By Chris Deed <\/p>\n\n\n\n
There is a simple problem at the epicentre of one of aged care\u2019s most persistent health challenges. So many older people need more nutrition at precisely the time in their lives when they feel like eating less. <\/p>\n\n\n\n
Appetite commonly declines with age and can be further affected by illness, medications, swallowing difficulties and changes to taste and smell. <\/p>\n\n\n\n
What often gets missed is that their nutritional requirements do not fall with it. <\/p>\n\n\n\n
It\u2019s a common misconception that older people in residential aged care need less protein, vitamins, minerals and energy than younger people. But energy needs are greater than traditionally thought, and protein, calcium and vitamin D requirements are in fact higher in older adults than younger ones. Weight loss is not a normal part of ageingi<\/sup>. <\/p>\n\n\n\n So, the gap between what someone needs and what they manage to eat widens at exactly the point it becomes hardest to close. <\/p>\n\n\n\n As you\u2019d expect, the consequences of that can be serious. <\/p>\n\n\n\n This is not a small problem. In one Australian study across ten aged care homes, 40% of residents were malnourishedii<\/sup>. For the person, it can often start with something as ordinary as leaving half a meal, day after day. <\/p>\n\n\n\n Malnutrition is associated with a range of consequences, including a higher risk of falls and fractures, elevated infection risk, slower wound healing and greater use of healthcare servicesii<\/sup>. It can contribute to a downward spiral in which declining nutrition leads to declining strength and health, which in turn makes eating well even more difficult. A recent Lancet review notes that once weight has been lost, it may be regained, but the muscle and strength lost along with it often cannot be, even with full nutritional supportiii<\/sup>. <\/p>\n\n\n\n We need to get much better at breaking that cycle. <\/p>\n\n\n\n Identifying residents at risk is essential, but malnutrition itself is often missed. Weight and BMI tell you someone’s size, not whether they are eating enough or losing muscle, so a resident can be a healthy weight, or even overweight, and still be malnourished. Screening tools designed and validated for older people are built to catch that, but they only help if there is a clear process for what happens next. Studies have found a positive screen is often not followed up, so nothing may change for that residentii<\/sup>,<\/sup>iii<\/sup>. <\/p>\n\n\n\n For residents identified as being at risk, one of the answers is hiding in plain sight: make every mouthful count. <\/p>\n\n\n\n When someone has a poor appetite, simply putting more food on their plate is unlikely to solve the problem. A large serving may become another barrieriv<\/sup>. <\/p>\n\n\n\n Making every mouthful count starts with the everyday menu. For many residents, the food provided by the aged care service is their only source of food and drink. That means the menu has to do all of it: enough protein and energy at every meal, food that is familiar and appealing, and choice that reflects what people actually want to eat. <\/p>\n\n\n\n Getting that right is skilled work. It is why menus are best planned and reviewed with a dietitian alongside the chefs and cooks who actually produce the food, rather than treated as a catering exercisev<\/sup>,<\/sup> <\/sup>vi<\/sup>. <\/p>\n\n\n\n Choice and the meal itself are part of the nutrition, not separate from it. A lack of choice reduces motivation to eat, and mealtime assistance and a pleasant, home-like dining environment are both rated as effective on strong evidence in international guidelinesvi<\/sup>,<\/sup>iii<\/sup>. Nutrient dense food that does not get eaten achieves nothing. <\/p>\n\n\n\n For residents at risk of malnutrition, guidelines recommend fortifying meals with energy and protein without substantially increasing their volume. Smaller, enriched meals and snacks can also create more opportunities across the day for people with poor appetites to get the nutrition they needvii<\/sup>. <\/p>\n\n\n\n Importantly, this is not about fortifying food for every aged care resident. Nutrition should be tailored to individual needs, with additional energy and protein targeted to those who need it. <\/p>\n\n\n\n Oral nutrition supplements have an important role where food-based measures are insufficient on their own. But for residents who need additional support there is a strong case for first making more of the food they already know and enjoy, because food people recognise and enjoy is food they are more likely to wantvii<\/sup>. <\/p>\n\n\n\n Nowhere is this harder than for people on texture modified diets. Modifying texture makes food safer to swallow, but adding liquid to achieve that texture also dilutes the nutrition in it. So this is a group already at higher risk of malnutrition, being offered food that starts with less in it. The more food has to be modified, the sharper that problem becomes. Which is why, for these residents, fortification makes sense across the whole menu rather than resident by resident viii<\/sup>,<\/sup> <\/sup>ix<\/sup>.