Access Allied Health

Malnutrition in Aged Care Facilities

Access Allied Health - Thursday, March 07, 2013

Would you believe that, in Queensland alone, half of all aged care residents are classified as malnourished?[1].  Well, perhaps a little shockingly, this is what current research shows.  However, what’s even more concerning is that further Australian based research shows that malnutrition is not being recognised in these residents and they are therefore not receiving the correct nutrition intervention[2].

Now this is not at all a reflection on the hard working clinical and support staff working in the aged care sector, but rather brings nutrition into the limelight as an area of aged care needing increased attention.

What is Malnutrition?

Malnutrition may be defined as a state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients cause measurable adverse effects on tissue (shape, size, composition), function and clinical outcome.  The predominant form of malnutrition in aged care is Protein Energy Malnutrition (PEM) which simply means that there are inadequate levels of protein and/or energy to maintain good health.

What does malnutrition look like?

A person with malnutrition may have one or more of the following presentations:

  • Reduced body weight
  • Muscle wasting and decreased strength
  • Reduced respiratory and cardiac muscular capacity
  • Thinning skin and loss of skin integrity
  • Decreased metabolic rate
  • Fatigue
  • Oedema and immunodeficiency

These presentations can compound and have a significant health impact such as:

  • delay in recovery from injury or illness,
  • poor wound healing,
  • increased occurrence of complications,
  • reduced quality of life which can lead to depression and
  • increased risk of falls.

As you can see, malnutrition is linked with poorer health, leading to an increased burden on health resources.

What can be done about malnutrition in the aged care setting?

Prevention is the best remedy for this costly and debilitating condition.  There are some simple but very effective strategies that aged care facilities can adopt to combat malnutrition in their residents.

  • Screening all residents for malnutrition on a regular basis
  • Implementing a protocol for malnutrition including both the screening of residents and an action plan when a resident is identified as having malnutrition
  • Seeking assistance from an accredited practicing dietitian when a resident is identified as having malnutrition

To discuss, assess, review or change the nutrition management procedures at your aged care facility, please speak to an accredited practicing dietitian who can assist you in this process.

[1] Banks M, Ash S, Bauer J, Gaskill D. Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutrition & Dietetics.  2007: 64:172-178

[2] Gaskill, D., Black, L. J., Isenring, E. A., Hassall, S., Sanders, F. and Bauer, J. D. (2008), Malnutrition prevalence and nutrition issues in residential aged care facilities. Australasian Journal on Ageing, 27: 189–194.

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Should I take nutritional supplements?

Access Allied Health - Thursday, February 07, 2013

In my youth, as newly-graduated dietitian armed with idealistic ambition to make the world a healthier place I would have answered this question a little differently than I will today.  Back then, when the broccoli was greener, I suspected that a lack of education was the main cause of rising fast food sales and the unpopularity of lentils.  “If I tell them,” I thought as I hummed the ‘Rocky’ theme song, “they will change”.  Surely all the motivation one needed to mix cottage cheese into their brown rice was the knowledge that their daily molybdenum requirement will be met (yes molybdenum IS an actual nutrient).

Armed with this belief and my youthful exuberance, I previously would have been quick to state the fact that a good diet will meet all nutritional requirements and the use of nutritional supplements is quite literally money down the toilet.  But now I’m not so young, I’m not so self-assured and while I still fundamentally believe in good nutrition for optimal health, I now consider there to be more than one way to skin a cat so to speak.

Now, don’t get me wrong – I mean, what sort of dietitian would I be if I thought that the food we eat couldn’t be meet our nutritional needs.  Of course it can – but does it?  While I don’t expect our molybdenum requirements to be the major driver of our food choices (anymore), far too often our frantic lifestyle and need of convenience are leading us to form food habits not conducive to meeting our nutritional needs.

Ok, ok – I’ll admit - I’ve only ever met one person in my years of practice that showed clinical signs from a vitamin deficiency and acute symptoms of dietary inadequacy in the developed world are rare.  So maybe it’s just some remaining idealistic ambition that I can’t shake, in continuing to push for dietary change – after all we seem to be doing alright.  However, when we consider non-clinical markers – such as fatigue, malaise and poor workplace productivity perhaps there remains a case for dietary change and a revitalised campaign to meet requirements.

While lifestyle change will always remain the flagship to correcting these dietary deficiencies, perhaps a multivitamin may offer, dare I say it, a reasonable solution.  Or perhaps I'm simply getting old and cynical.  Either way, before attempting dietary change or choosing a nutritional supplement, please speak to an expert - an accredited practicing dietitian.