Careful thought and creativity is as important to aged care menu planning as it is to the selection of our own daily meals – if not, more so, given the heightened health complications inherent with ageing.
When a person enters an aged care facility, their autonomy may have decreased significantly. One of the many choices an individual may mourn is the lack of choice in meal selection.
Residents largely forfeit their say on timing, duration and environment of mealtimes, it only seems fair that they will want input into the type of meals they receive.
It is well known that food consumption and nutrition is closely linked to our overall quality of life. Studies have shown when residents have the agency to choose from a menu, levels of food service satisfaction have risen to up to 30% (Abbey 2015).
Increased independence in food choice and active participation in food planning has also been associated with a reduced risk of malnutrition (Abbey 2015).
This article will provide broad nutritional advice for older people and outline methods of effective meal planning in aged care facilities.
One study, conducted by the British Journal of Nutrition looking into the nutrient content of meals in Australian aged care facilities, found that 68% of participants were either malnourished or had the potential to become malnourished (Rossi 2017).
In or outside of the aged care context, older adults are known to be at a disproportionate risk of malnutrition and health complications (Rossi 2017; World Health Organisation 2019).
There are many reasons for this, some of which are physical–the elimination of particular food groups due to the difficulty experienced by residents in chewing, swallowing or digesting food elevates their risk of malnutrition (Rossi 2017).
Older adults are at an increased risk of malnutrition if they also live with one of the following:
Inflammation – associated with disease injury or illness.
Eating dependency – requiring assistance with eating, such as those with cognitive impairment.
Eating restrictions – a person is unable to consume sufficient amounts of food.
Food intake – food intake is limited for various reasons, such as a person has difficulty in obtaining ingredients and preparing meals.
Preventing and Treating Malnutrition
The following three methods are advised for preventing and treating malnutrition
Ensure that sufficient energy and nutrient quality is met through meals and food between meals.
Improves the nutritional density in meals;
Can be used as a vehicle for nutrients, for example adding Vitamin D to foods.
Found to be particularly effective in hospital settings;
Potentially less effective in aged care settings.
Feeding assistance is one method to curb malnutrition in older adults. The level of assistance required by clients will vary. Assistance can range from:
Simply requiring supervision, prompting and encouragement;
Cutting up; and
Full feeding assistance.
(Eat Well Nutrition 2014)
The style and manner of feeding assistance is important to get right. Staff must be trained to feed in a controlled manner, distractions should be minimised, altered utensils are made available, and swallowing rehabilitation is to be encouraged if appropriate (Iuliano-Burns 2019).
A Dietary Guide for the Older Adult
Our dietary needs change as we age. It is important to know how much, and what a person should be eating in accordance with their age and gender.
The following is advised by Nutrition Australia as dietary recommendations in people over the age of 65.
Foods to Avoid
Limit consumption of salt-rich foods such as cured meats, snack foods, and sauces such as soy sauce.
Avoid or limit intake of foods containing saturated or trans fats, including pastries, chips, and chocolate.
Limit foods and drinks high in sugar, such as confectionary, sugar-sweetened soft drinks, cordials and fruit drinks.
Limit consumption of alcohol to no more than two standard drinks per day.
Keep 'extras' such as lollies, cakes, biscuits, fried foods and pizza to a minimum, they should not feature regularly and are not part of a healthy diet.
(Rossi 2017; Better Health Channel 2017).
Foods to Embrace
Eat from each segment of the food group regularly:
Vegetables, legumes, beans:
A daily serve of about 75 grams, consider ½ a cup cooked green or orange vegetables or ½ cup of cooked beans, peas or lentils.
Lean meats and poultry, fish, eggs, tofu, nuts and seeds:
A daily serve of 500-600 kilojoules, for example 65 grams of cooked lean red meat or two large eggs.
Fruits, grain (cereal) foods (mostly wholegrain and high-fibre):
Fruits–a daily serve of 150 grams, for example a medium apple or banana;
Grains–one slice of bread or ½ cup of porridge.
Dairy (milk, cheese and yoghurt):
A daily serve of 500-600 kilojoules, for example a cup of milk or ¾ cup of yogurt.
Swap foods that are high in saturated fat with foods containing polyunsaturated and monounsaturated fats.
Switch foods such as butter, cream, cooking margarine, coconut and palm oil with unsaturated fats from oil, nut-based butters and pastes, and avocado.
Eat ample amounts of fibre alongside increased fluid intake (6-8 cups a day).
High fibre and water intake will assist movement in slow bowels.
Fish should be eaten regularly as it has been known to reduce chance of heart disease, stroke, dementia and macular degeneration.
Consider vitamin or mineral supplements but these are not to be taken simply to compensate for a poor diet.
(Better Health Victoria 2017; National Health and Medical Research Council 2013)
(CC Australian Guide to Healthy Eating, Commonwealth of Australia 2016)
Nutrient Requirements of Older Adults
Increased intake of the following nutrients is recommended for older people. Keep these requirements in mind in all meal planning:
Calcium and Vitamin D;
Fats (polyunsaturate; monounsaturated).
(Wolfram 2018; Better Health Channel 2017).
We eat with our eyes first, which means that the visual appearance of a meal matters. Make sure to incorporate a wide variety of colours, textures, flavours and types of food to keep things interesting in aged care meal planning (Leading Nutrition 2017).
While rotational meals are doubtless a more convenient option in aged care facilities, keep in mind the importance of meal variation on resident nutritional needs and meal enjoyment.
To ensure that aged residents are meeting their nutritional needs, consider the following meal suggestions*.
Cereal with added yoghurt and fruit;
Nut-based spread, egg or sardines on wholegrain toast.
An open sandwich with cheese, ham, tuna/sardines accompanied by milk or banana smoothie;
Vegetable cheese frittata with salad;
White bean soup with vegetables and/or chorizo.
Grilled white fish or salmon with sauce, potatoes and vegetables;
Moroccan chickpea vegetable casserole;
Slow-cooked beef casserole with gravy and vegetables;
Creamy pasta with vegetables.
Ice-cream, yoghurt or custard with fruit.
Better Health Channel 2017; Pro Portion Foods 2018)
(*Take into account dietary restrictions; eating and swallowing capabilities; and cultural requirements regarding food and eating customs.)
Technology is rapidly enhancing the scope and appeal of pureed and textually modified foods, for suggestions on meal service and meal presentation see: Meal Service in Aged Care.
Flanagan, D, Fisher, T, Murray, M, Visvanathan, R, Charlton, K, Thesing, C, Quigley, G and Walther, K 2012, ‘Managing Undernutrition in the Elderly; Prevention is Better Than Cure, Australian Family Physician, vol. 41, no. 9, pp. 695-9.
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