Within aged care, the focus continues to be on food and nutrition for residents. As we move into the second half of 2024, we continue to prepare for the Strengthened Aged Care standards anticipated to commence in 2025. You may be starting to prepare your spring and summer menu and it is important to do so with an eye towards the future, particularly Standard 6: Food and Nutrition.

This week (11 – 18 March 2024) is Nutrition and Hydration Week, when dietetics professionals promote awareness of the importance of balanced and fulfilling dietary intakes. 

At Plena our dietitians work primarily with older people, in residential aged care facilities and within the community. A wholesome and nutritious diet is important for the wellbeing of all, but within aged care there are special considerations that need to be met to ensure quality of life.

The Australian government is implementing strengthened Aged Care Standards, due to launch in mid-2024. The Strengthened Standards introduce new benchmarks focusing on food and nutrition (Standard 6), incorporating new concepts and enhanced expectations that are important for dietitians and those working within aged care to understand.

The enjoyment of food and mealtimes is significant in our culture, with mealtimes representing a time for not only the pleasure of good food but also a time to connect with those around us. It is this sentiment that is reinforced by the Strengthened Standards. We know a lot of aged care residents look forward to mealtimes and so it is important to deliver an enjoyable dining experience that supports a sense of belonging, opportunity for social engagement and reablement. 

Key areas of focus for the new Standards include;

• Partnering with older people on how to create an enjoyable and satisfying food, drink and dining experience.
• Enable choice in food preference and selection, as well as when, where and how older people eat and drink.
• Provide an environment which encourages consumption of food and drink to maximise nutrition and hydration, and allows older people to eat as much as they want, when they want to.
• Regularly assesses each older person’s nutrition, hydration and dining needs and preferences, their dining experience, and their ability to eat and drink.
• Menus are developed and reviewed annually via a menu and mealtime assessment in collaboration with older people and dietitians.
• Provide a dining environment that supports a sense of belonging, social engagement, reablement and enjoyment. 
• Ensure there are opportunities for older people to share food and drinks with their visitors. 

Residential aged care facilities are required to partner with older people and their families to create an enjoyable food, drink and dining experience. This may mean including foods specific to a culture or background in order for an older person to feel their identity is recognised and honoured, while familiarity of food can enhance enjoyment and in turn consumption. 

Choice is important for each resident, and a key concept within Standard 6 is for older people to be able to express what, when, where and how they eat and drink. Flavoursome and appetising meals that provide variety is a priority, so too is access to nutritious snacks and drinks at all times.

Food satisfaction is essential for older people, as the enjoyment of flavoursome meals can reduce the risk of unplanned weight loss and support quality of life. Older people have specific nutritional needs with protein and calcium-rich foods being extremely important. Dietary needs can change over time so an individual’s needs and preferences must be regularly assessed by a healthcare professional. 

A new concept in Standard 6 is that there should be opportunity for older people to share their food and drink with visitors. This reinforces the connection between food/drink and social engagement, and helps older people enjoy practices that were part of their life before entering care.

As part of the strengthened standards, menu and mealtime assessments will be required annually, and allow a dietitian to support the development of a food service system that not only meets the nutritional needs of its clients but also delivers enjoyment and satisfaction for all recipients. This focus on quality and satisfaction serves all residents, including those on texture modified diets, reinforcing the importance of nutrition and hydration in aged care.

Plena Dietitians are highly qualified and experienced in menu and mealtime assessments, and can provide the support you need to best serve your residents and ensure you’re able to meet the new standards. Contact us today to book your menu review, and allow your residents to enjoy the satisfaction of quality nutrition and hydration and improved quality of life.

March 2024 will see the return of our highly valued Dietetic and Speech Pathology in person workshops ‘Sip and Swallow: Every Mouthful Matters’ across Brisbane, Sydney and Melbourne.

