A loss of appetite in older Australians, particularly those in residential aged care facilities, is common. Alarmingly, many aged care residents are malnourished, with a prevalence of up to 70 per cent. 

According to the Aged Care Quality and Safety Commission (ACQSC) and under the Aged Care Quality Standards, aged care service providers are required to ensure appropriate nutrition and energy intake for all residents.

So, why are so many aged care residents under-nourished? It's a complex issue with many contributing factors, but there could be a simple solution.

In a new study, researchers at the University of South Australia have found that the most important factor in improving nutritional intake is to simply serve larger meals.

After assessing environmental cues (music and fragrance) and other health information, researchers discovered that for each kilojoule increase in served energy, there was a 0.73 kilojoule increase in consumed energy.

Lead researcher Hei Tong Lau, says that the portion size effect was a manipulation to test the true impact of extrinsic food-cues.

"Our research is focussed on improving the nutrition and health status of older Australians living in a residential aged care facility.

"In Australia, up to 70 per cent of elderly people living in aged care facilities are suffering from malnutrition, the primary reason for which is inadequate food intake.

"To improve this, we must find ways to encourage older people to eat more," says Miss Lau. 

There has been a justified focus on the food itself, such as look, taste and texture, explains Ms Lau, but other factors can also improve the food experience.

"While exploring environmental factors that could improve the dining atmosphere, we found that portion size was highly correlated with the amount of food that residents consumed.

"And, that both music and fragrance could positively influence food consumption, but secondary to portion size, as we did see variances among each individual."

Ms Lau says these findings provide valuable insights for aged care caterers and providers.

"With an ageing population and high levels of malnutrition among aged care residents, there is a clear need to better understand factors that can influence residents' food intake.

"Increasing serving sizes may seem like a small step, but for residents who need the nutrition, it's a massive move forward," says Miss Lau.

Appetite loss in older Australians is a result of disease, side effects of medications, changes in the satiety mechanism, psychological issues and a natural slowdown in metabolism, says dietician Alex Rutkowska.

"It's important to find the cause of this problem and to adjust the treatment and dietary changes individually.

"However, there are ways in which we can improve digestion and increase the appetite of most seniors," says Ms Rutkowska.

Advice for increasing appetite in older Australians

Ms Rutkowska says physical activity, meal preparation, taste, ingredients, environment and hydration all play a part in correcting nutritional deficiency in aged care.

Remember physical activity
A walk that lasts several minutes has a positive effect on appetite and also improves sleep.

"Enjoy an outdoor activity at least once a day, and preferably before each main meal.

Prepare meals properly
Food for older Australians should be easily digestible, boiled, stewed, or baked, and of the right consistency.

"Many elderly people have trouble chewing and swallowing, which is why the consistency of the food is so important."

Fresh is best
Meals for the elderly should be prepared with fresh, local, and seasonal ingredients to provide all necessary nutrients and avoid food additives.

Use appropriate spices and herbs
The right herbs and spices can improve the diets of older people, as they improve digestion and appetite.
"Adding herbs and spices will increase the flavour of the dish and may encourage the elderly to eat a larger portion of the meal."

Use high-quality fats and oils
Preparing dishes using a good quality oil makes them more appetising.

"Fat is a carrier of taste and smell."

Include a rainbow
"The more colours on the plate, the better for health.

"This not only applies to having a greater diversity of vitamins and minerals but also increases the amount of pleasure derived from eating the food."

Use products that are liked and accepted
Food preferences should be taken into account to create an individualised menu.

"Of course, this can't be done 100 per cent with mass catering, but a general knowledge of food preferences will help to prepare meals that are eaten more willingly."

Eat in a friendly environment
"The composition and appearance of a meal are just as important as the environment in which it is eaten.

"So, let's take care of cleanliness and set the table nicely. It's also important to eat in a relaxed atmosphere and with other people."

Take care of proper hydration
Older people don't often feel thirsty, but water contributes to the proper functioning of all organs and systems in the body.

"[Hydration] maintains the proper level of physiological efficiency, maintaining concentration, and appetite."

Enhancing the nutrition of older Australians, particularly those in aged care, can be complex due to health status, eating habits and beliefs.

It's perhaps a combination of many factors, from portion sizes to environmental cues and personal preference, that will improve nutritional outcomes for older Australians.