Malnutrition is a significant issue in Aged Care. Malnutrition is a condition resulting from inadequate dietary intake or impaired digestion of nutrients. The negative consequences of malnutrition can severely affect a resident’s quality of life and place an increased burden on Aged Care facilities.
Nutrition screening is essential. This is the process of identifying the presence of characteristics known to be associated with nutritional problems. It aims to identify those who are malnourished or at risk of becoming malnourished so that management strategies can be put in place.
Monitoring body weight and food and drink intake is the simplest form of nutrition screening. There are also nutrition screening tools available that are validated for use in the Aged Care setting including:
- The Malnutrition Universal Screening Tool (MUST)
- The Mini Nutritional Assessment (MNA)
Any concerns re oral intake and/or weight loss should prompt a dietary review and appropriate interventions. One such intervention is the commencement of a High Protein High Energy (HPHE) Diet including mid – meals.
HPHE eating should be implemented using the ‘real’ food approach before the use of nutritional supplements is considered.
High Protein High Energy Diet
A High Protein High Energy (HPHE) diet provides a strategy for increasing the protein and energy content of food without increasing the volume of food. This can be very useful when a resident has a small appetite.
Good sources of protein include: meat, fish, poultry, milk and dairy products, eggs, legumes (e.g. baked bean, chick peas, and lentils), and meat alternatives such as tofu and also nuts. (Nut pastes may be easier for the elderly to manage).
Good sources of energy include: butter (margarine), cream, sour cream and mayonnaise, cheesy/creamy You can encourage high protein high energy menu choices by:
- Offering good sources of protein/ energy at each meal and mid-meal
- Offering desserts at both lunch and tea
- Offering cream- based or enriched soups with light meals
- Encouraging the resident to eat higher protein foods first
The protein and energy in recipes (food fortification) can be increased by adding fats, powdered milk and dairy etc. or by adding neutral nutritional supplement powders to food and fluids. For example:
- Add cream, yoghurt, margarine, grated cheese, and/or milk powder to soups, casseroles, desserts and drinks. Add legumes to soups and casseroles
- Use sauces or toppings to dress up meals and foods (herbed butter or cheese on meat, mince meat or vegetables, white sauce on lasagne or cauliflower, custard on desserts)
- Add nutrition supplement powders to foods and desserts
Note: If despite a HPHE diet being implemented a resident’s food intake is still very poor, a dietitian or doctor will often prescribe nutritional supplements in addition to a HPHE diet as a nutritional ‘top up’. Sometimes it may be necessary for nutritional supplements to be the sole or major source of nutrition.
Encouraging HPHE menu choices and increasing protein and energy in recipes without increasing the volume of the food offered are two strategies that may assist with increasing dietary intake. By ensuring that HPHE choices are offered throughout the day you will hopefully capture the different times that your residents may have a better appetite e.g. Many residents report that appetite is best on waking in the morning compared to later in the day.
Breakfast is an essential start to the day. Eating breakfast literally ‘breaks the fast’ after sleep as it will have been a considerable number of hours since the body last had any food. Breakfast can be the perfect opportunity to increase dietary intake.
Given the risk of malnutrition, and the essential role that good nutrition plays in both health, and quality of life, the 2012 Qld Health Nutrition Standards for Meals and Menus (NSMM)1 have made the following breakfast recommendations for Residential Aged Care facilities based on studies that indicated an increase in both protein and energy intake when fortified food and a cooked breakfast were provided:
- A hot protein choice shall be offered to residents on full and soft textured diets at least four times a week or on alternate days. e.g. bacon, eggs
- A cold protein choice at breakfast will be provided each day. e.g. yoghurt, cold meats
- A hot protein breakfast choice shall be offered to all residents on texture B minced and moist and texture C smooth pureed diets each day.
- A fortified hot cereal will be offered daily. e.g. fortified porridge
Offering a hot breakfast to your residents is an easy and economical way of providing extra energy and protein at the start of the day. Ensure that suitable breakfast choices are also offered to residents with dementia who either struggle to use cutlery or remain seated at mealtimes e.g. finger foods (mini quiches, meat balls).