What does the modern aged care resident look like and want?

New dietetic research shows while current dietary practices in residential aged care (RAC) mainly target managing malnutrition in older adults aged 85 and over, the emerging ageing population of baby boomers - adults aged 84 and under - are more likely to be overweight, while at least a third are likely to have diabetes.

Accredited Practising Dietitian (APD) Olivia Farrer, a PhD candidate and research dietitian at Flinders University, says the preliminary findings from her yet to be published research reveal the changing health needs and expectations of aged care residents.

Ms Farrer, who presented on the topic at the recent Dietitians Association of Australia (DAA) 34th National Conference, says the changing needs of residents presents new challenges around the quality and service of food for both dietitians and aged care providers.

“My study found that up to a third of current RAC residents have diabetes and those older adults aged <84yrs with type 2 diabetes were more likely to be admitted to RAC in the overweight or obese weight range and maintain this weight, or even gain weight, over a typical length of stay of two years,” she says.

“Whereas the oldest old (over 85yrs), were more likely to have been admitted within a healthy or underweight BMI weight range, and more likely to have lost weight over a similar time period.”

Ms Farrer conducted two studies - one, an audit of resident demographics and, the other, a series of focus groups with older adults both in residential aged care as well as prospective residents (baby boomers living in the community).

The focus groups revealed while the older group are more likely to be passive in their experience of ageing, diet and diabetes, baby boomers want autonomy in their health management and food choices.

“What I found was that there is a lot of similarity between the cohorts, but while our oldest old in RAC are reluctant to vocalise their preferences and speak more wistfully of their ideal service, the baby boomers were much more firm about their expectations for diet and diabetes management,” she says.

Ms Farrer, who is also a privately practising dietitian, says the groups highlighted issues of choice and food quality.

“Ultimately baby boomers want flexible diet options, whereby they can choose to have a ‘healthy’ diet more aligned with their diabetes education and self-sought dietary knowledge but also indulge without restriction when they choose to.”

Both cohorts also expressed concerns over the quality and acceptability of food provided in aged care.

“Most baby boomers interviewed had experience of either hospital or aged care food through their relatives, and the opinion was generally that the food was unappealing and this was associated with it being of poor quality,” Ms Farrer says.

“Older adults in RAC were vocal on this matter also and while they commented with complacency that the facilities were doing the best they could under the circumstances, residents did suggest that hotels are able to feed large numbers of people to a high quality and so ‘it can be done’.

“Despite efforts by dietitians and cooks to design menus to suit the clientele in RAC, many of the residents did not find the meals familiar or cooked in the style they might have done for themselves, and were particularly unhappy with food service systems where food was reheated or hot-held for mealtimes.”

Ms Farrer, who has previously examined aged care providers’ move away from offering a traditional diabetic diet to the same liberalised diet for all residents, says menu guidelines are now focused on clinical outcomes, the adequate inclusion of core food groups, and attaining optimal nutrition outcomes in residents.

But there’s much more to food than its nutritional content - it’s a large part of our social construct, identity, and our interactions with others, she adds.

Ms Farrer hopes her research, conducted under the supervision of Professor Michelle Miller and Dr Alison Yaxley, of Flinders University, and Associate Professor Karen Walton, of University of Wollongong, raises awareness of the gap in knowledge around the management of older adults with significant comorbidity, including those residents who may not initially present with frailty and malnutrition.

“I also hope to stimulate discussion around how, as a profession, we might look to support baby boomers and food service providers in a rapidly changing aged care paradigm, with more services being delivered in a community setting instead of residential aged care,” she adds.

Ms Farrer says dietitians are ideally placed to support aged care providers in delivering a client-centred menu with variety and choice.

“However, the menu is simply the blueprint for the food service system and relies on the skill in the kitchen to deliver appetising meals, staff to support and encourage positive mealtime experiences,” she says.

“Positive collaboration between aged care providers and dietitians, and consistency in our practices while maintaining a client-centred focus, would assist in better meeting resident ‘wants’.”