Nutritional Guidelines For Elderly In Residential Care Units

Target population

This report aims to focus on the diets of the elderly people in residential care units in Wales, United Kingdom.

The choice of the target population is guided by the fact that elderly people living in the residential care units are susceptible to nutrient deficiency. Adults tend to have fewer calories due to the decreased appetite and the activity levels. Such decrease in the intake of the calories causes deficient levels of the vitamins and the minerals. Dietary deficiencies in the older adults can be due to a number of factors like forgetfulness due to ageing, loss of apetite and the financial factors that limits the decisions of the food purchasing. Furthermore presence if several comorbidities and medications also reduces the ability of the body to absorb the nutrients (Bamford et al., 2012).

There had been evidences that the nutritional intake of the older people living in residential care units are suboptimal with high levels of saturated fat, salt and added sugars. Despite of receiving a 24 hours of service for the older people living in the care homes, they remain vulnerable to the malnutrition. According to the international estimates, the malnutrition vary as per the level of care and the methods of assessment, still ranging from 14%- 65% in the aged residential care (Bamford et al., 2012).

The UK food standard care agency has therefore established dietary guidelines for the people staying in residential care units.

Inadequate nutrition among the elderly people might lead to several comorbidities. Malnutrition might lead to vitamin deficiency diseases, reduction in the bone mineral density hindering the quality of life by decreasing the ability of the older people to carry out the daily chores of life. Dietary fats seems to be associated with the degenerative diseases like cancer of the common, prostate and pancreas. Atherogenic risk factors like increase in the blood sugar level, glucose intolerance are all affected by the dietary factors, which play a significant role in the development of the coronary heart disease in old age.

Consumption of non-nutritious and fatty foods might lead to an elevated level of serum cholesterol that is a risk factor for the coronary heart diseases. Dietary changes affect several risk factors throughout the life and can have a greater impact in the older people. More vitamin and protein rich diets and relatively reduction in the saturated fats and salt intake can reduce the blood pressure and the concentration of the cholesterol.

All the residential care centers and the nursing homes should meet the nutritional guidelines for the food prepared for the older people. Monitoring of the regular nutritional standards of the meals has to be carried out regularly and those residential care, not abiding by the guidelines should be advised and helped to meet the standards otherwise their registration would be forfeited.

• The average day’s food for the elderly people living in the residential care unit should meet the COMA report’s estimated Average Requirement for energy.
• Considering the common occurrence of the under nutrition in the older people living in the residential care units, the providers should increase the energy , calcium, iron and the zinc contents of the meals to about 40 % of the reference values and the Vitamin C content and the folate should be increased to 50%. The estimated average requirements of calories for the women are 1,810kcal (7.61MJ*) a day and for men aged 75 and  above are 2,100kcal (8.77MJ*) a day. For the older adults who are less active. Their dietary requirements for the calories might be less, but their requirements for the other nutrients should be changed (Bamford et al. 2012).
• Fat gives the most concentrated forms of calories and the saturated fats are mainly derived from the animal sources and are mostly found in cheese, butter and meat. The unsaturated fats are mainly obtained from the animal sources. WOMEN aged 75 and over needs, 70g of fats a day and MEN aged 75 and over requires 82g fats a day (Bamford et al. 2012).
• 50 % of the energy is got from the carbohydrates and includes both sugars and the starches. As per the dietary guidelines, 39% of the carbohydrates should be obtained from the starches and the milk sugars and only 11 % has to be obtained from the non – milk extrinsic sugars. WOMEN aged 75 and over needs 188g calories from the starch and the milk sugars, a day and MEN aged 75 and over needs 218g calories in a day (Bamford et al. 2012).
• Most of the food prepared for the elderly people should not be given with NME (Non milk extrinsic) sugars as that can depress their appetite in food (Health in Wales. 2016).
• The dietary reference value for non- starch polysaccharides should be 18 g a day. Adequate intake of the fluids a day helps to enhance the action of the fibers and helps to alleviate constipation (Health in Wales. 2016).
• The Reference Nutrient Intake of proteins for the WOMEN is 46.5g a day and for the MEN is 53.3g a day. This balance is required for setting a balance providing sufficient protein for the tissue repair without giving over burden over the kidneys (Bamford et al. 2012)..
• The reference nutrient intake for the vitamins for tee women aged above 50 are- Thiamin 0.8mg a day, Riboflavin 1.1mg a day, Niacin 12mg a day and for the men it is Thiamin 0.9mg a day, Riboflavin 1.3mg a day and  Niacin 16mg a day. Recommended level for the vitamin C is 40 mg , Vitamin A- WOMEN: 600 micrograms a day MEN: 700 micrograms a day , Vitamin D- 10 micrograms a day. Dietary sources for Vitamin D for the elders should include herring, mackerel, salmon or tuna. Cereals might contain several vitamins.
• Older adults require 700 mg of calcium a day. Older women are susceptible to osteoporosis (loss of the bone mineral density). Additional calcium supplements can help to increase the bone mass (de Jonge et al. 2012).
• Iron content in the food should be about 8.7 mg a day. In a national diet and the nutrition survey , 52 % of men and 32% of women was found to be anemic due to the iron deficit diets. In older people iron has to be in a form that can be easily absorbed for example  oily fish, meat and offals (Hill et al. 2013).

