CHA Bulletin #1
Committee for Healthy Ageing
Bulletin No 1, March 2010
Welcome to the first issue of our new quarterly Bulletin of the New Zealand Nutrition Foundation Committee for Healthy Ageing. The committee, a special interest group of the Foundation, was initially established in 2004, to champion the cause for improving the quality of life of older New Zealanders, through nutrition and physical activity. Each quarter, this bulletin will update you on issues of importance or topical interest in relation to optimal nutrition and physical activity of older people. We hope you will find them informative and interesting. Also visit the Foundation’s website, www.nutritionfoundation.org.nz, for more information, or to send us a question or comment for our attention via the ‘contact us’ link.
Goals of the Committee for Healthy Ageing
1. To promote strategies, Government and otherwise, throughout New Zealand, e.g. the Health of Older People Strategy and the Positive Ageing Strategy.
2. To encourage older consumers to make informed, healthy and enjoyable food choices as part of an active lifestyle.
3. To increase the awareness and knowledge of health professionals and care givers about the nutrition and physical activity needs of older people, including the risks associated with frail older people.
4. To promote Positive Ageing by networking and co-operating with groups in all sectors with similar goals and interests, e.g. food industry and agencies such as Age Concern, Grey Power.
To achieve our goals, the Committee has two groups of members – a Working Committee and an Advisory group of experts we call on when we have specific projects needing their expertise. The Working Committee meets four to five times a year and represents a diversity of interests relating to older people.
Introducing the Committee
Julian Jensen, Dietitian, Committee Chair
Dr Graham Davison, retired Geriatrician
Dr Bevan Grant, University of Waikato
Dr Carol Wham, Massey University
Dr Alex Chisholm, University of Otago
Sione Tupou, Health Promotion Advisor, Auckland DHB, member of Pacific Island Food & Nutrition Advisory Group
Alison Ogg, Age Concern
Professor Cliff Tasman Jones, former Medical and Scientific Director, New Zealand Nutrition Foundation
Julie Dick, Senior Nutritionist, Heinz Watties
John Rice, Auckland University of Technology, Director, Never2Old programme
Sue Pollard, CEO, New Zealand Nutrition Foundation
The Committee achieves its goals in a variety of ways:
Seminars for health professionals working with older people: These are often in partnership with other agencies, such as the ACC, Dietitians NZ and the NZ Association of Gerontology.
Resource development: Resources are developed in identified areas of need and, again, often in partnership with agencies such as NZ Food Safety Authority, 5+A Day and SPARC.
Media and communications: Communication with media through releases and one-on-one contacts is made proactively on topics of interest, as well as responding to requests for expert comment.
Special feature
Do we take dining rooms in residential settings for granted? Are they just a functional area for serving food, or a place to be enjoyed, offering social interaction?
In each issue of the bulletin, we will include a special feature highlighting a particular topic of interest or new piece of research. This time Committee Chair, Julian Jensen, describes recent research conducted by the University of Otago Dietetic Training Programme in a sample of rest homes.
A study was conducted to investigate the dining environment in a convenience sample of 50 rest homes in New Zealand to identify promoters and barriers to achieving an optimum diet, and to determine themes from the sample that reflected the food environment of these facilities. This study was conducted by 10 student dietitians in nine locations throughout New Zealand.
The student researchers found many promoters that enhanced the opportunity for a positive dining experience. These included the ambience of the dining room – newly refurbished, relaxed and comfortable, and the attitude of the staff – staff who took mealtimes seriously and who took care to ensure residents had meals they enjoyed, who chatted and joked with residents. Saying prayers or Grace and reading out the menu before the meal were appreciated as well. Residents spoke of enjoying having dining companions and the food because it offered variety and reminded them of when they were younger.
However, the residents also identified barriers. These included the dining room and/or the food were often cold, the meals were boring, and not liking to cause a fuss if something was not quite right. The student researchers identified barriers that reduced the potential for a positive eating experience. Many of these observations included residents not having the right utensils to eat meals or missing out altogether, rushed and stressful mealtimes, interruptions such as hairdresser appointments and desserts served before the main course was finished.
Staffing and staff training
Inadequate staffing or supervision at mealtimes was a significant contributor to malnutrition and dehydration in the elderly living in residential care (1). This study showed variable staffing levels in the dining room at mealtimes, with more staff available for the midday meal than in the evening.
