As the population continues to age and increasing numbers move into aged care facilities, Australia has seen a renewed focus on the quality of care, with recent calls for mandated staff to resident ratios just one of the many issues being tackled within the industry.

But while higher staff numbers and improved quality care are vital, another important area is being neglected, with potentially devastating results for residents, according to Accredited Practicing Dietitian Ngaire Hobbins.

Ms Hobbins believes dietitian involvement should form part of the routine care practices within aged care facilities, rather than the reactive model that currently stands.

"The current system in most organisations - where a referral is triggered usually by weight loss of 2, sometimes 3 kilograms, is absurd because once that has occurred, muscle loss has already happened and all the issues mentioned above are potentially already impacted," says Ms Hobbins.

"It is often too late to be able to really turn things around."

Ms Hobbins says dietitians should play a proactive role in the aged care experience, meeting with each new resident in order to flag potential issues, followed by ongoing involvement to ensure residents eat well, consuming quality food.

"That also involves ongoing involvement in meal and menu planning on an ongoing basis as well as education of staff."

According to Ms Hobbins, the importance of nutrition for the elderly is grossly underestimated, with both staff and residents often unaware of the impact of food on physical and mental health.

"It always amazes me that it’s only been quite recently that malnutrition has been recognised as such a major player in physical and mental decline in older people.

"The longer people live, the more critical appropriate nutritional strategies become for maintaining independence in later age."

Food for ageing bodies

One of the major differences between the dietary requirements of younger people, and the dietary requirements of the elderly, is the need for protein.

"The need for some nutrients, especially protein, antioxidants and some vitamins/minerals, are elevated by the accumulation of years," says Ms Hobbins.

"Oxidative damage compounds over time, chronic inflammation and some medical conditions mean that immune system demands are increased and the ability to maintain essential protein reserves in muscle is hampered," she says.

Brain function and cognitive ability are hampered because, while the brain contributes only 2% to body weight, it consumes 20% of body energy, so its demands are significant.

Its energy supply is almost exclusively glucose, but shortfalls in supply are common – more so in later age. Body fat is no help as it can’t be converted into glucose.

"However, protein can so our muscle reserve of protein takes up the slack and that means loss of vital muscle which gets more difficult to replace as time goes on," Ms Hobbins says.

"If we don't acknowledge that older adults need more protein than younger and we fail to provide food in aged care which provides for that, then wound care costs increase, wounds heal slowly or not at all, illness and infection rates increase and falls are more likely."

"Not to mention that our seniors deserve better than that - they deserve quality food. Sometimes it’s the only thing they look forward to in the day."

The importance of muscle

Maintaining a good muscle reserve is vital in later age because it forms a supply of protein which your body accesses between meals to keep up cognitive and immune function and body organ maintenance, as well as repair of any damage from accident, illness or surgery.

“In younger adulthood any protein lost from muscle at these times is usually quickly replaced at your next meal,” says Ms Hobbins.

“But as you get older, not only is replacement increasingly inefficient, but many, many people don’t eat enough protein to keep supplies up.

“That results in a gradual loss of muscle - and weight - that eventually hampers immunity increasing the chance of illness, slows down wound repair and recovery from skin tears, bruising and surgery, hampers organ maintenance, increases frailty, saps appetite and makes falling more likely.”

Well before muscle loss is physically obvious it can be reducing an individual’s reserve for many years, which is why Ms Hobbins believes diet should play a more prominent role within aged care facilities.

“In residential facilities where residents may have already suffered substantial muscle loss, the effects can be disastrous as immunity plummets and organs are not able to be adequately maintained.

“And that’s frequently exacerbated if people require hospitalisation: inexplicably, in far too many hospitals now, food provision falls into ‘housekeeping’ - competing for budget allocation with cleaning and maintenance rather, than where it rightly belongs as part of the medical focus of patient care.”

Food as medicine

Ms Hobbins says aged care facilities need to recognise food as medicine, along with its ablility to support body repair and maintenance.

“Eating in older age, and especially meals in aged care facilities, needs to be nutrient packed to support the additional needs of ageing bodies.

“Protein foods need to be the centre of three meals a day to support muscles.

“It’s not enough to concentrate the protein into one meal as is often the case.

“Along with that, antioxidants foods to combat the escalating oxidative load ageing imposes and essential vitamin and minerals act to release energy from food and allow body and brain systems to function efficiently.”