Eggs are sources of high quality proteins for the older adults to keep their bones strong and for the repair of the worn-out tissues. It also contains decent amounts of vitamin K (phylloquinone), vitamin A (beta-carotene), B5, B12, selenium, phosphorus, calcium and zinc (Tieland et al. 2013). More than half of the protein of the egg is found in egg white (Wolfe 2015). Eggs are a useful source of vitamin D that helps to protect bones and prevent osteoporosis in older adults. Sarcopenia is a common health issue for many elderly persons. This condition is closely linked to malnutrition and the can significantly reduce the quality of the elderly by causing muscular degeneration.  Smith and Gray (2016) have opined that eggs contain significant amount of leucine, an amino acid that is essential for the muscle synthesis in the elderly people. Hence, for most of the older people eggs are considered to be the accepted food protein at the breakfast and the other meals.  

Rationale for choosing the target population

Carrot has a high nutritive value and contains 26% of the daily value of the vitamin K, 20 % of folate , 17 % vitamin C of the daily value, Potassium, vitamin, B6,B5 and E. It also contains a small amount of manganese, magnesium, zinc, iron and phosphorus.  The antioxidant property of the vegetable helps in reducing the ageing of the cells in elderly. They have also been found to be having qualities to fight with cancer and the cardiovascular disease. (Cuervo et al. 2014). The water content of the carrot may vary from and 86-95 % and the portion that is edible consists of about 10 % of the carbohydrates. One medium, raw carrot (61 grams) contains 25 calories, with only 4 grams of digestible carbs. The main form of the soluble fiber that is found in the carrot is pectin that helps in lowering the blood sugar level by slowing down the digestion of starch and sugar. Furthermore, it can also disrupt the absorption of the LDL cholesterol from the digestive tract. The plant component that is are found in carrot and are important for the diet are- Beta carotene, alpha- carotene- an anti-oxidant that is partly converted in to Vitamin A. Lutein is the most common antioxidant that is found is god for the vision in elderly people. Lycopene present in the carrot decreases the risk of the cardiovascular diseases and polyacetylenes are some of the bioactive compounds that gives protection against leukemia.

Spinach is a source of vitamins such as Vitamin K (phylloquinone), Vitamin A (beta-carotene), Vitamin C and folate and minerals like manganese, iron and magnesium. Since, spinach contains high amounts of insoluble fiber; it acts as a roughage and helps to prevent constipation, which is important for preventing constipation in the elderly people. Some of the plant components found in spinach includes Lutein, Kaempfrol, nitrates, Quesrcetin and Zeaxanthin. Their antioxidant property helps in reducing cancer and the cardiovascular diseases.

Garlics should be included in the diet of the elderly people as it helps to lower the level of the cholesterol because of the antioxidant property of the Allicin present in garlic. Some of the compounds present in garlic are diallyl disulphide and s- allyl cysteine. The active components are found to be reducing blood pressure and diabetes (Padiya and K Banerjee  2013). Antioxidants property of the garlic prevents the formation of the free radicals that normally is responsible for the physiological process of ageing (Taguchi et al. 2013). A large 12-week study by Qidwai and Ashfaq (2013) has found that the average length of the cold symptoms were reduced to 70 % in comparison to the placebo groups. Garlic extract has been found to be useful against cold and congestion in elderly people.

Oily fishes like salmon contains long-chain omega-3 fatty acids EPA and DHA that  enhances the brain health and reduces the risk of having neurodegenerative diseases. An analysis on 12 controlled studies have found that 0.45-4.5 grams of the omega-3-fatty acids a day leads to a significant improvement in the arterial function (Calder 2012). A 3.5 ounce of salmon can contain approximately 22- 26 grams of proteins. The amount of potassium present in Salmon helps in reducing the blood pressure. Salmon fish is loaded with selenium that improves the bone health among the elderly and reduces the chance of the autoimmune thyroid diseases (Calder 2012). Asparagus is a spring vegetable that contains proteins, fibers and asparaptine , that helps in improving the blood flow and helps in lowering the blood pressure. It also possesses small amounts of micronutrients that are involved in blood clotting and bone health (Jagdish et al., 2015). Asparagus has been found to contain high amounts of flavonoids, quercetin, kaempferol and isorhamnetin that has been found to be having a reducing effect on blood pressure (Jagdish et al. 2014). Halloumi cheese is useful as it contains high content of calcium and sodium. Halloumi cheese is a good source of proteins and the can be a good option for the vegetarian (Tieland et al. 2012). The percentage of this cheese should be low (Kaminarides et al. 2015).  