<\/sup> <\/p>\n\n\n\n This is the problem we have spent our time on at The Pure Food Co. Texture-modified food does not have to mean lower nutrition or lower meal enjoyment, and these compromises are not inevitable. It is not the whole answer, but it addresses something we know is part of the problem. <\/p>\n\n\n\n Most importantly, this is an approach that can be scaled. Aged care operators shouldn\u2019t have to rely on dozens of individual kitchens achieving exactly the same level of fortification every day. Nutritional standards can be designed into food systems and delivered consistently across homes, regions and entire organisations, while still catering for resident choice. <\/p>\n\n\n\n Malnutrition will never have a single solution. Screening that leads to action, assessment, monitoring and individualised care all matter. But food itself is one of the most powerful tools we have, and it works with something residents already do every day. <\/p>\n\n\n\n If older people are eating less, the answer isn\u2019t simply to ask them to eat more. <\/p>\n\n\n\n We need to make more of what they can eat and ensure every single mouthful counts. <\/p>\n\n\n\n ___<\/p>\n\n\n\n <\/p>\n\n\n\n i Bartl, R. and C. Bunney, Best Practice Food and Nutrition Manual for Aged Care Homes Edition 2.2. 2015: Central Coast Local Health District: NSW Government. By Chris Deed There is a simple problem at the epicentre of one of aged care\u2019s most persistent health challenges. So many older people need more nutrition at precisely the time in their lives when they feel like eating less. Appetite commonly declines with age and can be further affected by illness, medications, swallowing difficulties […]<\/p>\n","protected":false},"author":2,"featured_media":8731,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","wds_primary_category":0,"footnotes":""},"categories":[25],"tags":[],"class_list":["post-8730","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"acf":[],"_links":{"self":[{"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/posts\/8730","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/comments?post=8730"}],"version-history":[{"count":1,"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/posts\/8730\/revisions"}],"predecessor-version":[{"id":8732,"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/posts\/8730\/revisions\/8732"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/media\/8731"}],"wp:attachment":[{"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/media?parent=8730"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/categories?post=8730"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thepurefoodco.com\/aus\/wp-json\/wp\/v2\/tags?post=8730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
ii O’Shea, M.-C., Bauer, J., Barrett, C., Corones-Watkins, K., Kellett, U., Maloney, S., Williams, L. T., Osadnik, C., & Foo, J. (2024). Malnutrition Prevalence in Australian Residential Aged Care Facilities: A Cross-Sectional Study. Healthcare (Basel), 12(13), 1296.
iii Dent, E., Wright, O. R. L., Woo, J., & Hoogendijk, E. O. (2023). Malnutrition in older adults. The Lancet, 401(10380), 951-966. https:\/\/doi.org\/10.1016\/S0140-6736(22)02612-5<\/a>
iv Nieuwenhuizen, W. F., Weenen, H., Rigby, P., & Hetherington, M. M. (2010). Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake. Clinical Nutrition, 29(2), 160-169
vAged Care Quality and Safety Commission. (2025). Provision of food and drinks. Australian Government. Accessed from: https:\/\/www.agedcarequality.gov.au\/strengthened-quality-standards\/food-and-nutrition\/provision-food-and-drinks<\/a>
vi Aged Care Quality and Safety Commission. (2019). Why meals matter. Australian Government. Why meals matter. Accessed from: https:\/\/www.agedcarequality.gov.au\/providers\/food-nutrition-dining-information-providers\/why-meals-matter<\/a>
vii Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., van Asselt, D., Wirth, R., & Bischoff, S. C. (2022). ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clinical Nutrition, 41(4), 958\u2013989. https:\/\/doi.org\/10.1016\/j.clnu.2022.01.024<\/a>
viii Wu, X. S., Miles, A., & Braakhuis, A. (2023). Malnutrition in aged care: interplay between dysphagia and diet. Current Opinion in Otolaryngology & Head and Neck Surgery, 31(6), 350-356
ix Wu, X. S., Miles, A., & Braakhuis, A. J. (2021). Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare (Basel), 9(6), 624.<\/p>\n","protected":false},"excerpt":{"rendered":"