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Nutritional Care of the Housebound Elderly Notes from the Conference held at the University of Sydney, November 2005 May 2006 The Conference was supported by the Australian Nutrition Trust and Sydney University Nutrition Research Foundation and Gosford Hospital, Northern Sydney, Central Coast Area Health Service If you have comments or would like to obtain further copies of this booklet, contact:Nutrition Department Gosford Hospital PO Box 361, GOSFORD NSW 2250, E-mail:rbartl@nsccahs.health.nsw.gov.au Thanks to Rachel Moerman and Marianne Alexander for help with this project Committee on Nutrition for Older Australians Sydney University Nutrition Research Foundation Presents: NUTRITIONAL CARE OF THE HOUSEBOUND ELDERLY A One-day Conference Friday, November 2005 One-day Conference Veterinary Science Conference Centre University of Sydney The Committee on Nutrition for Older Australians (CNOA) is organising a one-day conference on Nutrition for the Housebound Elderly This is the first conference on this topic to be held in Australia Speakers include both experts and practical field workers (refer to the list on the next page for details) Field workers and representatives of patients’ organisations are invited to attend We expect to hear about the food and nutrition needs and problems of this growing section of the community; what different organisations of field workers are achieving, what challenges they see for the future and perhaps what research might help This conference may help to remind the whole community of the importance of helping our housebound older people keep well fed and nourished Members of the planning committee (CNOA) have been involved in writing and popularising NH and MRC’s Dietary Guidelines for Older Australians (1999) and researching and preparing the Best Practice Food and Nutrition Manual for Aged Care Facilities (2004) But Australia seems at present to lack formal guidelines for nutrition of disabled and frail old people in their own homes CNOA is part of the Nutrition Research Foundation of the University of Sydney The major funding for the Conference comes from the Australian Nutrition Trust (a small, entirely independent fund with no commercial or political affiliation or agenda) Nutritional Care of the Housebound Elderly Program Registration and Morning Tea 8.30 - 9.30 am 9.30 am Chairman: Professor Stewart Truswell Opening Remarks: Margaret Fulton Undernutrition in housebound elderly: Dr Peter Lipski Importance of oral hygiene in older people: Dr Peter King Dietitians work with older people: Sally James The meaning of food: more than nutrients: Dr Susan Quine Economic aspects: Dr Michael Fine 12.30 – 1.30 pm Lunch Consumer involvement in nutrition and health: Sheila Rimmer Nutrition: is it on your training calendar? Janette Robinson Nutrition screening: ACAT: Nicole Vos Case study: an incident waiting to happen: Trish Devlin MOW: More than just meals: Debra Tape A practical approach to food issues: Carolyn Bunney A consumers experience: Marlene Brell Summing Up: Rudi Bartl Nutritional Care of the Housebound Elderly Committee on Nutrition for Older Australians (CNOA) Nutritional Care of the Housebound Elderly Conference SPEAKERS Stewart Truswell, AO, Emeritus Professor of Human Nutrition, Chairman CNOA Margaret Fulton, AM, Australia’s best known food writer Dr Peter Lipski, MD FRACP, Staff Specialist in Geriatric Medicine, Central Coast AHS Dr Peter King, BDS, Staff Specialist, Special Care Dentistry, Hunter and New England AHS Sally James, Dietician, Geriatric Ambulatory Care Service, Westmead Hospital Associate Professor Susan Quine, School of Public Health, University of Sydney Dr Michael Fine, Senior Lecturer, Department of Sociology, Macquarie University Sheila Rimmer, AM, Chair of NSW Home and Community Care State (HACC) Advisory Committee Janette Robinson, HACC Training Coordinator, Lake Macquarie, Newcastle, Hunter and Central Coast Nicole Vos, Aged Care Community Dietician, Sydney South West AHS Trisha Devlin, Program Coordinator, McKillop Community Care Central Coast Debra Tape, General Manager, Meals on Wheels Carolyn Bunney, Community Nutritionist/Home Economist, Central Coast AHS Marlene Brell, Consumer Advocate, Member CNOA Rudi Bartl, Community Dietician, Central Coast AHS, Honorary Secretary CNOA Nutritional Care of the Housebound Elderly The conference on NUTRITIONAL CARE FOR THE HOUSEBOUND ELDERLY at the University of Sydney on 4th November 2005 had a large enthusiastic audience and we said we intended to send them notes from the speakers after the conference We know a number of other people were disappointed to miss our