 

These workshops are suitable for those working across care, clinical, catering and quality, with a focus on: 

• Improving nutrition through a food first approach 
• Avoiding unplanned weight loss 
• Supporting people living with swallowing difficulties (dysphagia) 
• Providing texture modified foods and drinks that are IDDSI compliant 
• Preventing aspiration pneumonia and choking incidents 

 

Registrations are currently open for our 1 day – Sip and Swallow: Every Mouthful Matters workshops across the country. In order to access our early bird offer, be sure to register before Friday 9th February 2024. 

 

Save these dates & sign up now.

Brisbane: Thursday March 7 | 8am – 4pm
Download the event flyer, here

The focus on food and nutrition for aging people is increasing, with more transparency and accountability required of aged care providers. As part of the Aged Care Strengthened Quality Standards, providers will need to work with Accredited Practicing Dietitians to develop and have each aged care facility menu reviewed at least annually.

 

Understanding nutritional needs in ageing

The nutritional needs of ageing people are different to the general population. Older people need access to higher levels of some key nutrients for dietary health, such as protein and calcium. Additionally, older people can experience changes to taste, smell and appetite which can affect food intake.

 

Why is dietitian input into menus and the dining experience necessary?

Research shows around 50% of older Australians in aged care are malnourished and up to 50% of older Australians are at risk of malnutrition when living in the community.

This is of great concern, considering malnutrition is associated with reduced quality of life, increased hospitalisations and poor health outcomes. Increasing the focus on food and nutrition is key to reducing the prevalence of malnutrition within our older populations.

 

The impact of mealtime experiences on wellbeing

In addition to meeting the specific dietary needs of older people, mealtimes offer an important opportunity for social interaction and improving wellbeing. When mealtimes are enjoyable, they can often be the highlight of an aged care resident’s day.

An enjoyable dining experience has many facets:

• Providing appealing, flavoursome and varied food and drink options to all residents (food first is highly important)
• Creating a mealtime environment that is welcoming, fosters a sense of belonging and supports each resident to do their best with their meal.
• Having choice available to all residents, including what, when, where and how they eat and drink
• Partnering with residents as part of menu planning processes

 

The role of dietitians in aged care

Plena Healthcare Dietitians can support providers to provide a nutritious and enjoyable mealtime experience for residents and consumers, while meeting the requirements of the Aged Care Strengthened Quality Standards.

Our support includes recommendations and guidance on how to strengthen your menu and dining experience to deliver better nutrition for those in long-term care. As part of the Standards, providers will be required to ensure menus consider the specific needs of older people and that they are reviewed at least annually by a dietitian.

Plena Healthcare Dietitians work with you to implement nutritional programs as per the guidelines and adapt them to individual needs of residents.

Dietetic services are available to ensure your meal plans meet the nutritional needs of residents, including:

• Menu Review (menu and mealtime assessment)
• Individual Resident Consultation

 

Get in touch with us to learn more about how Plena Healthcare Dietetics can support you to meet the Strengthened Standards for Food and Nutrition and to improve the health and wellbeing of older Australians living at home. 

Shining a light on stronger bones: National Osteoporosis Day 2023

On National Osteoporosis Day, we’re heading into the world of bone health. Recent statistics reveal that over 2.2 million Australians aged 50 and over are affected by Osteoporosis. The good news is there are experts in the field of nutrition who can help combat this condition: accredited Dietitians.

Osteoporosis literally means “bones with holes”. It occurs when bones lose minerals such as calcium more quickly than the body can replace them”[1]. The bones become less dense, lose strength and are at increased risk of fracture.

Osteopenia describes a loss of bone mineral density compared to normal, however the bone density loss is not as severe as those with osteoporosis.[2]

Risk factors include age, sex, genetics (family history, cultural background), medications, low body weight, smoking, alcohol, and auto immune conditions can also increase your risk of osteopenia and osteoporosis.

Interestingly, approximately 50% of patients who survive an osteoporosis fracture (commonly hip or spine), are discharged into an aged care home. While Osteoporosis is most common in women due to increased loss associated with menopause, it can affect both men and women.

It is recommended that adequate calcium, vitamin D and exercise are included in diet and lifestyle as they help to ensure that the body is building and maintaining strong healthy bones.

