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Aged care facility food allowances ‘cutting corners’

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In its recent commission report, The Lancet states that ‘malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally’, while the World Health Organization recognises malnutrition as one of six contributing factors to the declining physical and mental capacity of older people. 
 
Approximately 8% of older Australians living in the community are malnourished, and it is estimated that of those living in residential aged care facilities (RACFs), between 22% and 50% are malnourished.
 
Representatives from the Dietitians Association of Australia (DAA) yesterday appeared before the Royal Commission into Aged Care Quality and Safety calling for all aspects of nutrition to be improved, following reports of inadequate daily allowances and quality of food provided to aged care residents.
 
The DAA provided evidence of ‘significant levels’ of malnutrition in aged care during the hearing, and likened it to a ‘faceless abuser’ as a form of mistreatment.
 
‘We would be disturbed if we fed our children the same way our older Australians are currently being fed. We cannot let elder abuse through poor nutrition continue any longer,’ DAA Chief Executive Officer Robert Hunt said.
 
Recommendations have been put forward for the development and implementation of a national nutrition policy incorporating the health of all older Australians living in the community and residential aged care.
 
The policy would address the critical aspects needed to improve nutrition in older people, including: 

• a public health awareness campaign to increase understanding of nutritional needs
• regular malnutrition screening by GPs, community care and residential aged care services
• adequate referral pathways and access to ensure provision of nutritional care
• nutrition education as a core component of aged care training, incorporating and continuing professional development delivered by accredited practising dietitians (APDs)
• planning and delivery of meal services to incorporate an assessment by an APD, to ensure nutrition needs are met
• priority given to mealtimes, including appropriate support, assistance and modifications needed to aid meal consumption, to maximise food and fluid intake. 

Dr John Parikh, a GP with a special interest in aged care, sympathises with the call for a national policy, but told newsGP it should incorporate further support for GPs to assist in their assessment of older patients’ nutrition, as part of their provision of healthcare.
 
‘Regular health assessments following national guidelines are common practise for GPs for all their older patients – not just in aged care – and this incorporates nutrition advice,’ he said.
  
Dr Parikh recommends GPs be actively involved in the process of assessing older patients’ diet, through collaboration with APDs and carers. However, this may not always be achievable for patients who are not in an RACF.
 
‘For these patients who are still living at home, GPs don’t have much control over what they eat. For example, they may or may not have the skills or resources to cook nutritional meals at home, or they may be on a modified diet due to medication for other conditions,’ he said.
 
RACF patients often require specific attention, which can be facilitated between the staff, dietitian and GP, according to Dr Parikh.
 
‘Somebody [in an RACF] might be on low-cholesterol diet, or a low-fat diet, but if GPs don’t know about it, the onus is on the dietitian, so communication is important.’
 
The Royal Commission into Aged Care Quality and Safety hearing prompted review of the daily allowance of around $7 per day per person residing in an RACF, which Dr Parikh said is ‘cutting corners’.
 
‘A lot of us spend more on coffee per day than RACF food allowances,’ Dr Parikh said.
 
‘We should go in [to an RACF] and eat the food for a day ... we would probably find it is not that tasty or appealing or nutritional.’
 
The RACGP’s Medical care of older people in residential aged care facilities (Silver Book) includes recommendations on screening for malnutrition and ongoing assessment. The Silver Book is currently being updated, with the new edition due for release later this year.

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aged care elder abuse malnutrition nutrition

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