conference, either because they were at another geriatric conference in Sydney the same day or for other reasons So Carolyn Bunney, Rudi Bartl and I have edited the notes that speakers gave us and/or their slides and/or notes we took, to produce this impression of the main points of what was said These are not definitive conference proceedings Speakers have not been asked to re-write these notes in a more formal way We hope these notes will add to those our audience may have taken for themselves and give interested people who could not attend some idea of the experiences, advice and problems our speakers shared with us The conference was not tape-recorded and we have missed points that came up in Discussions This was the first conference on this difficult subject in Australia and we haven’t seen any report of a comparable meeting elsewhere The subject is difficult because there is no available estimate of numbers of people at risk or numerical analysis of the problems they have or how severe they are It is difficult too because the many thousands of housebound elderly are in private houses and flats, often alone and widely scattered across the streets and suburbs of Australia and there is no register of who they are We hope the meeting of November 2005 will increase awareness of the community, of governments, NGOs and professionals so that Nutritional Care of the Housebound Elderly will receive increasing attention, study, planning and work Our Committee on Nutrition for Older Australians will try and help this along We are sending copies of this set of notes to all who attended and hope to have it on a Website soon as well Stewart Truswell, AO, MD, DSc, FRACP Nutritional Care of the Housebound Elderly NUTRITIONAL CARE OF HOUSEBOUND ELDERLY OPENING REMARKS: Margaret Fulton, AM Food Writer It seems remarkable to find myself 'The Cook' invited to be here to be heard When I speak of 'The Cook' I am recalling my early days when I decided on what was to be my career simply because I realised the kitchen was the place to be with family and friends, chopping, slicing, stirring, being frivolous but at the same time serious about the preparation of food, soon to be a delicious meal to be shared My career choice seemed odd at this time and I was to be referred to as 'The Cook' with a sniff of dismissal by my contemporaries From an early age I accepted that food was an important part of life It was the perfect way to start and finish a day, eating something good, with family and friends around a table My first realisation that cooking was so important was in the early 1940's when I was asked to give cookery lessons for the blind Classes began, with me a sort of novice, but I soon learned My excited students told me of the horrors of being blind at the time; being hidden, not allowed to touch anything, go anywhere, or anything This was after baking a batch of scones, baking a cake, frying an egg We bonded over the food we had prepared together They were so proud of their new skills It may have been bedlam but we did it together The Royal Society for the Blind had addressed a serious problem, things had to change, and special cookery classes were on the way It was a brilliant approach and had a more far-reaching affect than anyone had imagined Children respond enthusiastically to cooking and seeing what enjoyment there is in making a batch of pikelets, a jacket potato, a proper hamburger Understanding how to make salad, soup, wash, peel, grate a carrot or just eat one, raw or cooked It is great to be able to look after yourself, and learn what helps you to feel better, stronger They are quick to realise what helps you be good at whatever outdoors activities call for - running, jumping, catching or throwing balls they soon learn good food makes you think better Throughout life food plays an important role in our well being, but what happens when things go wrong? Today this group (CNOA) is interested in problems of the elderly and in being housebound Organisations, individuals, groups - church, charity, and ethnic are responding in different ways Nutritional Care of the Housebound Elderly Examples:       Kosher meals on wheels, available through the Jewish centre on ageing Hungarian catering based on Northside TLC catering - tender, loving cuisine offer meals that are National Heart Foundation approved, gluten-free, homemade dinners for diabetics and others Edith Models Pty Ltd offer a wide selection of dishes that could be used to compile an international cookbook Auntie Beryl's Kitchen - An elder of the Redfern community cooks and takes her caravan to the Hurstville area and of course Meals on Wheels These are just a few examples of what is going