This latest webinar in our food myth series is focusing on our older Australians in Aged care. Malnutrition is far too common in the elderly population with statistics showing up to 50% of residents in aged care homes are malnourished or at risk of malnutrition. Our amazing Accredited Practising Dietitian, Sarah Chater, placed 14 popular nutrition myths under the microscope, only using the latest evidence-based practice to help our older Australians and carers.
Let’s debunk some elderly myths!
Older people don't need to eat as much, to some degree.
As we age, our bodies’ energy requirements may reduce, but often protein requirement and other nutrients are increased. The reduction in energy is often because we lose muscle mass in our senior years and don’t do as much physical activity.
On the other hand, we might have increased needs for protein and other nutrients with wound healing, infections, surgeries and other conditions we might encounter as we age. People might also think older people don’t need to eat as much because they may lose their appetite and the ability to recognise hunger cues. So, it is important to main focus on eating nutrient dense foods, think colourful fruits and vegetables, lean protein, wholegrains and dairy. It’s more quality of what they are eating over the quantity of food.
Older individuals require greater amounts of protein, calcium and vitamin D compared to adults. Elderly skeletons lose calcium. So, while a diet high in calcium does not reverse age-related bone loss, it slows the process down. Some great food sources of calcium include yoghurt, milk and calcium-fortified cereals and milks.
Some great food sources of vitamin D include fatty fish, fish liver oils and products fortified with vitamin D. There are also calcium and vitamin D supplements - before taking supplements, it’s best to discuss this with your doctor.
Losing weight is not a normal part of ageing.
How many times have you heard people say ‘I should lose weight’ as they get older? Whilst weight loss in older people may occur, it is definitely not a normal or expected part of ageing. It’s essential to keep an eye on someone’s weight (monthly) to ensure that they are staying within a healthy weight range. Let us dig a little deeper into why people might think weight loss is a normal part of ageing.
It is important to recognise the various factors that can contribute to weight loss, such as changes in metabolism, appetite, body composition and other conditions/illnesses. We need to address any significant or unexplained weight loss in older people and consult a Dietitian and Doctor to rule out any potential health concerns and minimise the risk of malnutrition.
Up to 50% residents in residential care are malnourished which has so many negative health consequences. It is important we all work together to minimise the risk of malnutrition.
If an older person is maintaining a healthy balance diet and meeting the nutritional requirements over time, that person should be able to regain weight or maintain their weight throughout the years.
Not every resident needs to drink a supplement.
Not every resident needs a commercial supplement drink. Commercial supplements can be found as tetra packs, bottles and powders that one can drink. Many commercial supplements are rich, concentrated and quite sweet which means that many residents do not enjoy them.
Dietitians recommend a food first approach to enhance the taste of food and focus on quality of life and enjoyment of food and supplements are often the last resort.
If a resident has reduced appetite, poor oral intake and/or weight loss, there are so many ways to increase the energy and protein in before considering a supplement. Some of these can include yoghurt, cheese and biscuits, custard, ice cream and milk. We can also fortify the meals by adding cream, milk powder and cheese, for example, which often makes them tastier as well.
There is still a place for supplements playing a valuable role when a resident is unable to meet their needs through food alone. Supplements will be required for fewer residents, not every resident as we aim for the food first approach.
Older people need to eat their greens too.
Our green vegetables are just as important for older people as they are for any age group. Leafy greens such as broccoli, kale and spinach along with other vegetables are packed with a range of vitamins, minerals like calcium, fibre for our bowels as well as antioxidants.
Vegetables are one of the five food groups, and it is recommended that older people eat 5 serves of vegetables per day. Examples of a serve could be 1 cup of leafy greens, ½ cup of cooked broccoli, spinach, carrots or pumpkin or ½ cup of canned beans or corn.
There are many ways to include vegetables throughout the day in aged care homes, some of these can be having baked beans or an omelette with spinach and tomato at breakfast, lunch can include some salad or boiled vegetables and at dinner you can put some vegetables and legumes in a soup such as chicken and corn, pea and ham or minestrone soup.