Calcium requirements for the average adult is 1,000 mg of calcium per day. For women over 50 years and men over 70 years it is higher at 1,300 mg of calcium per day. [3]

If there is inadequate calcium in your blood, your body will take calcium the calcium it needs from your bone stores which increases your risk of osteoporosis. While dairy foods (milk, yoghurt, cheeses) contain the highest amounts of calcium, other good sources include tofu, tinned salmon, sardines, green leafy vegetables, broccoli, bok choy, oranges, almonds and brazil nuts, eggs and more.

Vitamin D assists with the body’s ability to absorb calcium in your diet. While we get most of our vitamin D from the sun, mushrooms, eggs, fatty fish like salmon, herring, mackerel, hard cheese, and fortified dairy or food sources.[4]

Exercise is recommended to help maintain muscle and bone strength throughout adulthood. It also helps to reduce bone loss in older age and maintain strength to support mobility and balance.[5]

There are several good resources available at the Healthy Bones Australia website and the Osteoporosis Foundation website, for both health professionals and clients.

https://healthybonesaustralia.org.au/

https://www.osteoporosis.foundation/educational-hub/material/patient-resources

Plena Dietitians can provide support and guidance around bone health to you in your private home or residential aged care facility. Get in touch to make a referral today.

[1] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis#what-is-osteoporosis

[2] https://www.healthdirect.gov.au/osteopaenia

[3] https://healthybonesaustralia.org.au/wp-content/uploads/2022/10/hba-fact-sheet-calcium.pdf

[4] https://www.osteoporosis.foundation/educational-hub/topic/calcium/list-of-calcium-content-of-common-foods

[5] https://healthybonesaustralia.org.au/your-bone-health/exercise-bone-health/

We’ve come a long way in the understanding and treatment of mental health and have been discovering the best ways to support those living with different conditions.

But there’s always more we can do to continue to educate ourselves on each condition and how to best work with our clients.

Mental illness is a general term for a group of illnesses that may include symptoms that can affect a person’s thinking, perceptions, mood, or behaviour. Mental illness can make it difficult for someone to cope with work, relationships, and other demands. The relationship between stress and mental illness is complex, but it is known that stress can worsen an episode of mental illness. Most people can manage their mental illness with medication, counselling, or both. As part of our services, we account for and help support our client’s mental health by improving wellbeing and working alongside other health professionals to ensure a holistic care.

The World Health Organisation (2022 a) defines health as ‘… a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. When thinking about mental health this means that it is more than just the absence of mental disorders or disabilities. It is ‘a state of wellbeing in which an individual realises their own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to her or his community.’ For humans to think, emote, interact with each other, earn a living, and to enjoy life we need to promote, protect ,and restore our mental health.

Despite having an improved understanding of the importance of mental health, mental health conditions are increasing globally (The World Health Organisation 2022b). Depression is now one of the leading causes of disability, and suicide the second leading cause of death among 15 – 29-year-olds. This is a sad statistic, so let’s review the different types and how at Plena we can help improve wellbeing.

Different Mental Health Conditions

Anxiety Disorders

Anxiety disorders are a group of mental health disorders that include generalised anxiety disorders, social phobias, specific phobias (for example, agoraphobia and claustrophobia), panic disorders, obsessive compulsive disorder (OCD), and post-traumatic stress disorder. Untreated, anxiety disorders can lead to significant impairment in people’s daily lives.

Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is an anxiety disorder. Obsessions are recurrent thoughts, images, or impulses that are intrusive and unwanted. Compulsions are time-consuming and distressing repetitive rituals. Treatments include cognitive behaviour therapy (CBT) and medications.

Bipolar Affective Disorder

Bipolar affective disorder is a type of mood disorder, previously referred to as ‘manic depression’. A person with bipolar disorder experiences episodes of mania (elation) and depression. The person may or may not experience psychotic symptoms. The exact cause is unknown, but a genetic predisposition has been clearly established. Environmental stressors can also trigger episodes.

Depression

Depression is a mood disorder characterised by lowering of mood, loss of interest and enjoyment, and reduced energy. It is more than just feeling sad. There are different types and symptoms and there are varying levels of severity and symptoms related to depression. Symptoms of depression can lead to increased risk of suicidal thoughts or behaviours.