on Hungarians like their rather stodgy but nonetheless delicious and comforting goulash, paprika, sour cream and cabbage dishes Jewish people have to have kosher foods, genuine, authentic I appreciate my porridge, it's the only way a Scot can start the day- with good organic oats And so it is with the rest of the world, we try other foods but we always return to what we call comfort foods Different countries, different customs, but based on good food, food that makes us what we are While it is obvious that there are people and groups who are addressing the problems of those needing care, my concern is the increasing role of machines No matter how clever or time and labour saving, they can't replace man Soups, cottage pies, vegetables etc, being whirred by those electric, clever magic wands - the trouble is everything becomes the same And this is only the beginning Clever technology and inventions invite the easy approach without giving the full human touch Steamers, chillers, freezers, microwaves - there's every trick in the book Then there are powders, packets and so many things They are useful of course but we shouldn't let them take over, nor should we allow anything but good foods to be used I know what a difference mass production makes, so the accountants For years we have seen the changes, in top institutions and hospitals Food is no longer always cooked on the premises, much is farmed out It makes sense to all but the sick patient or person who has no say in the matter and often has to eat what no self-respecting chimpanzee would choose I am here to speak up for the home cook, the cook in the home, hospital, and factory kitchen What 'The Cook' does cannot be replaced with a machine, or powder no matter how clever the invention The cook who chops, stirs, notices, watches and cares is irreplaceable It is my aim that we should all remember the true importance of eating, the necessity of educating our cooks, accountants, nutritionists, indeed us all in treading the paths in which we should go, in what is the aim of this conference, the well-being and enjoyment we can offer to the housebound elderly Nutritional Care of the Housebound Elderly UNDERNUTRITION IN HOUSEBOUND ELDERLY: Dr Peter Lipski Staff Specialist Department of Geriatric Medicine Gosford Hospital Conjoint Associate Professor Newcastle University Summary: Undernutrition is very common in the elderly The ageing process is not a cause of malnutrition Over two-thirds of acute Geriatric Medical admissions to hospital and over 50% of housebound, hostel and nursing home residents have some form of significant undernutrition At least 30% of independent community living elderly are undernourished 80% of undernutrition goes unrecognised The causes of undernutrition are multifactorial with common risk factors being  housebound,  social isolation,  dementia,  stroke,  Parkinson’s disease,  gait and balance disorders,  adverse drug reactions,  chronic pain, depression,  swallowing disorders,  fractured hip, and  recent hospitalisation People with Alzheimer’s disease have a reduced sense of smell and taste and this can reduce desire to eat Many older people eat food of low nutrient density Most critical nutrients include Calcium, Iron, Zinc, Vitamin B12, B1, D, Folate The complications of undernutrition include 30% increase in mortality within year, recurrent infections, falls, pressure sores, adverse drug reactions, dehydration, early hospitalisation and nursing home entry, prolonged and complicated hospital stay and increased health care costs Many elderly people lose weight in hospital “It is quite a paradox of modern medicine that most doctors pay little attention to the nutritional status of the elderly when it is such a common problem, leading to potentially catastrophic outcomes yet is potentially reversible” – Lipski 1997 Nutrition is regarded as a non-core medical subject and most doctors pay little attention to it Nutrition needs to be incorporated into medical student’s training Nutritional Care of the Housebound Elderly Early screening of high-risk groups is important for early intervention Screening tests include a good history, and screening tool such as the Mini-Nutritional Assessment Treatment includes:  a holistic general medical assessment,  diagnosis and treatment of underlying conditions, including managing chronic pain and depression,  appropriate time to consume meals,  safe swallowing techniques,  medication reviews and drug holidays,  early mobilisation and weight bearing exercises with rehabilitation where appropriate (Increased physical activity increases appetite)  nutritional supplements including fortified milk and fruit drinks,  eating at