How do you promote good nutrition in the elderly?

Part three in our three-part series on nutrition

Read Part two here.

How do you promote good nutrition in the elderly?

Although it is important for the elderly to have enough nutrients for the day, it may be difficult to achieve their nutritional requirements due to social, cultural and environmental factors. Here are a variety of ways we can promote good nutrition in the elderly:

1. Diet

A nutritious diet is important for general health, wellbeing and to prevent any further diseases and conditions from developing. A healthy diet includes consumption of the Australian Dietary Guidelines’ five food groups, including fruits, vegetables, whole grain foods, dairy products, and lean animal meats, seafood and poultry. A balanced diet is key to general wellbeing, as when there is inadequate food consumed, this may lead to weight loss, malnutrition, and vitamin deficiencies. On the other hand, foods very high in sugars, saturated fats and oils may lead to unhealthy weight gain, obesity and cardiovascular issues.

2. Menu

Creating a menu to meet nutritional requirements and cultural differences may be quite difficult to cater for all residents. To ensure the seasonal menu is sufficient, Dietitians should be involved to recommend strategies to improve on nutrition and include resident feedback through the menu. Dietitians should be included in every seasonal menu as they ensure all current Aged Care Standards and guidelines are being adhered to. Onsite Menu and Mealtime Quality Assessments are to be conducted in every home as a minimum annually. Dietitians Australia recommend these are conducted twice per year per home.

3. Food fortification

A food first approach is the best step in improving the taste of food and beverages as well as quality of life. Food fortification is making the most of every mouthful. Each mouthful may have more energy and protein, but the overall volume of food to be eaten is not increasing. For extra energy and protein, you can add the following ingredients to all meals and snacks where possible: eggs, fish, chicken, meat, full cream milk, cream, cheese and yoghurt, oil, butter, Ice-cream.

This is highly recommended to minimise weight loss and risk of malnutrition. This method is great to serve for those who have poor appetite, usually consume small meals and struggle to meet their nutritional requirements. Bulk food fortification for all residents is beneficial in reducing the rate of weight loss across all homes which in turn reduce the risk of malnutrition. The most common nutrient dense food is the use of high protein milk, which can be used in place of milk or when milk is used in recipes such as mashed potato, cereal, porridge, creamy soups, white sauces, dairy-based desserts.

4. High energy high protein foods

Endorsing high energy and high protein foods assist with the prevention of weight loss and malnutrition. Energy is the calories or kilojoules that fuels the body to allow us to function and do our daily activities. High energy foods include creams, sugars, oils and avocado. Protein is the building block of muscles and maintaining muscle mass through high protein foods prevents muscle loss and increases strength and mobility. High protein foods include animal meats, fish, poultry, eggs, dairy foods, legumes, nuts and seeds.

A combination of both high energy and high protein foods will optimise the intake of nutrients. Examples of high energy and high protein snacks include cheese and biscuits, bread and peanut butter, sandwiches with thick amounts of high protein fillings, fruit and yoghurt, or eggs and avocado. Other foods that can be eaten with a meal as extras include custard, ice cream, and yoghurt or scrambled eggs at breakfast. Dietitians may also recommend high protein milkshakes or smoothies for example. 

5. Celebrating cultural days and special occasions

Special events across the year are a great time to spend time with family. Food plays an important part of all celebrations; it strengthens the community and brings together a sense of belonging. Different cultures celebrate with food in different ways especially on occasions like Lunar New Year, Greek Easter, Diwali, Christmas, Thanksgiving, Hannukah, weddings, birthdays, and anniversaries. It is important to celebrate these special days for residents and helps create a sense of belonging and often encourage oral intake.

6. Cultural diversity

Providing culturally diverse foods may be challenging in homes where there is a large diversity in cultures from around the world. However, inclusion of these culturally diverse foods provides variety, connection and a sense of belonging. It is highly important for aged care employees to also recognise foods that may not be culturally appropriate. For example, Muslim residents may avoid pork and instead require halal or kosher foods meats. By having foods that residents may recognise, there is a higher chance of residents enjoying the food, consuming those foods and getting enough nutrients and reducing the risk of weight loss and malnutrition. 

7. Lifestyle and social 

Going out to eat at cafes, restaurants and bars are a great way to increase social interaction. When we are together with other people, we eat differently compared to when we are alone. Our dietary behaviour may change based on where we are and who we are eating with. Encouraging our residents to eat with others in the dining room allows them to make friends and enjoy a social meal together.

• Eating together brings people together
• Enhancing social aspect increases oral intake
• Cooking classes are great interaction that lifestyle team can run. 