Dissociation And Dissociative Disorders

Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories, or sense of identity. Dissociative disorders include dissociative amnesia, dissociative fugue, depersonalisation disorder, and dissociative identity disorder.

Eating Disorders

Eating disorders include anorexia, bulimia nervosa, and other binge eating disorders. Eating disorders affect all genders and can have serious psychological and physical consequences.

Paranoia

Paranoia is the irrational and persistent feeling that people are ‘out to get you’. Paranoia may be a symptom of conditions including paranoid personality disorder, delusional (paranoid) disorder and schizophrenia. Treatment for paranoia include medications and psychological support.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop as a response to people who have experienced any traumatic event. This can be a car or other serious accident, physical or sexual assault, war-related events or torture, or natural disasters such as bushfires or floods.

Psychosis

People affected by psychosis can experience delusions, hallucinations and confused thinking. Psychosis can occur in a number of mental illnesses, including drug-induced psychosis, schizophrenia, and mood disorders. Medication and psychological support can relieve, or even eliminate, psychotic symptoms.

Schizophrenia

Schizophrenia is a complex psychotic disorder characterised by disruptions to thinking and emotions, and a distorted perception of reality. Symptoms of schizophrenia vary widely but may include hallucinations, delusions, thought disorder, social withdrawal, lack of motivation, and impaired thinking and memory. People with schizophrenia have a high risk of suicide. Schizophrenia is not a split personality.

What We Can Do For Ourselves And Our Clients

We feel passionately about supporting our clients with all holistic health care. The best way to a support high quality of life is to improve wellbeing for our clients. But what is wellbeing?

Wellbeing is a way of improving our lives, of staying resilient, building social support and self-efficacy, and helping us to cope with difficult times.

It is a positive outcome that is meaningful for people and informs one that people perceive they are thriving in many areas of their lives. It combines several elements, including considering how we:

• Cultivate meaning and good relationships
• Use our strengths
• Contribute to a ‘greater’ cause
• Find pleasure in losing ourselves in things we find challenging and enjoyable

It is about purpose and meaning, of being a part of something bigger than yourself. It explores the satisfaction we find in our social connections and when we accomplish things.

Having a strong sense of wellbeing contributes to good mental health. It helps to protect us from feelings of hopelessness and depression, offering protection for our mental health. Mental health is not merely the absence of mental illness rather it is a state of overall wellbeing.

How is wellbeing measured?

Wellbeing is measured through self-reporting as it is a subjective state of being. There are many instruments used to measure wellbeing which are used for different purposes i.e., for public policy purposes, for clinical outcomes, population health outcomes, and more.

In general, wellbeing is related to:

• Good health
• Positive social relationships
• Availability and access to basic resources i.e., housing, income etc.

Looking after mental health and wellbeing

At Plena, we help our clients in a number of ways. Whether that be constructing strategies to help with routines, accessing services, or encouraging mindfulness and positive interactions.

• Community Integration

Occupational therapists, in particular, focus on helping individuals reintegrate into their communities after experiencing mental health challenges, this can include assisting with social participation.

• Comprehensive Care

Allied health professionals often work in multidisciplinary teams with medical doctors, psychiatrists, and other mental health specialists to provide holistic care. This collaborative approach ensures that both physical and mental health needs are addressed simultaneously.

• Health Education

Allied health professionals can educate individuals about the relationship between lifestyle choices, physical health, and mental health. This knowledge can empower individuals to make informed decisions about their well-being.

• Nutrition

Eating well is important as it provides essential nutrients and energy to get through the day; keeps your immune system strong for fighting infections; helps promote better sleep; improves concentration; and can reduce stress. Plena Dietitians can provide assessments and tailored plans to ensure they are receiving all the nutrition they need.

• Emotional Support

Allied health professionals, such as occupational therapists and speech therapists, often work closely with clients, providing a safe and supportive environment for individuals to express their emotions, build self-esteem, and improve their overall well-being.

