“But where do you get your protein from?” This is a common question of vegetarians, perpetuated by a long-standing myth that if you don’t eat your meat you will become weak and emaciated.
This myth has been well and truly busted – but it doesn’t mean that people who eschew meat can rest on their laurels. Like all older adults, vegetarians need to be mindful of meeting their protein needs.
It is true that we need protein, even more so with aging. While Australian guidelines spout 0.75g/kg bodyweight per day, this falls short of international guidelines stipulating 1.2g/kg for older adults – and recent evidence putting it as high as 1.5g/kg.
These levels help counteract diminishing lean muscle mass and strength that occurs with aging, reducing risk of sarcopenia and associated falls, fractures, hospital admissions, declining independence and mortality.
And it’s not just muscles that need protein. These industrious amino acid assemblages support wound healing, bone density, immunity, lung function and cognition.
So how do vegetarians get theirs?
When combined with exercise, research shows it doesn’t matter which type of protein people eat – plant, animal or otherwise – to boost muscle health.
But while plant sources comprise 40% of the world’s protein intake, Australians get 60% of theirs from animal origins.
And although the Australian Guide to Health Eating recommends legumes as a primary protein source for vegetarians, a review found that legumes constitute a meagre 0.44% of diets in aged care facilities – served with meat.
Even for non-vegetarians, legumes are a no-brainer – they are cheap, versatile, packed with nutrients and fibre and one of the best solutions to soft-textured diets for older adults with swallowing or chewing difficulties.
The scrumptious, wholesome meals that can be cooked with legumes are only limited by the imagination, ranging from a vast range of soups and vegetable patties to dals, dips and casseroles.
Other non-meat sources of protein abound too, including eggs, milk, cheese, nuts, wholegrains, seeds and hemp.
For older adults with higher protein needs due to poor appetite, declining muscle mass and strength or illness, eggs and dairy (cream or milk powder) can be used to fortify meals and make a great base for snacks.
Beyond protein, evidence suggests that a good quality diet is most important for preventing frailty and fragility, providing all the nutrients, polyphenols and fibre essential for good health.
After addressing dietary needs, some nutrition supplements might be advisable. Vegetarians and vegans would benefit from an algal source of the long chain omega-3 fatty acid DHA that is consumed directly through deep-sea fish.
Vegans may need supplementation to meet requirements for Vitamins D and B12. Pea protein can be used as a concentrated protein source where needed. Contrary to popular opinion, there is plenty of iron in plant foods – including legumes.
With a growing population embracing various diets without animal-sourced food – for health, ethical or environmental reasons – aged care facilities need to step up and leave the antiquated “meat and three veg” behind.
Special diets aside, the variety and quality of food provided in residential care is in dire need of an overhaul to address nutritional, cultural and personal needs and preferences in a way that enhances appetite and the social bonding that can only come from sharing a tasty meal in a pleasant environment.
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.
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Like all industries in the 21st century, the aged care sector is under increasing pressure to factor sustainability into its business model and long-term planning.
This includes employee satisfaction and social equity, which are necessary for a thriving, successful business and for achieving sustainable solutions and resident wellbeing.
The intimate connection between environmental and economic considerations is becoming harder to ignore as precious resources dwindle and prices go up.
Population growth is driving up demand for food, water, energy and land, while reliance on fossil fuels and excess waste is becoming increasingly untenable.
Add to that an ageing population, with a quarter of Australians expected to be over 65 in just three decades, increasing demand for residential care facilities.
Key pressures to make these sustainable by minimising water and energy use and waste derive from the need to operate more efficiently and to create a good reputation.
Evidence shows that engaging employees through sustainable programs is fundamental to achieving positive outcomes, through their input into generating ideas and carrying them out.
“An investment in sustainability – people, planet and prosperity – is core to how an organisation can succeed and prosper as a business,” writes sustainable business expert, Dr Kaushik Sridhar.
Energy bills in aged care can be reduced by 80%, according to energy efficiency consultancy Conservia, as well as improving resident comfort and staff productivity, and can even achieve net zero energy use.
Their aged care package involves a multipronged approach included solar panels, submetering, a system to manage the building’s mechanical and electrical equipment, reflective window films, thermal paint for cooler roofs, and voltage optimisation.
Educating staff is also a high priority, to teach them how to use central control systems and change behaviours around opening windows and doors.