 

8. Serving hot and tasty food

Our residents may experience altered taste changes which may make it difficult for them to enjoy the foods they are used to. However, serving hot and tasty food can impact on how much the resident can eat as it tastes fresher and is more enjoyable. Ensuring food is always served hot to every resident is important to maximise oral intake. Also, enhancing the flavour profile of foods through herbs, spices, salt, pepper, sauces and other techniques are great ideas too.

9. Meal presentation

We use all our five senses when it comes to eating, and usually the first senses we use is sight, followed by smell and taste. Creating a colourful, visual plate increases food engagement and we are more likely to try meals that are well presented. Although, for those who are on specialised diets such as texture modification, presentation may be more challenging to achieve. And so, great ways to overcome this issue is by having multiple food colours on the plate, using piping bags to pipe the food on the plate, decorate the plate and using suitable texture modified garnishes.

10. Education

Understanding why a balanced diet is important for the elderly motivates change to menus, provide the nutrients they need for the day, understanding a disease and condition and how nutrition assists, cooking classes, and education posters and flyers. OSCAR Care Group have 32 quick education sessions designed to provide in-depth knowledge on Nutrition in Aged Care. These educations sessions are designed for Nurses, care team, food service team, kitchen team, care directors, and lifestyle team. Topics include Diabetes Management, Cultural diversity in food, Food Fortification, Dementia Nutrition, and more.

11. Cooking classes

Cooking classes are a great way to keep our residents active and provide a sense of independence in the homes. Cooking classes are fun and may teach the residents the importance of food and why nutrition is important for their diet. Lifestyle team can run interactive cooking classes with residents for special occasions or on a regular basis. Baking bread, for example, is a fantastic way to cook together, and create an amazing aroma through the home, which also encourages oral intake. Dietitians can also assist chefs on increasing their knowledge on different foods and ingredients that will assist in providing nutritious meals.

12. Family visits

Family visits are a special moment for residents and often encourage oral intake. It is also a good way for families to bring food that the resident may really enjoy. Families understand the resident and their food preferences, which makes it more likely to be consumed.

13. Dining experience

Getting the dining experience right in aged care is essential in providing a safe, comfortable, and friendly environment. By achieving this, allows for a more enjoyable dining experience and increases food oral intake. Aged Care homes often consider the comfortability of chairs, the type of utensils used, lighting, mealtime assistance and room size.

14. Mealtime assistance 

Some elderly may struggle to eat due to a cognitive impairment, physical disability or due to side effects from diseases and conditions. This may require assistance from employees or family to help feed the resident or open food packages when necessary. Ensuring the resident has the required assistance will improve their nutritional intake which in turn minimises the risk of weight loss and malnutrition.

15. Dietitians

Dietitians help with all the above. Dietitians are a fantastic source for reliable and evidence-based information. Google is not your friend for nutrition information – there is so much out there from celebrities, influencers, ads and social media. Dietitian referrals are great for personalised 1-on-1 support for residents in meeting their nutritional requirements, meetings with families, residents and other health professionals, and providing education to employees.

What do Dietitians do?

• Offering personalised nutrition advice to help us maximise our lives
• Enhancing your wellbeing
• Helping you live with food intolerances
• Managing your type 2 diabetes, Parkinson’s Disease, other chronic diseases
• Assisting with food allergies
• Nutrition training
• Assessing Residents in Aged Care Homes
• Menu Reviews and Menu Development
• Recipe Development and Recipe Analysis
• Recipe Books

 

When to refer to a Dietitian?

Unintentional weight changes are the main reason to refer to a Dietitian, however did you know that there are many other reasons that are just as critical? Refer to a Dietitian for any of the following:

• Chronic cachexia, malnutrition – at risk of malnutrition or malnutrition
• BMI <23kg/m2
• Ongoing symptoms: nausea, vomiting, diarrhoea, constipation
• Following a positive COVID-19 result
• Infection, wounds, pressure injuries
• Diabetes and unstable Blood sugar levels
• Acute CVA (cerebrovascular accident)
• Underlying renal/liver failure
• Enteral Feeding (e.g. PEG feeds)
• Blood test results that are out of reference range (e.g. electrolytes)

 

Our residents can face many nutritional challenges as they age. Achieving specific nutritional requirements is important to maintain a healthy weight and promote good health and wellbeing. There are different strategies that can be implemented when facing a barrier, this may include altering the seasonal menu to provide different foods to create a tastier and nutritious meal, food fortification and changing the diet code to meet the standards of care for the resident. In addition to meal changes, environmental factors need to be considered as they also contribute on food oral intake. By understanding potential aspects that may impact on food intake, this prevents the risk of developing diseases that may be life-threatening. Please reach out to an OSCAR Care Group Dietitian Accredited Practising Dietitian for support.

You can find more information here: respite care, long term care, food and nutrition and how to care for the elderly at home.