Malnutrition is a growing health issue among older adults, particularly within aged care facilities. A global study[1] across various healthcare settings revealed that approximately two-thirds of older adults, with a mean age of 82 years, were at nutritional risk or already malnourished. In New Zealand, a staggering 90% of older adults were found to be either malnourished or at risk of malnutrition upon admission into aged care facilities[2]. In aged care, malnutrition often goes unnoticed, leading to serious health complications such as muscle wasting, infections, and delayed wound healing[3].
At The Pure Food Co, we understand the importance of providing nutritious meals that meet the specific dietary needs of older adults while maintaining the familiar and comforting tastes they know and love.
Why older adults are more susceptible to malnutrition
As we age, physical and physiological changes impact our ability to meet our increasing nutrition needs. Factors such as, reduced appetite, cognitive impairments like dementia, chewing and swallowing difficulties[4], and poor oral health all contribute to reduced food intake, resulting in weight loss, muscle weakening, and an increased risk of falls and infections—complications that could be reduced with good nutrition[5].
Protein is a critical nutrient for older adults, playing a significant role in reducing the risk of falls, frailty, and infection[6]. Research shows that a higher protein intake of around 25-30g per eating occasion, distributed evenly across meals throughout the day, supports building and maintaining muscle[7],[8]. However, for many older adults, achieving adequate protein intake through regular meals and snacks alone is a challenge, especially as appetite often decreases with age. This is where food fortification becomes essential.
What is food fortification?
Food fortification involves adding extra nutrients, such as protein and energy, to meals and drinks without increasing the volume of food. It is a flexible and effective malnutrition prevention strategy, ensuring every mouthful is as nutritious as possible5, [9]. This approach is particularly beneficial for those with smaller appetites or individuals suffering from dysphagia (difficulty swallowing), as fortifying foods can significantly improve overall intake of essential nutrients[10], 5. However, not all fortification techniques may be equally effective.
For example, traditional fortification methods involve adding milk powder, butter, or cream to common foods like mashed potatoes, baked goods, and hot drinks. While these methods increase energy intake without compromising taste, they may not provide enough protein to meet these higher requirements. Protein is one of the essential elements in maintaining muscle mass and preventing malnutrition risk[11].
The challenge: Not all proteins are created equal
While kitchens and care teams may be familiar with basic fortification techniques, achieving the right balance of protein can be more complex than it seems. Not all protein sources are equal in nutritional density. For instance, 100 grams of milk powder provides up to 38 grams of protein, while 100 grams of cream provides can only provide around 2 grams[12]. In contrast, concentrated sources like pea, whey and rice protein powders (depending on the brand used) deliver as much as 79 grams, 79.8 grams and 80 grams of protein per 100 grams, respectively. This makes them far more effective for fortifying the protein content of meals in aged care facilities.
It’s important to ensure fortification does not impact the taste and texture of meals. Unfortunately it is not as easy as just adding protein powders to meals, which can change the taste and texture in a negative way compared to traditional energy dense methods. Fortification shouldn’t negatively affect the taste of food as this could further reduce intake and increase the risk of malnutrition. It is critical that meals are tasty, and to the liking of older adults, so that they can still enjoy the familiar flavours they are used to with the beneficial increased nutrition.9
How The Pure Food Co makes every bite count
At The Pure Food Co, we take the guesswork out of food fortification. Our team of expert chefs, food technologists, and dietitians work together to ensure that older adults get the essential nutrients they need without altering the familiar, great taste of their meals. We fortify all our meals, snacks, and smoothies with high-quality pea and rice proteins, carefully balancing nutrition and flavour. As our products are designed for convenience, we remove the technical aspect, allowing kitchen and care teams to simply plate, thaw, heat and serve.
This approach ensures optimal nutrition while preserving the familiar flavours that residents enjoy. Our meals are particularly beneficial for those at risk of malnutrition, including individuals with dysphagia, providing an easy and effective way to ensure they receive the protein and energy needed to promote health and wellbeing.
Get in touch
If you’d like to learn more about how The Pure Food Co can improve nutrition in your aged care facility, get in touch with us today. Every bite counts when it comes to preventing malnutrition and ensuring your residents receive the best care possible.
Reviewed by New Zealand Registered Dietitian Vanessa Tregoning, NZRD
References
[1] Kaiser, M.J., Bauer, J.M., Rämsch, C., Uter, W., Guigoz, Y., Cederholm, T., Thomas, D.R., Anthony, P.S., Charlton, K.E., Maggio, M., Tsai, A.C., Vellas, B., Sieber, C.C. (2010), Frequency of Malnutrition in Older Adults: A Multinational Perspective Using the Mini Nutritional Assessment. Journal of the American Geriatrics Society, 58: 1734-1738. https://doi-org.ezproxy.otago.ac.nz/10.1111/j.1532-5415.2010.03016.x
[2] Senior, S.; Richter, M.; Allen, J.; Wham, C. Prevalence of Malnutrition and Dysphagia in Advanced Age Adults Newly Admitted to Age-Related Residential Care. Proceedings, 2019, 8, 22
[3] Ahmed, T., & Haboubi, N. (2010). Assessment and management of nutrition in older people and its importance to health. Clinical Interventions in Aging, 5, 207-216.
[4] Bauer, J., et al. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. *Journal of the American Medical Directors Association, 14*(8), 542-559.
[5] Geny, A., Petitjean, M., Van Wymelbeke-Delannoy, V., & Sulmont-Rossé, C. (2023). Impact of food-based fortification on nutritional outcomes and acceptability in older adults: systematic literature review. Frontiers in nutrition, 10, 1232502. https://doi.org/10.3389/fnut.2023.1232502
[6] New Zealand Nutrition Foundation (2022). Protein. Accessed 22/11/2024 Protein – NZ Nutrition Foundation
[7] Houston, D. K., Nicklas, B. J., Ding, J., Harris, T. B., Tylavsky, F. A., Newman, A. B., Lee, J. S., Sahyoun, N. R., Visser, M., Kritchevsky, S. B., & Health ABC Study (2008). Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. The American journal of clinical nutrition, 87(1), 150–155. https://doi.org/10.1093/ajcn/87.1.150
[8] Paddon-Jones, D., & Rasmussen, B. B. (2009). Dietary protein recommendations and the prevention of sarcopenia. Current opinion in clinical nutrition and metabolic care, 12(1), 86–90. https://doi.org/10.1097/MCO.0b013e32831cef8b
[9] Smith, R., Methven, L., Clegg, M. E., Geny, A., Ueland, Ø, Synnøve Grini, I., et al. (2024). Older adults’ acceptability of and preferences for food-based protein fortification in the UK, france and norway. Appetite, 197, 107319. doi:10.1016/j.appet.2024.107319
[10] Smoliner C., Norman K., Scheufele R., Hartig W., Pirlich M., Lochs H. Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition. 2008;24:1139–1144. doi: 10.1016/j.nut.2008.06.024
[11] Putra, C., Konow, N., Gage, M., York, C. G., & Mangano, K. M. (2021). Protein Source and Muscle Health in Older Adults: A Literature Review. Nutrients, 13(3), 743. https://doi.org/10.3390/nu13030743
[12] The Concise New Zealand Food Composition Tables 14th Edition 2021. Accessed here: https://www.foodcomposition.co.nz/downloads/concise-14-edition.pdf
