The appalling, substandard quality of residential aged care in Australia hit the limelight in recent years after staff spoke out and sparked a much needed royal commission. Malnutrition was one of many pressing issues, compounded by scant food budgets, low quality food, poor working conditions and inadequate staff training.
This pervasive problem has flown under the radar for far too long. It’s estimated that around half of aged care residents are malnourished, with dire and far-reaching consequences for health, quality of life and mortality. While efforts are being made to address malnutrition, it is complex and we still have a long way to go.
A complex problem
Addressing malnutrition in older adults goes well beyond serving nutritious meals – although that would be a good start. Other contributing factors include poor appetite, gut issues, swallowing difficulties, depression, chronic conditions such as dementia, diabetes and frailty, and even something as basic as inaccessible food packaging.
Institutions and staff also need to consider individual food preferences and dietary needs, and create a pleasant, appetising dining experience. “We have the opportunity to impact on every resident’s life six times a day,” said an aged care worker in a study of food service, “by providing them nutritious, healthy, beautiful looking tasty food.”
Professor Judi Porter from Deakin University in Victoria emphasises the importance of this. “One-on-one nutrition care provided by dietitians is important, however the food service, and particularly the menu, underpins the care for all people in hospitals and aged care. It’s critical to get this right,” she says.
Follow up is also needed at mealtimes, helping where necessary and investigating why meals aren’t eaten. A recent study led by Prof Porter in four residential facilities found that out of 420 aged care residents, only around one in ten finished their lunch or dinner.
What can be done?
Various people and organisations have taken steps to tackle the issue of food quality and consumption in residential aged care, including Maggie Beer, Nutrition Australia and The Lantern Project.
One key focus is enhancing the experience of enjoying good food through a warm, friendly atmosphere with appealing food presentation. Some enterprising homes have introduced edible gardens while others have been engaging residents in cooking meals.
On a broader scale, the Victorian government released recommendations to improve food standards in hospitals and aged care, and the Australian government recently started releasing a series of Food, Dining and Nutrition Resources. These initiatives are not just good for staff and residents, but many might be surprised that it can actually save healthcare costs. It could also address the broader problem of food wastage.
For such initiatives to gather momentum, it would help to have mandatory nutrition standards. To support this, there was a recent call to integrate independent research into aged care. Added to that, it has long been noted that dietitians should be given a greater role in facilities, recognising the importance of food and mealtimes as fundamental to effective healthcare.