least meals per day,  avoiding restrictive diets,  adequate fluid intake, and  improved social contact Better nutritional care has clearly been shown to improve health outcomes and quality of life for housebound, institutionalised and hospitalised undernourished elderly, and also reduces health care costs For every dollar spent on better nutrition care for the elderly, $5 is saved in health care costs Nutritional Care of the Housebound Elderly LAKE MACQUARIE, NEWCASTLE, HUNTER AND CENTRAL COAST TRAINING PROJECT: Janette Robinson HACC Training Coordinator Lake Macquarie, Newcastle, Hunter and Central Coast The aim of this presentation is to provide information about our Training Project, to encourage others to develop a training plan and to highlight the importance of training and sharing information for HACC services Training Project priorities included training, communication and future vision An advisory group was formed with membership comprising of  Four HACC development officers  Two service providers  One Department of Ageing, Disability and Home Care representative (DADHC)  One Aboriginal and Torres Strait Islander representative (ATSI)  One Cultural and Linguistically Diverse representative (CALD) Overall roles of the Training Project:  Provide training for volunteers, paid staff and management  Assist services develop and deliver internal training  Identify training needs of HACC service providers  Liaise with specialist training providers The Training Project target groups are:  Volunteers in HACC funded projects  Management Committee members in HACC funded projects  Management in HACC funded projects  Paid staff in HACC funded projects  Clients 22 Nutritional Care of the Housebound Elderly Nutrition Related Training “Healthy cooking for me and you” Based on the Department of Veteran’s Affairs (DVA) program “Cooking for one or two” This program will run for six, two to three hour sessions and is due to “roll out” in the next few months The working party consists of representatives from Meals on Wheels, DVA, Northern Sydney Central Coast Health Nutrition Department (Gosford) and DADHC “Healthy Cooking for me and you” will: Encourage older people to continue to cook and to eat nutritious meals Incorporate practical cooking activities, basic nutrition knowledge, food hygiene and budgeting Offer social contact and interaction Nutrition workshops were included on HACC training calendar The workshops, entitled “ The Challenge and Importance of adequate food intake” incorporated topics for discussion that included high protein, high energy foods; diabetes and the glycaemic index; finger food ideas and texture modification of food During these workshops, debate ranged around practical ideas for services and emphasised food enjoyment Effective consultation and promotion is essential if workshops of this nature are to be successful It is anticipated that these workshops will continue to be offered Adequate food intake and sound nutrition is extremely important if ageing in peace is to be a real option Is nutrition training on your calendar? 23 Nutritional Care of the Housebound Elderly MEALS ON WHEELS “MORE THAN JUST A MEAL”: Debra Tape General Manager NSW Meals on Wheels Many Meals on Wheels/Food Services Organisations are voluntary groups run by volunteer/volunteer committees – most of whom now employ a coordinator to manage the service on a daily basis and to be responsible for service development Some are local councils and others are not for profit organisations Over the course of a year, 18 million meals are delivered, by more than 100,000 volunteers, to about 60,000 recipients Australia wide In NSW 20,000 people per day are assisted by 210 local MOW/Food Service organisations with over 35,000 volunteers In NSW alone, there are 3.5 million meals delivered each year Many Meals on Wheels organisations also deliver frozen meals to tide their clients over weekends/public holidays Clients are encouraged one day a week (or more) to have their meal in a nearby centre They are taken to the centres by volunteers or community transport This allows socialisation with people of the same age What NSW Meals on Wheels Peak body to act as a statewide voice and advocate for member interests Service development projects including nutrition, multicultural food services, food safety, future of volunteering Organisational development programs, eg: fundraising, training and development, human resources and industrial advice A unique community sector insurance program (CRISP) About the Services         Clients can choose to have daily, weekly or fortnightly meal deliveries Most services provide a Centre-Based Meal Service Some provide shopping