Effect of inadequate nutrition in older adults (80+)

Conclusion

Older persons are vulnerable to malnutrition and due to their varied nutritional requirements, providing them with adequate nutrition can be challenging. As both the basal metabolic rate and the average body mass decreases, the energy requirements also decreases. Hence, the food should be chosen carefully for the diet, keeping in mind comorbidities of the geriatric population. The protein, vitamins and the mineral contents of the food should suffice the nutritional requirement of each of the elderly people and should meet the nutritional standards of the UK.

While the preparation of a meal plan, it is important to have a note about the presence if any forms of allergies among the residents. It is due to the fact, that may people might suffer from shellfish or shrimp allergies. Again, some of the foods that can be suitable for some people might not be suitable for the other people. However, apart from the choice of healthy foods, physical activities are also required to promote a healthy living among the elderly adults.

References

Bamford, C., Heaven, B., May, C., and Moynihan, P. 2012. Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory. Implementation science : IS, 7, 106. doi:10.1186/1748-5908-7-106

Calder, P.C., 2012. The role of marine omega?3 (n?3) fatty acids in inflammatory processes, atherosclerosis and plaque stability. Molecular nutrition & food research, 56(7), pp.1073-1080.

Cuervo, A., Salazar, N., Ruas-Madiedo, P., Gueimonde, M. and González, S., 2013. Fiber from a regular diet is directly associated with fecal short-chain fatty acid concentrations in the elderly. Nutrition research, 33(10), pp.811-816.

de Jonge, E.A., Rivadeneira, F., Erler, N.S., Hofman, A., Uitterlinden, A.G., Franco, O.H. and Kiefte-de Jong, J.C., 2018. Dietary patterns in an elderly population and their relation with bone mineral density: the Rotterdam Study. European journal of nutrition, 57(1), pp.61-73.

Padiya, R. and K Banerjee, S., 2013. Garlic as an anti-diabetic agent: recent progress and patent reviews. Recent patents on food, nutrition & agriculture, 5(2), pp.105-127.

Gonzalez, S., Fernandez, M., Cuervo, A. and Lasheras, C., 2014. Dietary intake of polyphenols and major food sources in an institutionalised elderly population. Journal of human nutrition and dietetics, 27(2), pp.176-183.

NHS Wales. 2016 .Nutrition. Access date: Retrieved from :https://www.wales.nhs.uk/healthtopics/lifestyles/nutrition

Hill, C.L., March, L.M., Aitken, D., Lester, S.E., Battersby, R., Hynes, K., Fedorova, T., Proudman, S.M., James, M., Cleland, L.G. and Jones, G., 2016. Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose. Annals of the rheumatic diseases, 75(1), pp.23-29.

Jagdish, P., Reena, C., Pooja, S. and Maheep, B., 2015. In vivo Investigation of antiamnesic effect of Asparagus racemosus root extract in scopolamine induced amnesic mice. Int J Herbal Med, 3(5 Part A), pp.20-4.

Kaminarides, S., Litos, I., Massouras, T. and Georgala, A., 2015. The effect of cooking time on curd composition and textural properties of sheep Halloumi cheese. Small Ruminant Research, 125, pp.106-114.

Smith, A. and Gray, J., 2016. Considering the benefits of egg consumption for older people at risk of sarcopenia. British journal of community nursing, 21(6), pp.305-309.

Taguchi, C., Fukushima, Y., Kishimoto, Y., Suzuki-Sugihara, N., Saita, E., Takahashi, Y. and Kondo, K., 2015. Estimated dietary polyphenol intake and major food and beverage sources among elderly Japanese. Nutrients, 7(12), pp.10269-10281.

Tieland, M., Borgonjen-Van den Berg, K.J., van Loon, L.J. and de Groot, L.C., 2012. Dietary protein intake in community-dwelling, frail, and institutionalized elderly people: scope for improvement. European journal of nutrition, 51(2), pp.173-179.

Wolfe, R.R., 2015. Update on protein intake: importance of milk proteins for health status of the elderly. Nutrition reviews, 73(suppl_1), pp.41-47.

Qidwai, W. and Ashfaq, T., 2013. Role of garlic usage in cardiovascular disease prevention: an evidence-based approach. Evidence-Based Complementary and Alternative Medicine, 2013.

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