The uptake of training opportunities in food and nutrition by staff was generally low. It is known that well-trained staff have enhanced awareness of nutrition risk associated with ageing, and that where training is inadequate, poor nutrition status is not recognised, there is a lack of awareness of the need for intervention either by the dietitian or the nurse, and there is poor knowledge of nutritional care.
The menu, meals and the foodservice system
The influencing factors described above obviously have a key role in promoting optimum nutrition. Positive features, supported by the literature, include:
· Menu cycles of four or more weeks, and audits by dietitians
· Adequate food purchases and portion sizes of key items
· Frequent meals, snacks and beverages (preferably 24 hour availability)
· Meal service systems encouraging familiarity with the norm – buffet, bulk, dinner at night
· Choice
· Familiar foods and catering to specific needs – cultural, age, dislikes, nutritional needs
· Serving all residents at the same time
· Self-service to enable greater autonomy
· Minimisation of restrictive diets
This study found most of these features in dining environments, to a greater or lesser extent. One facility in our study had a café where residents, friends and family could socialise. Another facility was introducing the Eden Alternative Philosophy, where residents are encouraged to take more control and autonomy over the choices for their own lives in their rest home.
Barriers to optimum nutrition that relate to the menu, meals and foodservice included:
· Limited choice/options, short menu cycles
· Inadequate food purchases and/or portion sizes to meet needs
· Lack of autonomy or acknowledgement of older people’s etiquette
· Inadequate use of feedback in menu development and not acknowledging age culture
· Menu changes by staff with inadequate nutrition knowledge
· Increased nutritional requirements, with decreased food intake
· Quality issues – temperature, time, taste
The dining environment
The eating environment plays an influential role in encouraging an optimum diet. Our study identified that most dining rooms in our study featured positive attributes, and that most residents ate there on at least two occasions per day. People were free to sit in the dining room after meals to enjoy each other’s company in many facilities. While ‘protected meal times’ policies were not mentioned specifically by any facility, freedom from distractions was reported in 30 of the 50 facilities. However, music was played in only 11 facilities, and 37 had the television on during meal times. Thus we concluded there are things that can be done in dining rooms to make the environment more conducive to a positive dining experience.
Nutrition care and the use of registered dietitians
In New Zealand, there is no legislative requirement for dietetic input into nutrition care of residents in rest and residential care facilities. The rest homes included in this study all had a dietetic presence – this was a convenience sample recruited from a number of facilities recommended by dietitians.
This study recommends dietetic input in rest homes should include menu auditing, policy development, nutrition care, caregiver education. The costs for this input should be included in the annual budget, based on numbers in the facility and a contract with a dietitian.
In conclusion, this study has provided some basic data about the eating environment and associated factors in the residential care setting. Because of the use of a convenience sample, the results cannot be extrapolated to the wider rest home population, but it is known not all rest homes use a dietitian, and even when they do, referrals are not always made when they need to be.
One of the most important needs in this sector is staff education or training in nutrition issues for the older age group. This should be compulsory for all nurses, caregivers, cooks and caterers. Good and appropriate nutrition is critical, and an understanding of the nutritional needs of the non-standard resident is especially important.
A dining environment that is welcoming, calm and unrushed, a foodservice that encourages client autonomy with some choice and self service, and staff who observe and assist, and who listen to and respect the feedback of residents forms the basis of an environment conducive to allowing residents achieve an optimum diet.
1. Shipman D, Hooten J. Are nursing homes adequately staffed: the silent epidemic of malnutrition and dehydration in nursing home residents. J Gerontol Nurs 2007; 33(7): 15-18.
Taken from: Chisholm A, Jensen J, Field P. Report on the University of Otago Postgraduate Diploma in Dietetics Practicum: The eating environment and nutrition risk – promoters and barriers to achieving optimal nutrition in the residential care setting. Feb 2010
Seminar of the New Zealand Nutrition Foundation’s Committee for Healthy Ageing:
Nutrition risk in older people: making meals matter
A seminar for health professionals and care givers
Date: 5 May 2010
Venue: AMI Nelson Suburbs Football Club, Saxton Field, 142 Saxton Road East, Stoke
For further information go to: www.nutritionfoundation.org.nz
Next Bulletin: June 2010. Please email us if you have any topics you would like discussed, or included in the Bulletin. The NZNF reserves the right to determine the final content.