services Some services provide culturally appropriate meals This will depend on the local service and the supply available to them Clients and service providers have access to Translating and Interpreting Service (TIS) to communicate with clients who are not fluent in English Coordinators receive training in Nutritional requirements Only 32 services have production kitchens Clients can be referred by GPs, family members, neighbours, health care workers, themselves 24 Nutritional Care of the Housebound Elderly       Clients information is collected by using the Client Information and Referral Record (CIARR) Clients usually have a choice of hot, cold or frozen meals Meals are delivered by volunteers, usually at lunchtime Clients pay the meal cost Administration costs are funded by DADHC Volunteers monitor client’s wellbeing MYTHS AND FACTS MYTHS  Provided meals are only for the frail aged  Meals on Wheels is a charity  Meals on Wheels is a government department  Meals are not nutritionally sound FACTS  Many clients are young people with disabilities  Meals on Wheels is a not for profit organisation  Clients pay for their meals  Community support is provided through volunteers  Not just a delivered meal – posting letters, cooking lessons, home shopping, companionship and centre-based activities  All Coordinators have access to Destination Good Nutrition and have been trained in understanding the nutritional needs of their clients Products Available (not all are available in all services)  Main Meals – Hot, Cold or Frozen  Soup  Dessert  Fruit Juice  Mini Meals/Light Meals  Snacks, Morning/Afternoon Tea  Breakfast Packs  Hospital Discharge Packs  Salads  Special Meals such as Soft, Pureed, Gluten Free, Lactose Free Costs to Clients  Cost to clients varies from service to service  Ranges between $3.50 and $7.50 per package  Package is typically a soup/main/dessert/fruit juice  Payments vary and can be by: Cheque – Direct Debit – BPAY – Centre Pay – Cash  If a client receives a Community Aged Care Package, the client pays the meal cost and the CACP provider pays full cost recovery to the service 25 Nutritional Care of the Housebound Elderly Current Issues  Need for community care is increasing  MOW/Food Services must grow to meet the challenge  Innovative and flexible programs need to be tried and tested  MOW need to provide more services with less funding  There are increased Food Safety and OH&S requirements  Increase in clients with complex and challenging behaviour (eg dementia) Future Issues  Sourcing authentic culturally appropriate meals  Retention of volunteers to deliver services  Increasing need for Centre-Based Meals Services  Continuing need to provide more for less I urge you to visit your local Meals on Wheels Service for further information and a taste test of the meals 26 Nutritional Care of the Housebound Elderly A PRACTICAL APPROACH TO FOOD ISSUES: Carolyn Bunney Public Health Community Nutritionist Home Economist Nutrition Department Gosford Hospital Northern Sydney Central Coast Health The importance of adequate and appropriate food intake cannot be overestimated Inadequate food intake can lead to  increased frailty  poor healing  depression  confusion  hospitalisation  residential care Preparation for this presentation involved work experience with field staff of care organisations, MOW volunteers and talking to a range of care organisation management and field staff Those encounters highlight important nutritional issues A tiny lady, very underweight, sores on legs not healing, had been ill and in hospital, no appetite A friend commented that “she has always been small “, implying there was no need to worry World War Veteran, had been ill in hospital, lost lots of weight, no appetite, continuing to lose weight What to try?  Small frequent meals that are easy to eat, pleasant to taste, easy to make or buy  If people like DESSERTS, that is a bonus as desserts can be both nutritious and energy dense Eg: Custards (homemade or packet, full cream and don’t worry about the sugar even for people with diabetes) Icecream Yoghurt (All full cream) Fruche  What about PORRIDGE! Made on milk with extra milk powder then served with cream and sugar (good nutrition and heaps of calories) makes a great breakfast or snack Quick cook and instant varieties make life easy 27 Nutritional Care of the Housebound Elderly  SUPPLEMENTS Sustagen and Ensure are well known but the homemade variety should not be over looked Milo made with full cream milk, extra milk powder and a scoop or two of ice cream is very acceptable What about a fruit smoothie also with full cream milk, ice cream and perhaps a bit of honey? It is important to get people