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17th October 2015

Sometimes we need to remember the simple things in life!

Readers of this blog will appreciate the concern around prevalence of malnutrition and dehydration in older adults, and that much of the regulation around care home nutrition focusses on prevention of this. Rightly so – malnutrition has an enormous detrimental impact - clinically, financially and for quality of life. So some progress has been made to establish better methods of screening and development of care plans and suitable interventions.

But do we spare much thought to something as simple as the packaging of food?

The weight of packaging, accessibility of packaging and the familiarity of brand can play a role in an older person’s food and drinks choice, and his/her ability to access and prepare food.

More research has been undertaken to understand the accessibility of packaging amongst the ‘well elderly.’ For example, research has been undertaken to improve our understanding of the accessibility of glass jars with a vacuum lug closure, commonly used for sauces, preserves and pickles. Yet very little research has been undertaken on the issue of packaging in hospital and care home environments.

Declining manual dexterity and strength may reduce ability to open packs

Some care establishments may consider using packaged foods for a number of reasons – including portion control, consistency, budget and food safety. However older people may be frail, may not recognise packaged foods and may have reduced manual dexterity and strength, all of which can impact on the ability to open both food and beverage items. This can make many service users feel more dependent, and issues relating to the association between a lack of feeding assistance and risk of malnutrition become relevant here.

An Australian report looking at malnutrition in older people has highlighted the difficulty experienced by some people in opening food and beverage packaging. Furthermore, a limited number of researchers have also identified inability to access food and packaging as one of the contributory factors to malnutrition amongst older and disabled patients in hospitals.

Manufacturers of food and drink should consider the end user of the product. Opening some packaging relates more to strength (like water bottles), whilst accessing other packages like tetra packs or juice cartons with straws relies more on dexterity. There is a direct link between reduction in dexterity and the time taken to open a pack. The dexterity required to open food packaging is in fact quite complex – using significant amounts of wrist, arm and finger pinch gripping to access items.

Wellness and motivation may also be important

Interestingly though even users with poor dexterity can open packs in time, as observed with medication packaging. Researchers have therefore concluded that inability to open packs is not only a function of dexterity and time taken, but also of motivation. In care settings where the age, health status and posture of users may affect dexterity and increase time taken, the degree of ‘wellness‘ is also likely to contribute to reduced motivation in opening food and drink packaging.

A question we need to ask and act on then is ‘Is the food packaging used in your organisation fit for purpose, or is it a barrier to people eating and drinking?’

Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributor

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