SPECIAL REPORT: Superior Nutrition and Hydration Needed for Seniors

In the UK, malnutrition affects more than three million people at any one time, according to NHS England Guidance – Commissioning Excellent Nutrition and Hydration. Older people are the most at risk of being malnourished, as 1 million malnourished people are over the age of 65.

 

In fact, 35 percent of people admitted to care homes will be malnourished or at risk of becoming so.

 

Last year, NHS England was asked by the UK Department of Health to review the Council of Europe ‘10 key characteristics of good nutrition and hydration care’ so that they met Hospital Food Standards. The characteristics also highlight the things that must be done to ensure good nutrition and hydration in the wider society as the majority of those at risk of or suffering from malnutrition – 93 percent according to latest statistics – will be living in the community.

 

The British Association for Parenteral and Enteral Nutrition (BAPEN) is a professional association and registered charity committed to addressing malnutrition and to improving nutritional care and treatment in hospital, care homes, and the community.

 

They recently launched a new online Malnutrition Self-Screening Tool after data from their Nutrition Screening Week surveys revealed that 30 percent of people admitted to hospital are at risk of malnutrition, many of which could have been identified and treated in the community. The charity believes that self-screening could help in the prevention and management of malnutrition as individuals at risk can download a dietary advice sheet that gives them basic information and suggestions for improving their nutritional intake, until they receive further advice from a healthcare professional.

 

Campaigns & Research
The global campaign ‘Nutrition and Hydration Week’ has just passed (14-20 March). In the UK, the Nutrition and Hydration Week is supported by a number of social and industry organizations, including Patient Safety First, the Hospital Caterers Association (HCA), and National Association of Care Catering.

 

Dr Rekha Elaswarapu, from the Natural Hydration Council (NHC) explained to NutritionInsight: “Nutrition and Hydration Week, held annually, aims to create a global movement that will reinforce and focus, energy, activity and engagement on nutrition and hydration as an important part of quality care, experience and safety improvement in health and social care settings. This gives the opportunity for individuals and organizations to work together to raise awareness about hydration and share good practice.”

 

Afternoon tea was served around the world in health and social care settings on 16 March in an aim to promote the Week, as well as the work the organization does, and to ensure people gain an understanding of how to improve nutritional intake.
The Portuguese Dietetics Association (APD) held their ’More Water, Less Salt’ Week during the Nutrition and Hydration Week. They arranged 16 afternoon tea parties all over the country, aiming to reach more than 1000 people.

 

In Hungary, different kinds of tea (black-, green- and fruit tea) were provided by Unilever Food Solutions, and Coca-Cola provided bottled drinks (still- and sparkling mineral water, juice and ice tea) for their care home residents’ ‘World Tea Party’.

 

The University of East Anglia will shortly be recruiting British care home residents for a study creating a ‘pro-drinking environment’ to encourage them to keep hydrated. The study will run from January 2016 to July 2017 and includes setting up a tea club for residents. Principle investigator Dr Lee Hooper, Reader in Research Synthesis, Nutrition & Hydration in the Norwich Medical School at University of East Anglia told NutritionInsight about her ‘Making Drinking Fun’ study:
“One out of every five older adults living in residential care doesn’t drink enough fluid to stay hydrated and keep as healthy as possible. All sorts of drinks (including tea, coffee, water, squash, fruit juice, milk, pop, Bovril, soup) help us stay hydrated. For all of us drinking is an important social activity, so our research will focus on making drinking fun, and making drinking a central part of day-to-day events, activities and friendly moments.”

 

“We are exploring ways to support drinking being even more enjoyable in care homes. We believe that this will help older adults to enjoy drinking, drink well and stay hydrated,” Hooper concluded. For further information, please visit https://www.uea.ac.uk/

 

New Dietary Guidelines
Last week, Public Health England (PHE) revised the ‘Eatwell’ dietary guidelines to now include drinks recommendations.

 

The new Eatwell Guide states a healthy diet should now include more fruit, vegetables and starchy carbohydrates, and fewer sugary foods and drinks. Local authorities, non-governmental organizations, the food and drink industry, key community figures and health professionals are being encouraged to use the guide to help the nation improve its diet.

 

The drinks recommendations clarify that adults should be aiming to have 6 to 8 glasses of fluids per day ideally from water, lower fat milks, and unsweetened tea or coffee.

 

Dr Alison Tedstone, chief nutritionist at PHE, said: “Our new Eatwell Guide helps people to understand what a healthy balanced diet looks like. The evidence shows that we should continue to base our meals on starchy carbohydrates, especially wholegrain, and eat at least 5 portions of a variety of fruit and vegetables each day.”

 

“On the whole, cutting back on foods and drinks that are high in saturated fat, salt, sugar and calories would improve our diets, helping to reduce obesity and the risk of serious illnesses such as heart disease and some cancers.”

 

“A smoothie, together with fruit juice, now only counts as 1 of your 5-a-Day and should be drunk with a meal as it’s high in sugar.”

 

“It is good to see that water is the first choice for hydration. Following the news of the sugar tax it is great to see the plate is encouraging consumption of one of the healthiest ways to hydrate,” commented Tom Sanders, hydration expert and Emeritus Professor of Nutrition & Dietetics at Kings College London, UK.

 

In the US, the MyPlate has just been revised (as reported in NutririonInsight earlier this month) to help improve the eating patterns of older adults. The new ‘MyPlate for Older Adults’ icon also includes images of good sources of fluid, such as water, milk, tea, soup, and coffee.

 

Oral Nutrition Supplementation
Comprehensive reviews, undertaken by experts in clinical nutrition and health economics in a variety of healthcare settings and disciplines from across Europe, have shown that managing malnutrition with oral nutritional supplements (ONS) can produce an average cost saving of around 10 percent compared to standard care across a broad range of patient groups. Also, meta-analyses in hospitalized patients show that ONS use is associated with fewer deaths, a reduction in complications and shorter length of hospital stays.

 

One example of these ONS ready-to-drink ranges is Ensure by Abbott Nutrition –  who is one of BAPEN’s industry partners. Ensure claims to be “the #1 Recommended Brand among doctors who recommend liquid nutritional products to their patients.” It has been widely available to the US market since 1973. Their Enshake powder can also be added to foods such as custard and desserts to increase their nutritional content.

 

Nualtra Ltd, founded in 2012, claims to be the fastest growing Medical Nutrition company in the UK and Ireland: “Nualtra is unique in that it is the only medical nutrition company in the UK that was founded by a registered dietitian [Paul Gough],” Phillip Wood, Nualtra Marketing Manager, told NutritionInsight.

 

“In terms of how we aim to help prevent or treat malnutrition in the elderly, we believe great-tasting supplements are at the heart of improving patient compliance, creating better health outcomes and reducing product waste; this is why we invest so much in trying to produce the best-tasting products on the market.”

 

“Our supplements have been proven to achieve market-leading patient compliance rates of up to 96 percent. One of our leading products is Foodlink Complete: a high-protein, nutritionally balanced powdered supplement.”

 

Industry
There is an important role for the food industry in fighting malnutrition. European frozen food company apetito Ltd, creates and supplies meals for care homes, local authorities and hospitals. In the UK it is the leading supplier for the NHS and those receiving residential care or community meals; it is also part of the HCA.

 

Amelia Draffin, Client Development Manager, told NutritionInsight: “As a leading provider of delicious and nutritious meals to care homes, apetito is a major advocate of the value of good nutrition, which is why we’re keen to support Nutrition and Hydration Week every year.”

 

“By working with us, homes can rest assured that residents are treated to meals that fit their individual nutritional needs and – more importantly – that they can look forward to eating.”

 

What we eat and drink can have a significant impact on our general health and quality of life –  at all age groups. Let’s hope that the medical nutrition and food industries, along with campaigns such as ‘Nutrition and Hydration Week’, continue to help fight malnutrition for all."