eating With small appetites, food should be nutrient dense Male, frail, losing weight, having skim milk and other low fat dairy products Well meaning family members kept the fridge stocked with these items as they were concerned about their Dad’s cholesterol What to do? Family could be informed that loss of weight is more of an issue than cholesterol especially since Dad is well into his 80’s Providing a list of high energy, nutrient dense foods could be helpful Man, frail, just home from hospital, really thankful for MOW, thought he would have soup for tea; knew that he should have something else as well as the soup but really didn’t know what Visibly at a loss What to do? Provide food suggestions both verbal and written Include scones, toast or bread rolls plus a dessert which can be as easy as a banana or some tinned creamed rice Finish with a drink, preferably milk or milk based (full cream) Housebound male making a valiant effort to care for himself Has just cooked enough vegetable to last a week (something that he has been doing successfully for quite some time) This example relates to food hygiene What to do? In the interest of food safety, probably three days (or four) is long enough to keep these cooked vegetables in the fridge Giving the correct information is integral to duty of care However it is important to support client and avoid stress Information re food safety when preparing food this way would be appropriate Eg Check fridge temperature Explain how important it is for containers to be clean (and how to this) Emphasise the importance of not mixing newly cooked food with left overs Use small flat containers to cool food faster Explain that food does not have to be cool before placing into the fridge Best to only cook enough for four days Make use of frozen meals Use frozen peas and corn These only have to be reheated Reheat food once only 28 Nutritional Care of the Housebound Elderly Issues relating to dementia Dementia presents challenges with eating Food will need to be not only tasty and nourishing but also easy to eat, easy to manage, easy to reheat and there may be the need for foods that won’t go “off “ quickly when left out of the fridge Finger food may be a practical way of presenting food Recipes may need to be modified so that the food can be held and eaten easily People with dementia may lose their ability to use knives and forks, but fingers can be great utensils Fingers are an efficient way of getting food from plate to mouth with a degree of independence Food texture may need to be modified for people with chewing or swallowing problems Food textures may need to be adjusted – once on a puree doesn’t necessarily mean forever on a puree It is important that swallowing be properly assessed and continuously monitored What about the future? “600,000 frail older Australians living in the community will not have someone to care for them by 2031 “ (report “Who Is Going To Care?” – Brotherhood of St Lawrence and Myer Foundation) We need to look to future food and nutrition needs of frail older Australians who endeavour to remain in their own homes We need to address staff training so that the needs of older people can be appropriately catered for 29 Nutritional Care of the Housebound Elderly A CONSUMER EXPERIENCE: Marlene Brell Consumer Advocate, Member CNOA Over the past five years, the aged care industry has changed dramatically Historically, aged care facilities have seen the presence of the churches and the not-forprofit charities holding 60% of the business: with a cluster of small family businesses running the rest Now nearly 90 health care and services companies are listed on the ASX – some with holdings up to $1 billion Investment people are predicting that the baby boomers will for aged care what they have already done for the nation’s coastal real estate There are about 2.5 million Australians aged 65+ = : What will this mean for those who wish to age at home? First of all they will need money to pay for many of the services What services are available for those people who have restrictions – be it a physical or a mental problem and wish to remain in their home? How you find out about these services? The local council provides some information but the consumer needs to know this and be able to seek out other information There are an increasing number of commercial services that will deliver at a cost One company offers delivery of meals (breakfast, lunch and dinner) on a minimum of days per week for $48.50 per day! Most supermarkets also offer delivery services and there is a growth in online ordering and delivery I am hoping that either ‘Choice’ or nutrition students get round to analysing