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.
As residents largely forfeit their say on the 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 are 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 rise 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, which looked 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).
Older adults are known to be at a disproportionate risk of malnutrition (Rossi 2017). There are many reasons for this, including:
Decreased food intake due to factors such as isolation and reduced ability to access food
Physical impairment such as disability, reduced appetite, reduced sense of taste or smell, difficulty chewing or swallowing, difficulty self-feeding and difficulty preparing food
Cognitive and psychological issues such as dementia, depression, anxiety, self-neglect and bereavement
Being unable to consume certain food groups due to difficulty chewing, swallowing or digesting
Polypharmacy, which may impair nutrient absorption or increase nutrient loss
Having a poor eating environment
Inflammation associated with disease, injury or illness
Requiring assistance with eating due to factors such as cognitive impairment
Being unable to consume sufficient amounts of food.
(TAS DoH 2020; Rossi 2017; Iuliano-Burns 2019)
Preventing and Treating Malnutrition
The following three methods are advised for preventing and treating malnutrition
Ensuring that sufficient energy and nutrient quality is met through meals and food between meals
Improving 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:
Supervision, prompting and encouragement
Setting up cutlery etc.
Cutting up meals
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 type of food a person should be eating in accordance with their age and gender.
Foods to Avoid
Limit foods that are high in saturated fats, including cakes, pastries, processed meats, pizza, fried foods, potato chips etc.
Limit foods and drinks with added salt and avoid adding salt to food when eating
Limit consumption of salt-rich foods such as cured meats, snack foods and sauces such as soy sauce
Limit foods and drinks high in sugar, such as confectionery, 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
Note: These recommended servings are for older adults aged over 70. For a comprehensive list of servings based on age and gender, see the National Health and Medical Research Council’s Australian Dietary Guidelines Summary.
Eat from each segment of the food group regularly:
Vegetables, legumes, beans:
Five serves per day. One serve is about 75 grams (e.g. ½ a cup of cooked green or orange vegetables or ½ a cup of cooked beans, peas or lentils)
Choose a variety of types and colours (e.g. green, orange, red, yellow, purple and white)
Two serves per day. One serve is about 150 grams (e.g. one medium apple or banana, or one cup of diced fruit)
Lean meats and poultry, fish, eggs, tofu, nuts and seeds:
Two (women) or two-and-a-half (men) serves per day. One serve is about 500 to 600 kilojoules (e.g. 65 grams of cooked lean red meat or two large eggs)
Grain (cereal) foods (mostly wholegrain and high-fibre):
Three (women) or four-and-a-half (men) serves per day. One severe is about 500 kilojoules (e.g. one slice of bread or ½ a cup of porridge)
Dairy (milk, cheese and yoghurt):
Three-and-a-half (women) or four (men) serves per day. One serve is about 500 to 600 kilojoules (e.g. one cup of milk or ¾ of a cup of yogurt)
Drink plenty of water (six to eight cups every day)
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
High fibre and water intake will assist movement in slow bowels
Eat fish regularly as it has been known to reduce the risk of heart disease, stroke, dementia and macular degeneration
Some older adults may benefit from vitamin or mineral supplements, however, these are not to be taken simply to compensate for a poor diet.
(Better Health Channel 2017; NHMRC 2013; Nutrition Australia 2013)
Nutrient Requirements for 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 and 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*.
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)
Meal Planning Considerations
Some residents have specific meal requirements. When planning meals, always take into account the following: