Menus in Aged Care

 Why just providing  nutrition is no longer good enough.

For years, dietitians have been asked to evaluate a menu for an aged care home. The menu assessment generally results in providing adequate energy, protein and variety of food groups with a few recommendations to improve. But this comes with a caveat – they have to eat everything offered on the menu to achieve their requirements.

In two recent research studies conducted in Australia, a standard menu offered 8181kJ and 77g protein but residents only consumed 5272kJ and 47g protein, and a texture modified menu offered 7966kJ and 83g protein with an average intake of 4572kJ and 46g protein.

Those on texture modified menus are at risk of unplanned weight loss and malnutrition. Residents do not need to have dysphagia to be served a texture modified diet. In the texture modified diet study, only 35% had dysphagia, weight loss ranged from an average of 1.41kg to 3.82kg for the three months prior to the study, and 24% were malnourished. Of this cohort, 46% were on an oral nutritional supplement and 43% had a high energy high protein diet.  Interestingly, the subgroup with the lowest unplanned weight loss had 83% of the residents taking an oral nutritional supplement. What does this say about the menu?

When an alternative diet was offered to the texture modified group, the menu offered 10239kJ and 93g protein which offered re-shaped foods, a larger variety of meal options, desserts and snacks (other than custard, yoghurt, mousse, and pureed fruit). The intake improved to 6237kJ and 62g protein.

With this in mind, the mealtime experience, the menu, the way the food is presented and the choice of ingredients and recipes used should be at the forefront of improving nutritional status and reducing malnutrition. This research highlights the need to ditch a simple menu assessment purporting nutritional adequacy, and to engage dietitians to look at the menu as well as the mealtime, foods consumed and integrate the National Mandatory Aged Care Quality indicators to the assessment and care model.  Engaging the dietitian with the whole care team can value add to your nutrition program and make every mouthful from the menu count.

These studies are part of Lisa Sossen’s PhD thesis, Exploring Food First Approaches in Aged Care, Monash University (2021, unpublished). Check out www.lisaandassociates.com.au  For more information contact Lisa lisa@lisaandassociates.com.au for menu assessments and integration of the meal experience with a holistic care model of nutrition analysis and assessment.