these products and evaluate their true value/cost/nutritional content       I believe that the older person needs a re-education or program in the following areas: myths and misconceptions about common foods eg; milk causes mucous, acidic foods cause arthritis, canned and frozen foods are not nutritious etc home delivered meals such as “Meals on Wheels” provide the day’s requirements not understanding the importance of including a range of protective foods that give a variety to the diet the correct time to take medications importance of drinking 6-8 glasses of water/day and finally: Making food an important issue: that nourishing food is just as important as when you were younger It does matter what we eat! Because we are what we eat! 30 Nutritional Care of the Housebound Elderly SUMMING UP: NUTRITION FOR THE HOUSEBOUND ELDERLY Rudi Bartl Public Health/ Community Nutritionist, Nutrition Services Central Coast Health Service, Honorary Secretary CNOA Australia has an increasingly aging population Approximately 90% of older people live independently Many are poorly nourished and may have one or more chronic conditions that could be improved with appropriate nutrition By improving the nutritional status of free living older people, we will maintain and improve their health so that they may remain independent for as long as possible Organisations, groups and individuals working toward the well being of independent older people eg; Home Care Service (HCS), Meals on Wheels (MOW), Community Nurses, Community Aged Care Package staff, Aged Care Assessment Teams are in a position to act as nutrition advocates The aim of this Conference: ‘Nutrition for the Housebound Elderly’ is to provide the evidence and ideas for carers to provide useful and practical information for their clients The days proceedings can be adequately summed up using the Australian Nutrition Screening Initiative Checklist as a guide The Australian Nutrition Screening Initiative checklist is a 12 point checklist to identify if older people may be at risk of undernutrition Whilst not diagnosing undernutrition it provides carers with an indication where improvements may be made to reduce the risk This checklist is useful only for older people living independently and not for older people in hospital or residential aged care facilities The screening tool and brief information on each of the points the checklist highlights is included in this summary 31 Nutritional Care of the Housebound Elderly What can be done to reduce the risk?  Are you on a special diet? If so, talk to your doctor or dietitian regularly to see if any changes are needed Many magazines publish diets It is not a good idea to put yourself on these diets unless you ask your doctor first Are you eating enough? Try to have three meals a day but if you prefer to eat smaller amounts of food more often, that is O.K Eating a variety of food will help to give your body the nutrients it needs Include fruit, vegetables, bread, cereal, meat, dairy foods Good snack choices are scones, pikelets, finger buns, fruit loaf, toast, cheese on biscuits and milk drinks   Try to eat fruit and vegetables most days Fresh, frozen or tinned are good choices Fruit juice is fine although you miss out on fibre 32 Nutritional Care of the Housebound Elderly  Are you eating dairy foods? These provide calcium and other nutrients Dairy foods include fresh milk, powdered milk, UHT milk, evaporated milk, sweetened condensed milk, buttermilk, cheese, yoghurt, custard and icecream Full cream, low fat or skim products are all good Try for three serves each day A serve is a cup of milk or calcium fortified soy milk, or a slice of cheese, or a small tub of yoghurt, or three scoops of ice cream  Are you getting enough fluid? Aim for 6-8 cups a day You will be pleased to know that this not only means water but also includes juice, tea, coffee, cordial, soup, jelly and custard but not alcohol  Do you drink alcohol? Moderation is the way to go and it is a good idea to have something to eat if you have a drink  Chewing and swallowing problems can limit the amount and type of food you eat Good dental care, well fitting dentures, adding sauces and custards to food and changing food texture can help Discuss swallowing problems with your doctor  How many medicines you take? Check from time to time to make sure you still need all your medicines and that they are working together properly Check with your doctor or pharmacist before buying "over the counter" medications such as laxatives, painkillers, cough mixtures and vitamins  Do you have enough money for food? If not, contact a welfare service in your area for help  Being as independent as possible is