• Implementing self-care strategies

Taking time to take good care of yourself and engage in a range of self-care activities is essential to protect your mental wellbeing. We can assist clients in engaging in healthy activities they enjoy and find relaxing. We can provide transportation, connect with local groups, or provide tools and assistance in completing favourite hobbies.

 

We are passionate about helping our clients and ensuring they have access to all the support they need. If you think you or a loved one could benefit from our services call us on 136 033, or learn more about what we offer on our website.

If you need someone to talk to:
Lifeline – 13 11 14
Beyond Blue – 1300 224 636

References
World Health Organisation 2022a, ‘Mental health: strengthening our response’, World Health Organisation website,
https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

World Health Organisation 2022b, ‘Mental health’, World Health Organisation website,
https://www.who.int/health-topics/mental-health#tab=tab_2

Peripheral neuropathy is the most common systemic complication of diabetes, affecting up to 25% of all diabetics (132 million people worldwide). Diabetic neuropathy is implicated in upwards of 75% of non-traumatic amputations yearly.

Peripheral neuropathy is thought to be caused by damage to nerves and their blood supply and lead to a lack of protective sensation. This puts the individual at risk suffering an injury and it going unnoticed.

Peripheral neuropathy can also affect the motor nerves, often presenting as difficulty with fine motor activities; or even disrupt autonomic nervous system function and interfere with things like bowel movements and blood pressure.

Peripheral neuropathy can also be caused by a number of health problems and interventions: vitamin deficiency, chemotherapy and radiation, alcohol abuse, peripheral vascular disease, spinal tumours and even simple pressure on a nerve.

In short, we need to look after these little nerve fibres, because without them the body doesn’t know what is happening around it. And if you don’t know what is going on, you can’t react appropriately.

Podiatrists currently play a key role in the screening for peripheral neuropathy and the management particularly of skin concerns which result from it. The nerves furthest from the spinal cord are often the first affected, meaning the feet and lower limbs are the first symptomatic presentation of neuropathy in most cases.

Podiatrists are able to perform foot and vascular assessments which can be used to determine the appropriate treatment for peripheral neuropathy. These involve a thorough assessment of the feet including, but not limited to, the following:

• Palpation and doppler assessment of pulses
• Examination of venous function
• ABPI (Ankle Brachial Pressure Index)
• Perfusion and skin assessment
• Sensation testing, including vibration perception and monofilament.

These assessments are helpful in the prescription of compression therapies and are key to monitoring disease progression.

Dietitians assist in many ways with diabetes management including assessing diet quality, alongside medical management of diabetes, making recommendations and monitoring effects. The evidence-based approach however in long-term care environments, may differ to what many people think.

Several relevant organisations and research bodies agree that for clients in long-term care, restricting diet is unnecessary and may increase risk of malnourishment. Additionally, most clients living in residential aged care have a life expectancy of less than 10 years, which negates the long-term impacts of diabetes and this needs to be considered alongside clients who often have multiple comorbidities, impaired cognition and/or frailty.

Treatment goals for clients in younger age groups differ greatly from this approach, however in aged care, nutrition approaches are usually a somewhat relaxed and screening for malnutrition and dehydration becomes a greater focus to prevent glycaemic extremes and potential short-term effects of diabetes.

Often residents who have lived with diabetes for several years may have been told previously to restrict certain foods, however this approach can be detrimental to maintaining lean body mass and therefore function. Some residents and families will have questions about this approach and can benefit from education on diabetes management to make informed dietary choices.

A dietitian assessment is encouraged if this is the case to ensure meals are nutritionally adequate and that the resident and or relatives are educated on current diabetes management practices to make informed dietary choices.

 

Coeliac disease is an autoimmune condition that causes a person’s immune system to abnormally react to gluten ingestion. Gluten is a protein found in many products containing wheat, rye, barley and oats.

For someone without coeliac disease, gluten does not cause any negative effects. However, for those with the disease, even a very small amount of gluten can cause damage to the lining of the intestine and cause villous atrophy, which reduces the surface area of the small intestine’s absorption layer. This process can cause a range of other health issues from debilitating gut symptoms to reduced bone density (source: https://www.coeliac.org.au/s/coeliac-disease).

