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.


Detox Diets

Access Allied Health - Thursday, January 31, 2013

There is a vast array of ‘Detox’ diets available – in books and magazines, on the internet, and in your local pharmacy.  However, while they often promise amazing results, there is a lack of evidence to support these results.  So is the ‘detox’ experience worth the high price tag many are willing to pay?

What is a detox diet?

The purpose of a detox diet is to remove toxins from the body.  Although there are many types of detox diets, generally they involve a strict regime of eating raw vegetables, fruit, fruit juices and water.  It may also involve a period of fasting and using herbs and other supplements.  Detox diets also encourage severe restriction of whole food groups such as meat or dairy food, therefore they will not meet nutritional requirements and if used for a prolonged period of time may result in nutritional deficiencies. 

Natural Detoxification

Our bodies have organs and systems in place, designed to filter out toxins.  Our kidneys, lungs, skin, lymphatics and liver all play a role in the removal of toxins.  Excessive consumption of highly processed foods such as sugary snacks and fatty fast food as well as drugs such as caffeine and alcohol make these systems work harder and perhaps leave us feeling a little run down.  If this is the case, simply decreasing our intake of these foods and replacing them with core foods such as bread, fruit, dairy, meat and vegetables as well as increasing our intake of water will have us feeling much better in no time.

Who shouldn’t try a detox diet?

A detox diet can be potentially dangerous.  Pregnant or nursing women or children should not try these styles of diet.  Also, people with health conditions such as liver or kidney disease or diabetes may be putting themselves at risk of serious medical conditions due to the restrictive nature of these diets.

The Bottom Line

This type of diet is not a long term solution and can be quite dangerous for some people.  For lasting results consult an accredited practicing dietitian who can help you achieve healthy eating, everyday – the best health solution there is!

Label Reading - what do nutrition claims mean?

Access Allied Health - Thursday, April 26, 2012

With so many products to choose from these days, we can take the initiative and time to read the labels to know what we're buying.  The nutritional information can help you to make informed choices about the foods you want to eat.  Here are some common nutrition claims and what they actually mean.

All Natural
This usually means there are no artificial colours, flavours or preservatives.  It doesn't mean it's the best choice as the product may still be high in fat, sugar and/or salt.

'Light' or 'Lite'
This does not necessarily mean less fat or lower in kilojoules.  For example, 'lite' potato chips are thinly sliced and 'lightly' salted but are still high in fat.  Light oils are light in colour/flavour, not in fat.

No Cholesterol or Cholesterol Free
This does not mean low fat.  Foods made with vegetable oil will have no cholesterol, as cholesterol only comes from animal based foods, but can still be high in fat.  E.g. a bottle of olive oil has no cholesterol but is still nearly 100% fat.

Carbohydrate Modified
These products contain sugars other than sucrose (cane sugar).  Sugars like sorbitol, mannitol and sylitol are often used.  These sugars are similar to sugar, i.e. the same calories and are not suitable for diabetics.

'Low-joule' or 'diet'
These terms mean that the product is lower in kilojoules than a similar product - usually due to the addition of artificial sweeteners.

'No Added Sugar'
This means that no extra sugar has been added to the product but it still may contain natural sugar already present in the food.

Reduced Fat
This label indicates that the product contains less fat than standard products but may not necessarily be low in fat.  Usually there is 25-33% less fat than the standard counterpart.

'Creamed', 'Toasted' or 'Oven-baked'
These terms mean that more fat and kilojoules have been added to the original product, as is the case with toasted muselies.