Nutrition in aged care
For any meal to be successful in the aged care environment it needs to be eaten ensuring that residents are receiving the nutrients they need Karen Abbey reports.
One of the primary functions of food services is to produce the food which our residents will consume. Aged care in Australia is changing with the focus shifting to high-level care where the residents are more frail and vulnerable. In many cases today the menu for the majority of residents is their primary source of daily nutrition. It is important to understand that if a resident is unable to access foods from outside then the aged care facility is totally responsible for their nutritional care.
When we think about nutrition there are two main themes to consider. The first is the biological where food provides the essential nutrients to ensure the body is able to function and stay well. This takes into the account the amounts and type of nutrients which eating a wide variety of foods will provide. This is essential to ensure that residents are receiving adequate nutrition to avoid developing wounds and malnutrition. It also involves monitoring the amount of foods residents eat daily and flagging when a resident’s intake is in decline. It is also essential to ensure adequate hydration and make sure residents drink throughout the day, with water as one of the main fluid sources, however, all other fluids are important. The second focuses on the social aspect of food and how important it is to the individual. Food is such an important part of each person’s day and builds our social connection, even in aged care. It is well known that for any meal to be successful in aged care it needs to be eaten ensuring that residents are receiving the nutrients they need. We are very lucky in this county to have a wide variety of foods available to use in our menu planning.
As part of my PhD with the University of Queensland – the recent National Menu Survey, which was conducted to examine menu planning in aged care across Australia, indicated that facilities plan and put menus together in a similar way. The trend is to have the main meal during lunchtime with an alternative choice and a dessert. The evening meal consisted of a variation of soup, salads, sandwiches, hot entrees, light dessert and fresh fruit. Everybody was serving very similar types of fluids and mid-meal snacks. Overall hot breakfast was only offered once or twice a week and menus were on average four weeks’ in cycle length.
Menu planning can be a complex process – balancing the needs of all your residents and trying to make the majority happy daily is quite a task. Our residents often tell us what kinds of foods they would like to eat through surveys and menu planning meetings which is how menu planning starts. When planning a menu, you need to consider the nutritional aspects like ensuring adequate calcium serves are planned, that a wide variety of meats is included, vegetables, cereals, fruit and dairy rich desserts. Making sure that the menu has adequate fruit serves and also some rich sources of fibre, in the types of cereals and breads which are offered, is also important. Additionally, hot breakfast is an important part of menu planning and provides a valuable source of protein – how often you have a hot choice is something to consider. The mid-meal snacks and fluids are also important as they provide the opportunity for small bursts of nutrition, for example, cheese on crackers, the creative way muffins can be made both sweet and savoury, and jazzing up scones with pumpkin or dates.
In planning a menu you also need to ensure that thought goes into the quality aspects. Menus need to be flexible and move with the resident preferences, but they also need to change with the seasons, and be of a considerable cycle length of at least four weeks as a minimum. It is always important to honour the traditions (Easter/Christmas) with the traditional foods, but it also is a good idea to have some flexibility to incorporate a theme day or chefs/cooks surprise so that from time to time the menu delivers something special that gets everyone talking and breaks the pattern of the menu. I often hear that residents don’t like change but sometimes putting in different foods, mixing it up having a meal of the month not only allows the catering staff to do different catering, but it again provides freshness to the menu. This is crucial so that the menu is not predictable and boring. After-all everybody likes a change and the change can be as simple as giving all your residents a chocolate ice cream heart for dessert at lunch time on Valentine’s Day, trying a different kind of BBQ meat or making a culturally diverse meal.
One of the best ways to engage residents is to discuss options with them and create the excitement of food services. One of the challenges faced in aged care facilities, especially in the cities, is the multi-cultural aspects of producing meals for a wide variety of different nationalities. This is often challenging and difficult as the menu can only support a certain amount of food items, and often compromises need to be made to ensure that residents are receiving foods which are similar to their preferences. You must remember that menus provide the sole source of nutrition and therefore the challenge is to keep the menu fresh.
