BETTER PRACTICE IN FOOD AND NUTRITION SERVICES - MENU PLANNING AND MENU DESIGN TO DELIVER OPTIMAL NUTRITION TO RESIDENTIAL AGED CARE

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1 BETTER PRACTICE IN FOOD AND NUTRITION SERVICES - MENU PLANNING AND MENU DESIGN TO DELIVER OPTIMAL NUTRITION TO RESIDENTIAL AGED CARE Karen Abbey Dietitian/Manager Residents Support Services Nambucca Valley Care PhD student University of Queensland

2 AGED CARE AUSTRALIA Aged care population across Australia 160,000 residents Numbers of aged care facilities 2,500 + People entering aged care is 80+. NVCL average population age was 80 (08) 83 (09). Population is becoming frailer (high care) Length of stay shorter NVC high care 2.5 years Under nutrition is an area of concern Research Australia Woods et al % residents in low care (risk of under nutrition) Gaskill et al % residents in aged care moderately malnourished 6.4% severely malnourished

3 AGING Geriatric Nutrition is complex and often involving more then one disease process, behavior and social dynamics of residents Decline in mobility and self care General decline of the human body Behavior and ability to communicate Dementia unable to feed or recognise food and feeding Total dependence for care Loss of senses and ability to smell and taste food Decreased food intake (sparrows) Poor absorption of nutrients

4 THE ROLE OF FOOD Food plays an important role daily in the lives of residents living in aged care facilities Part of the home environment is to create catering which will provide this for all areas of aged care including dementia care and to the very frail Menus are essential to create the necessary food service structure Stimulating the appetite and improving nutrition intake for every meal is an important care factor Focal point of the day Forward moves residents It s the one thing that residents really have control over and the most vocal point

5 FOOD SERVICES IN AGED CARE Important part of resident care More then just putting a meal on a plate Social aspects of food Total dependence on the menu to provide all of the nutrition 100% Eating environment is very important Meal time Providing mid meal snacks Food safety Budget

6 What we don't know What does this population group need in terms of nutritional care ( years old) Macro and micro nutrients What do we need to do to nourished the very frail residents Menu design to support nutritional care Are the current menus in Aged Care Suitable for feed the range of residents in aged care including the very frail and those requiring texture modification What kind of food service system are operating in aged care Production and delivery What does nutritional care look like

7 National Residential Aged Care Foodservice Menu Survey To make a significant contribution to foodservices in residential aged care and gain understanding as to what is happening across Australia. To take a snap shot and build a foundation of what residential aged care foodservices looks like Understand menu planning and menu design in residential aged care across Australia Wanted to find out what facilities thought about food fortification, portion control and use of supplements Never been done before so why not lets ask and see

8

9 PROJECT OUTLINE PhD program with the University of Queensland 2700 surveys 10% return. Surveys were received from all over the country Facilities had about 4 months to fill it in and send it back with a copy of the menu Consent was implied if survey was returned Facilities could contact myself for any questions and assistance Eleven pages, open ended questions and tick boxes

10 INSIDE THE MENU SURVEY Production and delivery system Dietitian s use in aged care facilities frequency of visits Menu cycle - what time period and seasonality Menu structure - types of foods for mid and main meals Portion control of menu items Supplements and food fortification Menu planning, organisation and choice Extra services Staffing figure and cost of food + labour (general food service cost)

11 SNAP SHOT SO FAR

12 PRODUCTION AND DELIVERY SYSTEM Range of facility sizes (small to large) Production system - In house cook fresh Delivery system bulk, tray combinations of these serving baine marie into dinning room, tray services, decentralised re-therm Mixture of who is in charge of foodservices Chef, Foodservice manager to Director of Care

13 DIETITIAN AND MENU STRUCTURE Dietitian facilities Full time linked to a hospital As required Menu review Yearly One survey so far mentioned the APD program Cycle 4 weeks with winter and summer 2 week cycle menus Typical menu structure for breakfast, lunch and dinner Mid meal snacks

14 FOOD COMPONENTS MAIN MEALS Breakfast Lunch Evening meal Porridge cereals Meat Soup Toast Meat alternative Sandwich Fruit (tinned, prunes) White vegetable Salad Egg Orange vegetable Hot meal Yogurt Green vegetable Dessert Juice Dessert Bread Fresh fruit/tinned fruit Fresh fruit Weekly hot breakfast Salad

15 FOOD COMPONENT MID MEAL SNACKS Morning tea Afternoon tea Supper Biscuits Biscuits Biscuits Scones Cake Cake Fruit Pikelets

16 BEVERAGES Beverages Tea Coffee Milk Milo Water Juice Cordial

17 PORTION CONTROL - MEAT Chicken breast 50g 318 kj 14 g protein Chicken breast 200g 1274 kj 58 g protein

18 PORTION CONTROL WET DISH Apricot chicken 30g 218 kj 2 g protein Apricot chicken 200g 918 kj 6 g protein

19 PORTION CONTROL - DESSERT Cream rice and fruit 30g 183 kj 1 g protein Cream rice and fruit 150g 918 kj 6 g protein

20 PORTION CONTROL VITAMISED MEAT Spaghetti bolognaise 50g 350 kj 13 g protein Spaghetti bolognaise 200g 1410 kj 48 g protein

21 SUPPLEMENTS AND THERAPEUTIC DIETS Nutritional supplements were used widely by aged care facilities Nutritional supplements ranging from liquid, powders and puddings. Sustagen very popular Facilities provided for a wide range of diets Diabetic Weight loss Texture modification Gluten free Low fat Standard recipes (not all had nutrition values on standard recipes)

22 FOOD FORTIFICATION EXTRA FOODS Not all facilities filled in this section The information provided was very confusing Facilities not understanding what was meant by what food fortification is Mashed potato add milk and butter Facilities were asked about extra foods to residents and most provided extra foods Extra foods where provided (bread, cheese, ice cream, yogurt, milk) Reduced body weight Returned from hospital with weight loss Poor appetite

23 MENU PLANNING FEED BACK Menus were planned through the following ways Resident meetings Resident surveys Feed back from staff Feed back from family Price Likes and dislikes Plate wastage Very little dietetic input during the planning stage

24 MENU PLANNING BARRIERS Barriers to menu planning were as follows: Cost Availability Attitude of staff (care and foodservice) Food safety Cultural requirements Likes and dislikes

25 MENU CHOICE We asked facilities to indicate at what point did residents have the ability to choose menu items before service. Just prior to meal service The morning of the meals The day before the meal Only upon admission to the aged care facility where choice and food preferences are taken into consideration

26 IN SUMMARY Nutrition is delivered through the menu for all aged care facilities Starting to build what current menus and foodservices looks likes across the country Foodservice is a complex process that interfaces with care these two areas must work together to ensure that residents are being nourished. What does the menu look like for optimal nutritional care catering for all residents (especially our very frail residents) needs a lot of thought and work.

27 What do we do KEEP ON DOING THE DATA ANALYSIS TO DEVELOP AN OVERALL PICTURE OF MENU DESIGN PREFERENCE DATA FROM THE MENUS TO BUILD THE PICTURE OF WHAT THIS GENERATION EATS PORTION CONTROL DATA TO EXAMINE THE NUTRITIONAL ADEQUACY OF CURRENT MENU DESIGN

28 WOULD LIKE TO THANK Dr Olivia Wright University of Queensland Professor Sandra Capra University of Queensland John Butler CEO and staff Nambucca Valley Care All the participants of the survey

29 WHERE WE LIVE Nambucca Valley Care

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