Some places, like HammondCare, are also getting creative with recycled materials, harvesting grey water, water-efficient gardens and optimised natural light as part of their Environmental Position Statement that aims to reduce energy and waste.
LED lighting and solar installations are key energy saving tools, which Regis Aged Care is focussing on at 35 of its sites across Australia to reduce their energy bills and environmental footprint.
They estimate these steps alone, involving enough solar panels to cover 33 tennis courts and more than 15,000 lights, could reduce annual energy consumption by up to 20% and greenhouse gas emissions by 3,700 tonnes, the equivalent of taking 1,500 cars off the road.
Importantly, their investment is projected to pay itself off in less than four years.
Warrigal aged care has been making impressive inroads in sustainable strategies for more than ten years through university collaborations, winning them several sustainability awards.
As well as energy efficiency initiatives, they have created a ‘sustainability in the home’ guide for independent living residents. They also recycle clothing and buy Greenfleet carbon offsets.
Committed to finding ways to reduce energy and waste and to apply sustainability design standards to new and upgraded buildings, sustainability manager David Rogers also recognises the importance of developing the right staff culture.
“We acknowledge that this is an ongoing journey and until sustainability is ingrained as a habit in all of our 750 staff, I’m not going to consider it successful,” he told Ageing Agenda.
Joining in the spirit, enterprising residents at Emmaus Village have been teaming up to recycle plastic bottles through Scouts Recycling Centre and have raised funds that go back into organising activities for the residents.
Others are putting on their gardening gloves, which not only reduces the need for food packaging and transport, but also has established benefits for physical and mental health and wellbeing.
Food waste is another pressing environmental and economic issue, especially pertinent to health care facilities. Solutions are also at hand here, such as the Love Food Hate Waste Program.
Anglican Care trialled it and reduced food waste by 6,000 kg per year on average per residential aged care, diverting it from landfill to local farms as mulch and compost – a win-win all round.
While multitudes of people around the world face food insecurity, a whopping third of food is lost or wasted. This equates to more than a billion tonnes of food valued at nearly $940 billion every year.
Australia is a part of the problem: five million tonnes of food reach landfill annually, which would fill 9,000 Olympic sized swimming pools, according to OzHarvest. This comes at no small cost – wasted food costs the Australian economy around $20 billion a year.
Apart from the financial cost, food waste impacts the environment. Precious resources such as water and energy are used to grow, transport and sell food. And every tonne of food that ends up in landfill results in 750kg of carbon dioxide being released into an already overloaded atmosphere.
Every business, school and household needs to pull their weight to address the problem. But health care facilities face unique challenges in dealing with their contribution.
Food surplus accounts for half of all waste generated by the health system, squandering resources, labour and finances.
In 2015, an Australian audit found that 200 grams of food was wasted, on average, per bed each day in hospitals and aged care facilities. Most of this came from uneaten food on patient trays. Other sources are hospital kitchens and cafeterias, according to a US survey.
In hospitals, food service revolves around health care procedures, generating several different routes for food waste. These include bulk cooking, long delays between ordering and serving, and missed meals due to hospital procedures, fasting, test scheduling, and patients being checked out.
Patients and older adults are more likely to have poor appetite and treatments and conditions that limit eating through symptoms like pain and nausea.
Palatability of hospital food is a key issue, as well as packaged food that is unopened and thrown away or half-eaten – which also contributes to plastic pollution.
These issues not only have implications for food waste, but also for patients’ nutrition intake.
Methods for serving patient meals have not changed in 30 years. Improved technologies offer several ways in which the issue of food waste – and associated problems like surplus food costs and malnutrition – can be addressed.
A study by HealthShare NSW reformed hospital food delivery using improved workflow processes and menus, staff training and technology. The project aimed to decrease the time lag between ordering and getting meals to four hours or less, improve food quality and nutrition and increase patient choice.
As a result, improvements were made at various stages of the process, reducing patient food waste by half. Patients’ food intake also increased considerably.
Other health care facilities have switched to a room service model for feeding patients. This personalised approach results in better patient satisfaction, in turn improving nutrition intake and reducing food waste.
Melbourne’s health department joined other organisations to trial recycling organics, finding it a viable way to divert wasted food from landfill.
In all, combining streamlined technologies and procedures for storing, ordering, delivering and disposing of food with improved patient choice, food quality and dining environments can improve nutrition intake and reduce food waste – a win-win on all counts.