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18th May 2015

Let’s dispel some of the common nutrition myths for older people in care homes!

Senior Couple Enjoying Meal Together

This week, we look at 10 of the common nutrition myths as applied to older service users.

They’re old – just give them anything to eat

Inadequate diets can lead to weight loss and poor nutritional status, which, in turn, may result in increased risk of falls, infections, pressure sores and delayed wound healing, as well as decreased quality of life and greater need for increased assistance in daily activities. Nutritional well-being in care is not only a key CQC standard, but is also a key dignity issue.

They can eat whatever they want

While it’s important that everyone is able to eat foods they enjoy, balance is still important. Good nutrition is important throughout the life course at any age - how you eat can impact on how well you age. The key for service users may be ‘nutrient dense’ foods - foods that have a high nutrient content per calorie, especially if appetite is poor. Such foods include fruit and vegetables, wholegrains and sources of protein, such as fish, poultry, beans, nuts and dairy.

They aren’t that active so it’s OK for them to skip meals

Skipping meals will almost certainly result in impaired intake of essential nutrients. Older adults may have increased requirements for key nutrients, such as protein, calcium, and vitamin D, and need regular and balanced meals to ensure adequate quantities are obtained. Activity should also be encouraged as it can assist in improving appetite.

Thickened’ describes all requirements for texture/fluid-modified diets

There is not one texture for all! There are recognised variations for modified textures of both diets and fluid in older people with swallowing difficulties. Providing the incorrect textured meal or fluid thickness can not only adversely impact on nutritional intake but will increase risk of aspiration (food or liquid going into their airway). UK food texture descriptors include: Thin Purée Dysphagia Diet, Thick Purée Dysphagia Diet, Pre-mashed Dysphagia Diet and Fork Mashable Dysphagia Diet. For fluids, Extremely Thick (like a pudding), Moderately Thick (like honey), Mildly Thick (effort required to drink through a straw) and Normal Fluids are used to describe fluid textures. Ask a dietitian or speech and language therapist if you are unsure.

Diabetics must have a sugar-free diet

Older adults, including those with diabetes, should be encouraged to have a healthy, balanced diet, and should have well-balanced, individualised dietary plans which are compatible with nutritional wellbeing and maintenance of body weight. This does not mean that residents with diabetes need to eat a sugar-free diet, but the aim should be that foods containing sugar are consumed in moderation. Sugar can be used in foods, and in baking, as part of a healthy diet. Using sugar-free, no added sugar or diet squashes/fizzy drinks, instead of sugary versions can be an easy way to reduce sugar in the diet. Food labelled as ‘diabetic’ is unhelpful and misleading. Some people might see it as a stamp of approval or even essential for people with diabetes. The reality is that ‘diabetic’ foods can be as high in fat and calories as standard products. Also foods labelled as being ‘suitable for diabetics’ often cost more than equivalent standard products.

Drinking less fluid is a good way to prevent frequent toilet visits

It is important to drink enough fluid each day to keep the bladder healthy. When you are not drinking enough, the bladder gets used to holding smaller amounts of urine, and may become more prone to infection. Nutrition policies in care homes should ensure adequate hydration is available for all service users.

Nutrition supplements should be given as soon as someone loses weight

It is important to investigate the cause of weight loss first. Is it due to illness, loss of appetite, depression, declining ability to feed oneself independently, swallowing problems, or something else? The solution might involve a number of actions that promote food rather than an oral nutrition supplement, the taste and texture of which may fatigue over time and therefore be consumed less consistently. If a service user has been prescribed nutritional supplements for some time, and you are unsure if they are still required, it may be useful to consult a dietitian.

The dining environment isn’t as important as what is on the plate

It’s all very well producing a balanced, nutritious and tasty meal, but if it isn’t eaten, there is no benefit. The environment residents eat in plays a significant role in ensuring they eat well. Social interaction, combined with a dignified environment free from distraction, such as loud noises, television, clinical procedures or medication rounds, will help ensure that residents are given the opportunity enjoy their meal.

Overweight residents are well nourished

Not necessarily. Being overweight can result from eating energy-dense (high calorie) but nutrient-poor food and fluids. If combined with reduced activity levels, skeletal muscle mass can decrease and being overweight can also mean being frail. The imbalance between obesity and low muscle mass is associated with important, negative health outcomes in older individuals. In fact, micronutrient deficiencies are often more common in obese adults than those of normal weight, so being overweight is not equal to being well nourished.

Care givers don’t need to worry about food safety – that’s the kitchen’s responsibility

Everyone that is involved in food service to residents should consider food safety as part of their responsibility. Hygiene standards should be observed for all staff entering kitchens; food should be appropriately labelled and stored, and hands washed regularly.

Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributor

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