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Appetite for Life – Nutritional Needs
There's been a lot of coverage in the news media this week about the merits of the Mediterranean diet, rich in fresh fish, vegetables, salad and olive oil and lower in protein from red meat. In the adversarial manner characteristic of the UK press it became a Mediterranean diet versus statins 'face-off', which somehow managed to obscure the potential benefits of both (in my view). Anyway, it got me thinking about the nutritional needs of individuals receiving support, particularly in residential care settings.
Institutional v Modern Attitudes
Thirty (plus) years ago - when I was starting out in my career, residential care was characterised by the smell of boiled cabbage and an old fashioned school-dinners type approach to catering. A sort of one-meal-suits-all approach. In reality, clients sometimes went hungry because food was not specific to their requirements, or because it was bland and unappetizing.
I think it's one of the things that has changed most within the care sector over the intervening decades, that now, individual dietary needs and personal preference are mainstays of catering considerations. Today faith, culture and health needs are considered as a matter of course so that offerings may be culturally appropriate and suited to diabetic or reducing regimens, gluten free or otherwise allergen specific as well as being nutritionally balanced, professionally prepared and presented. In other words, the standard of catering has improved enormously.
In contemporary society older people generally are more likely to suffer from malnutrition and this risk escalates amongst those using health and social care services. Between 19 and 30 percent of all people admitted to hospitals, care homes or mental health units are at risk of malnutrition (BAPEN, 2007). The Social Care Institute for Excellence (SCIE) have reported that malnutrition also extends into some care settings.
SCIE view nutrition as being both fundamental to well-being and part of the wider dignity entitlement of service users, and state that care providers should provide "a choice of nutritious, appetising meals, that meet the needs and choices of individuals, and support with eating where needed." Furthermore, they urge that the importance of mealtimes as a social event is recognised so that service users are able to sit with individuals with whom they feel comfortable and in a pleasant environment. SCIE point to a Swedish study (Sidenvall, 1999) which reported that older people cling to an ability to feed themselves as they value it as integral to their self-esteem. Skilled assistance for those who have difficulty feeding themselves is also important in warding off the risk of neglect and malnutrition.
Mealtimes and Life Quality
SCIE stress that meals and mealtimes are a key factor in contributing to life-quality, and are a critical indicator of service quality. We've come a long way since the 'boiled cabbage' institutionalised approach. We must ensure that policies are up to date and that staff are well trained in this area. Ensuring that feedback regarding meals and mealtimes is elicited, and developing service best-practice guidelines, are other practical steps that can be taken to ensure a personalised approach to nutrition. If we are going to help our service users retain an appetite for life, the least that we can do is provide nutritious, tasty food in sociable surroundings.
Reference: The Nutrition Screening Survey in the UK 2007 was carried out by BAPEN, the British Association for Parenteral and Enteral Nutrition.
See the SCIE guidance HERE.
Nic Bowler - Welsh Care and Social Services Inspectorate Specialist
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