Coeliac disease is most often diagnosed by a genetic marker serology test followed by an endoscopy to confirm. If confirmed, clients can feel lost and restricted when it comes to following a gluten free diet; this is where a Plena Dietitian can help.

Dietitians can often educate on ways to improve the variety of foods that someone with coeliac disease can have, make recommendations about meal ideas that are achievable and bust myths that make a gluten-free diet unnecessarily overwhelming! Dietitians can even support a client seek a diagnosis of coeliac disease as we are often asking clients questions about gut symptoms, known deficiencies and energy levels [2], which are some of the key markers of Coeliac disease.

At Plena, our Dietitians support our aged care homes to provide meals to residents with coeliac disease that are nutritionally balanced, promote dietary variety and support the kitchen to correctly prepare meals to avoid gluten contamination. We also support the client, their families and their GPs with education about gluten-free diets.

Nutrition Education within residential aged care homes is beneficial for several reasons:

1. A home could serve the most nutritious meal available, but it all goes to waste if the resident does not actually eat it. Educating staff on topics such as appetite, meal preferences, assistance and pre-meal care improve the likelihood of meals being eaten.
2. The noticeable effects of poor nutrition in an aged care resident are often gradual, therefore it is important that staff can recognise warning signs of malnourishment before it becomes a risk to quality of life and hastened mortality.
3. Nutritional care needs to be front of mind at every mealtime and the dietitian cannot always be there to support this. This means that the more awareness staff have about nutrition issues, the more likely dietetic interventions will be effective.
4. When aged care staff are empowered and confident in their ability to improve nutrition outcomes for a client, they begin to advocate and share their knowledge with team members, which improves nutrition across a whole home.

Plena Dietitians are also able to provide a range of education sessions for clinical staff, food service staff and aged care management teams. This may include anything from supporting wound healing to educating kitchen staff about gluten-free diet preparation. Nutrition education also provides staff with an opportunity to ask questions about nutrition processes in the home and discuss specific client cases.

Here are some signs that a RACF may benefit from nutrition education:

• There are large amounts of wastage of food or nutrition supplements.
• The dining room is noisy, poorly lit or distracting for many residents.
• Staff are struggling to find time to provide meal assistance to all residents who need it.
• There are a high number of residents having gluten-free or dairy-free meals.
• There are a high number of residents with pressure wounds.

Case study: Toaster contamination

Mary, an 80-year-old client with coeliac disease, diagnosed in her 30’s, had been living at a residential aged care home for over a year. She was concerned that the meals being served to her, were causing uncomfortable bloating and constipation. Mary had also recently returned a blood test result that showed her iron levels were low.

When our Dietitian spoke to staff at Mary’s home, they reported that they struggled to know what to offer her at mealtimes; Mary and her family were also frustrated by the lack of coordination within the kitchen. Some weeks, Mary was served chicken, rice and vegetables at every meal for days.

Our Dietitian spoke to the kitchen staff and management who agreed to some training with the food service team about the importance of a gluten-free diet and how to reduce risk of contamination in the kitchen. During the training and with guidance from our Plena Dietitian, staff discovered that they had been preparing Mary’s gluten free bread for breakfast in the same toaster as regular bread. This caused tiny amounts of gluten to be consumed by Mary every morning through contaminated toast crumbs. This was simply fixed by having a toaster and knife dedicated to preparing Mary’s breakfast. By the next review in a month’s time, Mary reported that her symptoms had reduced significantly.

Would you like to find out more about how we can make your life easier and take care of your residents allied healthcare needs or provide expert training to your staff click here.

References

1. Coeliac Australia. (2023). What is Coeliac Disease?. Webpage. https://www.coeliac.org.au/s/coeliac-disease
2. Shepherd, Sue & Gibson, Peter. (2006). Understanding the gluten‐free diet for teaching in Australia. Nutrition & Dietetics. 63. 155 – 165. 10.1111/j.1747-0080.2006.00090.x.