important Not being able to shop, cook or feed yourself can lead to poor eating habits Home delivered meals such as Meals on Wheels or even a delivered pizza may help Buy pre-prepared foods such as BBQ chicken, frozen meals etc  Have you lost or gained 5kg (about one stone) over the last six months, without wanting to? If so, a check up with your doctor is a good idea Your food needs could have changed  Do you eat alone? If you do, make a special effort not to slip into the "toast and tea" habit A community program in your area may offer you the opportunity to eat with others If you would like more practical food and nutrition information, the booklet ‘Reduce the Risk’ is available from the Nutrition Department, Central Coast Health PH 4320 2251 Information complied by the Nutrition Department, Central Coast Area Health Service and based on the Australian Nutrition Screening Initiative Appendix K Dietary Guidelines for Older Australians November 1999 33 Nutritional Care of the Housebound Elderly IDEAS ON INCREASING YOUR WEIGHT If you are underweight or have recently lost weight a high protein, high energy diet can help Some tips to achieve this include Eat small frequent meals Try having small meals per day making sure to include foods that are high in protein such as: Milk Cheese Yoghurt Meat Fish Poultry Nuts Seeds Legumes Make every mouthful count Choose nutritious foods and drinks such as milk and fruit juice rather than filling up on tea, coffee, water, clear soup or diet drinks as these foods have little nutritional value Enrich the food you eat Some ideas to get you started: Add • Grated cheese to: pasta, white sauce, vegetables, egg dishes eg omelettes, baked beans and salads • Cream or sour cream to: soups, sauces, desserts, cereals • Skim milk powder to: milk drinks, milk desserts, soups, sauces, cereals, mashed vegetables eg mashed potato • Seeds and nuts to: breakfast cereals, yoghurt, pasta, desserts • Dried fruit to: breakfast cereals, desserts • Margarine or butter to: vegetables, rice, pasta • Eggs to: milk drinks, milk desserts, sauces, soups, fruit juices • Mayonnaise to: salads, sandwiches, meat/chicken • Honey or glucose to: fruit juices, milk desserts, milk drinks, breakfast cereals Ideas for snack time Dried fruit and nuts Cheese and dried fruit Buttered crackers and cheese High protein drinks eg milkshakes, smoothies, iced coffee Fruitcake with butter or margarine Scones or pikelets with jam and cream or butter Peanut butter on toast Ice cream with topping Desserts eg custard, yoghurt, cheesecake 34 Nutritional Care of the Housebound Elderly DRINKS TO BOOST YOUR ENERGY The following drinks are very nutritious and high in protein and energy They are suitable for people who have lost weight recently or are having trouble eating three balanced meals each day Fortified milk is milk enriched with skim milk powder to boost the protein and energy content It can be used anytime you normally use milk (in hot or cold drinks, custards, in soups or on cereal) to increase your intake of protein and energy Make up a jug and have it on hand in the fridge RECIPE FOR FORTIFIED MILK CUP cup (200ml Milk) tablespoons skim milk powder Whisk together Makes one cup LITRE litre milk cup skim milk powder Whisk together Makes one litre DRINK SUGGESTIONS Milkshake cup fortified milk scoop ice cream Topping (i.e chocolate, strawberry, or pineapple) Cream as desired Blend the first three ingredients together and serve with dollop of cream as desired Fruit Lassi ½ cup fruit juice ½ cup plain yoghurt teaspoons sugar Blend together Banana Smoothie cup fortified milk small banana scoop ice cream Honey and sugar to taste Blend together and serve Strawberries or other fresh fruit can be used instead of banana High Energy Milo/Coffee cup fortified milk teaspoons Milo or 1tsp coffee scoop ice cream Served hot or cold Adapted From: “Appetite for Life Manual, 1999” Community Nutrition Unit, Tasmania 35 Nutritional Care of the Housebound Elderly Nutritional Care of the Housebound Elderly Notes from the Conference held at the University of Sydney, November 2005 May 2006 ... Nutrition Unit, Tasmania 35 Nutritional Care of the Housebound Elderly Nutritional Care of the Housebound Elderly Notes from the Conference held at the University of Sydney, November 2005 May... treading the paths in which we should go, in what is the aim of this conference, the well-being and enjoyment we can offer to the housebound elderly Nutritional Care of the Housebound Elderly. .. Coast AHS, Honorary Secretary CNOA Nutritional Care of the Housebound Elderly The conference on NUTRITIONAL CARE FOR THE HOUSEBOUND ELDERLY at the University of Sydney on 4th November 2005 had