So what about low fat and low sugar foods? Menu planning in aged care should integrate as much as possible; therefore, separate desserts for low fat and sugar diets are not encouraged. One of the most important points to remember in aged care is that this most likely your residents’ last home. You need to think carefully about what you are really trying to achieve. There are some residents who will need a dietary modified diet. However, in planning any dietary restrictions, it is important to remember quality of life and ensure that the resident continues to get similar foods to the other residents. For residents that require lower fat or reduced sugar a good strategy is to provide the same desserts or meals, but in smaller portions and supplement with extra custard or vegetables. To explain that further, if you’re serving pavlova as the dessert for the day, for a diabetic a small serve can be provided with some additional fruit or if you serve apple pie and cream this could become apple pie and custard which will reduce the fat content. For meals that are high in fat for example, like pies and pastry items, it’s about a smaller serve with extra vegetables. There are many ways in which the menu can be altered to make residents feel included and enjoy the same foods that everyone else is. If a resident wants to have their little special dietary habits then that’s fine, it is all about choice. One thing we should ask ourselves when menu planning is how important is it to have our frail aged residents on low fat diets or sugar reduced diets when they are in their nineties? So when planning think about the types of foods this generation likes to eat. The light meal type of foods like party pies, sausage rolls, pizzas, sausages, fish and chips, although high in fat, they do contain protein and are high in energy. They are good to have on a menu now and again and as our residents become more frail they tend to become thinner, so it’s important to have yummy treats full of flavor.
When it comes to texture modification foods – they are altered to ensure safe swallowing. Like all other principles of menu planning texture modified foods should also come off the menu and be similar to foods which are served during the day to other residents. However, texture modified foods should not be used to speed up the feeding process and should be avoided until absolutely necessary.
When foods are modified in texture they will lose their shape and appearance, though they taste the same, they don’t look the same and everyone eats with their eyes. Menu planning for textures should be centred on making foods look attractive, with colour contrasts, layering foods and using individual cups and bowels. Again planning your menu for texture modification is to integrate from the general menu and the production run makes additional serves which can be modified. This menu in parallel to the general menu ensures that residents are receiving similar types of meals. Most food items can be modified including salads and desserts.
It’s all a balancing act when it comes to planning the menu and delivering the meals. The fine balance between good nutrition and making sure the residents are enjoying their meals at times means that foods on the menu won’t always conform to the best nutrition. Everyone’s food intake and nutrition cannot be measured in one day, it is a continual process of eating widely and ensuring that residents are actually eating the meals that are served. You can have the best planned menu in the world, but if the foods are not eaten or enjoyed then that defeats the purpose of what we are trying to achieve in aged care.
Menu planning guidelines
- Have at least two weeks’ in between menu items, e.g. pumpkin soup on weeks one and three.
- Try not to have the same type of meal on the same day, e.g. don’t have pumpkin soup every Monday.
- Try to avoid having the same type of meat on the same day, e.g. chicken meal every Monday.
- The roast and fish on Sunday and Friday are sewn into the food culture but you can always provide different variation on these.
- Colour combination enhances the way a meal looks.
- With every cycle menu you plan always compare week one to week four to avoid the repetition of foods.
Bachelor of Science, Honours in Human Nutrition, Graduate Diploma in Nutrition and Dietetics, Masters in Health Science Management.
Dietitian/Manager Resident Support Services
Nambucca Valley Care
Karen is a food service and aged care specialist dietitian and has worked in the aged care industry for over 15 years. Karen has presented at conferences nationally and internationally on topics ranging from menu design, nutrition specification in food service, and nutrition for the elderly. Karen has worked for Queensland Health as a rural aged care dietitian, with the Rural Allied Health Team and done extensive work for Queensland Meals on Wheels delivering training in nutrition and menu design. Karen is currently the Resident Support Services Manager and Dietitian working for Nambucca Valley Care an aged care facility on the Mid-North Coast of New South Wales and is currently undertaking a PhD with the University of Queensland examining menu design and delivery of optimal nutritional care in residential aged care. Karen can be contacted at: firstname.lastname@example.org
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