If we do have older people who aren’t fond of their greens, we can explore alternative options that still provide similar nutritional benefits. The key is to encourage a diverse range of vegetables in all colours.
It is possible to maintain muscle mass as we get older.
Maintaining muscle mass as you get older is indeed possible. Muscle mass plays an important role in our overall health and wellbeing: it supports mobility, balance and helps us perform everyday activities. Movement is important too, and as we reduce our mobility, we tend to lose muscle mass.
From the nutrition side of things, protein plays a key role in maintaining muscle mass, as we age our bodies may require a slightly higher amount of protein. This can be found in lean meats (beef, lamb, veal, pork), poultry, fish, eggs, tofu, nuts, seeds, dairy and legumes. We all have different protein requirements. You can consult an OSCAR Care Group Dietitian if you want to determine individual protein intake as it may vary with specific conditions.
Older people can maintain strong healthy bones.
During the ageing process, we tend to lose bone density, which increases our risk for osteoporosis. The key players in bone health are Calcium and Vitamin D. These can be found in dairy/alternative products, leafy green vegetables and fortified foods. Vitamin D also comes from the sun which some older people aren’t able to get outside as much so additional supplementation may be required.
Older people don’t want bland food.
The belief that as we age our taste buds fade and all we want is flavourless food. That is in fact False.
Older people still appreciate and enjoy a diverse range of flavours in their meals. Some older people may experience taste changes with certain foods and medications which may change what they enjoy eating, they may also require less salt due to heart conditions but that doesn’t mean we need to compromise on flavour.
There are many ways to enhance flavours without relying on excessive salt such as adding:
Herbs
Spices
Garlic
Onion
Lemon zest
Vinegar
Garnishes
Pepper
These can improve the smell, taste and visual presentation keeping food as an enjoyable experience.
Repetitive menus are not acceptable
This is not acceptable due to taste fatigue. We recommend seasonal 4-week menus, regular changes and always including resident feedback and preferences. Offering a diverse menu provides a range of nutrients, flavours and cultural diversity which often increases oral intake and appetite for older residents. Food that reflects their cultural backgrounds can act as a source of comfort and create a sense of connection.
A Dietitian’s input is required for all seasonal menus and a Menu & Mealtime Quality Assessment is recommended twice per year as per Dietitians Australia. The Menu & Mealtime Quality Assessment is The Gold Standard, onsite assessment and the Dietitian RECOMMENDED option.
It has been developed by Dietitians Australia for the exclusive use by Accredited Practising Dietitians, to provide your Aged Care home with an expert assessment and recommendations for your homes’ residents’ nutrition care, menu and mealtime experience. This assessment uses the Aged Care Quality Standards as the framework.
More information here Mandatory Aged Care Menu & Mealtime Quality Assessments are coming
Milkshakes can be good for residents due to the full cream milk and ice-cream.
Residents that require extra energy and protein may benefit from a high energy high protein milkshake which has added ice-cream, full cream milk and full cream milk powder. They can be an appealing option for individuals with increased energy or protein needs finding it difficult to meet their requirements through regular meals and snacks.
It is often enjoyed by residents and the flavours can be changed daily with toppings including strawberry, milo, chocolate, caramel, blue, vanilla, lime etc. or fruit such as bananas/berries.
Older people don’t necessarily have to eat soft foods to ensure a full diet.
Not all older people need to have soft foods to ensure an adequate diet. They may experience some challenges with chewing or swallowing difficulties, and in this case, it is best to refer to a speech pathologist to identify what type of texture food a resident or older person may require. The Regular Diet (IDDSI level 7) allows the benefit of enjoying foods of all textures. As we move down the pyramid to the lower levels with softer food, there are usually less food options to cater for resident safety for chewing/swallowing. So, it can become more restrictive.
