritional deficiencies.
But the overarching take-home message – that most agree on – is that supplements do not replace a healthy diet.
First and foremost, a diet rich in plant foods like fruit, vegetables, legumes, nuts, seeds, wholegrains and healthy fats (e.g. extra virgin olive oil) delivers a kaleidoscope of vitamins, minerals, antioxidants and fibre, with interactive health benefits that supersede supplements alone.
Basically, you may eat your cake, but taking a tablet won’t make it healthier for you.
Australians are amongst the world’s highest supplement users per capita. Older Australians – particularly females – are the cohort most likely to take nutrition supplements, according to the latest national survey.
Supplement users were also more likely to eat healthier diets, so are likely to be more health conscious. Researchers caution that this combination could result in exceeding recommended daily intakes.
In this case fat soluble vitamins like Vitamins D and E are ones to be most aware of because excesses are retained in the body. If water soluble vitamins like the Bs exceed requirements, they are safely excreted.
In aged care, a survey revealed that expenditure on nutritional supplements and food replacements had increased by 128 percent. In this scenario older adults may suffer malnutrition, in some cases requiring supplements like concentrated protein powder if appetite is low.
For instance, a study in convalescing patients with disabilities found that nutritional supplements combined with resistance training improved muscle mass and activities of daily living.
Other nutrients that may be at particular risk in aging, and therefore benefit from supplementation, include B12 and Vitamin D. It is recommended to advise your health care provider of all supplements and medications so they can be aware of potential adverse interactions.
Pill swallowing can be daunting. In fact, one survey revealed around 40% of adults who otherwise had no swallowing problems struggled with pills. What if, on the other hand, pills themselves make food and liquid difficult to swallow – otherwise known as dysphagia?
Medication use is widespread in older people. According to a survey published in 2012, more than 80% of Australians over 50 reported taking one or more medicines within the past 24 hours. Over 40% had taken five or more medications – both prescription and complementary.
Medication side effects, particularly in aging, can cause drug-induced dysphagia. Directly or indirectly, this can result from a specific medication, a certain combination of medications or ‘polypharmacy’ – taking more than 5 medications, as is common in older people.
Dry mouth or confusion, central nervous system suppression and muscle relaxation are medication side effects that can interfere with swallowing either temporarily or persistently. Some drugs can directly damage swallowing mechanisms.
Much of this drug-induced dysphagia can be avoided by thoroughly and accurately assessing a patient’s medication use. Patients should be informed and empowered to request this from their practitioners. Where possible, unnecessary or harmful prescriptions can be eliminated or replaced with alternative or liquid medications.
Other strategies to facilitate easy swallowing include taking medications at least 30 minutes before bedtime with plenty of fluid and sitting at a 45-90-degree angle, sipping water regularly throughout the day, using a saliva substitute, and taking one pill at a time.
One study tested two further methods to help pills go down.
The first is a “pop-bottle method.” This involves filling a bottle with water, placing the tablet on your tongue and drinking the fluid and pill with a sucking motion, lips placed firmly around the bottle opening. Study participants reported swallowing large pills was 60% easier doing this than sipping water from a cup.
The next method yielded an 89% perceived improvement. Somewhat counterintuitive, this approach involves putting the pill on your tongue, taking a sip of water without swallowing, then dropping the chin down to your chest to swallow the pill.
Unavoidable dysphagia can be managed by a team including speech pathologists and dietitians to facilitate swallowing and recovery. Most importantly, nutritional needs must be addressed to avoid malnutrition and further complications, where necessary using texture-modified food.