Ideally softer foods should only be provided for all meals and snacks if that was what an individual person needs, it is not what all older people need. IDDSI training is recommended for all staff in aged care that work with foods or drinks: nursing, care, lifestyle, food service, kitchen staff and chefs. OSCAR Care Group offer IDDSI training to best support your residents. Reach out to book your session now.
It is not essential for residents to eat 3 proper meals a day.
Whilst regular meals are important and some people can thrive on three meals a day, others may prefer smaller, more frequent meals and mid meal snacks. What truly matters is ensure that residents receive balanced nutrition and meet their requirements whether that is in 3 meals, across 6 meals, through fluids, supplements or even enteral feeding (tube feeds to through the nose or stomach for example). Everyone is different and that personalised nutrition approach will find what suits their needs.
A resident may require a supplement for more reasons than looking undernourished.
While visible signs of malnutrition can indicate the need for additional support, it is important to have a Dietitian to make an assessment and possibly meet their needs through a food first approach as discussed in earlier. Then a commercial supplement can be considered as a last resort. There is a place for supplements in aged care, but it doesn’t have to only be if a resident looks undernourished. Other times where supplements may be required:
If a resident has reduced oral intake and other methods have already been trialed.
If a resident is unwell for short term for example if they recent have COVID with poor appetite.
Following a surgery for recovery
Wound healing for short term
If enteral feeds are requires, this will require a supplement ongoing
It is important for supplements to be reviewed every 3 months by a Dietitian to monitor and evaluate the effectiveness of the supplement and make adjustments to the dose if required.
Diabetic diets are not commonly used in aged care.
Diabetic diets are not used in many aged care homes. A well-planned and balanced menu should be provided to all aged care residents including those who have diabetes. It can be challenging to manage diabetes in an aged care setting, as it can be a balancing act between controlling blood glucose levels, optimising quality of life and preventing weight loss and malnutrition.
If blood glucose levels are within range, it is important not to unnecessary restrict their diet further which can result in decreased food and fluid intake and can lead to a risk of malnutrition.
The main goal should be on meeting their dietary requirements and older people should be able to enjoy all types of food including carbohydrates. Milk, yoghurt, HEHP sandwiches and milo are all good contributions to the energy and protein intake in the elderly. Restricting those further in diabetic patients may lead to weight loss and malnutrition.
Refer to your OSCAR Care Group Dietitian for a personalised approach to support your diabetes, as we are all different and our blood sugar ‘normal’ range is different from another person.
It's never too late for seniors to improve their eating habits.
Regardless of age, making positive changes to one’s diet can have significant benefits for their overall health and wellbeing. Age is just a number when it comes to improving your eating habits.
Some impacts of improving eating habits in seniors include:
Enhance nutritional intake: As people age, their nutrients needs may change due to factors such as increased requirements with disease states, infection, wound healing and absorption efficiency. Improving their eating habits can help ensure they are getting the necessary nutrients to support their bodily functions and maintain good health.
Managing Chronic Conditions: A balanced diet can play a crucial role in managing and preventing various conditions that are common in seniors such as heart disease, diabetes, osteoporosis and kidney failure. An accredited practising dietitian can help you identify areas in your diet which can be improved to manage these conditions such as balancing protein intake throughout the day, limiting salt if swelling is involved, managing carbohydrates and increasing calcium intake.
Maintaining a Healthy Weight: Adopting healthier eating habits can help seniors to manage their weight and reduce the risk of malnutrition and complications associated with obesity. Adequate protein intake and a balanced diet can help older adults maintain muscle mass and strength which is crucial for maintaining independence and mobility.
As we get older, our protein, calcium and Vitamin D requirements actually increase. So, it is certainly not too late. Now is the time to really focus on ensuring these nutrients, in particular, are being met.
Remember, small changes can make a significant difference, and it is never too late to improve your eating habits through better nutrition.
We’re here to help you!
We hope you enjoyed this elderly nutrition webinar. Dietitians are a reliable source of evidence-based nutrition so always reach out to a Dietitian for support.
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