Catering for Care

CATERING FOR CARE Feeding The Elderly Population

Matt Goodman, Catering Manager at The Royal Alfred Seafarers’ Society discusses the challenges his team faces when catering for elderly residents and the importance of finding a balance between food, nutrition and taste

The UK has an ageing population, with almost 20% (18.2%) being 65 years of age or older . As we reach the later years of our lives, our personal circumstances may change, with some of us requiring supported living to help meet our needs. One thing that remains the same for residents within a care home setting is the routine of breakfast, lunch and dinner. As the Catering Manager at The Royal Alfred Seafarers’ Society ’s care home, Belvedere House, it is my responsibility to ensure not only that residents receive the correct nutrients for their specific dietary requirements, but also enjoy their food. We also work hard to make mealtimes a sociable event for residents. We understand that everyone is different and we take time to cater for all diets including vegetarians, vegan, pescatarians, diabetics and those living with coeliac disease, with specialist menus for each different food specification.

In later life, there are many reasons why mealtimes can sometimes become tricky for residents; tastes can change, appetites can deplete, and we tend to become less mobile as we age. Mealtimes can also be an area of concern for those living with dementia, when communication and motor difficulties can seriously affect how food is consumed.

At The Royal Alfred, we have a specialist dementia annexe which cares for 36 residents living with the disease. I work with my catering staff to ensure that we make mealtimes as easy as possible for these residents and their carers. Sometimes, simple changes such as altering mealtimes where sleep patterns are disrupted can have a big impact as residents may become hungry and only want to eat at midnight, rather than at teatime. This ensures that whatever the individual’s personal circumstance may be, we can deliver on our key responsibility of providing the residents with the correct nutrition, around the clock.

Dementia can also change our tastes, so it is recommended that we use strong-flavoured or sweet foods to entice these residents to eat and enjoy their food; one of our chefs, Janice is famous in the care home for her cakes and sweet treats! There is also the issue of dementia patients thinking they have already eaten, so refusing food is common, or forgetting that they have just eaten and wanting to eat again. Belvedere House has nutrition and hydration stations in all lounges, which encourages the residents to help themselves if they are peckish.

Helping residents to physically eat food is also an important element of caring for our residents with dementia. Some will struggle to understand when food may be too hot to eat, or have difficulty chewing, so it’s important we follow personalised instruction cards to see how an individual’s meals will need to be prepared. Communication is vital between the catering and care staff and it’s our job to work together to make sure residents are properly fed and watered.

One of the elements I love so much about my job is creating the menus, as I am passionate about providing the best quality food and catering experiences. We utilise quarterly resident meetings to discuss menus, have tasting sessions and use catering surveys for feedback on our ideas, ensuring all residents are very much involved. We also alter residents’ menu plans after monthly weigh-ins, according to their health needs.

The catering team attend a large number of trade shows from which we draw menu inspiration, but we also love watching TV cooking shows and creating recipes inspired from these.

The feedback on food we receive from the residents and families is very positive and the fact that diners can choose their meals from a detailed menu ensures an element of independence for residents and a feeling of normality

One of the hardest parts of the job is trying to please 68 residents! Another is ensuring residents get enough calories and fluids, when caring for vulnerable adults is such a massive responsibility for us.

As with all adults, it is recommended that we eat a balanced, varied diet containing plenty of fresh fruit and vegetables, fibre, protein and calcium. Omega-3 fatty acids are recommended for over-65s as they may also help to alleviate joint issues and arthritis which are common in later life and can also help protect against heart disease.

To maintain good bone health, older adults are recommended to eat a diet rich in calcium , which comes from dairy products like milk and cheese and can also be found in green leafy vegetables, nuts and bread. We ensure we fortify menus for residents where it’s necessary, using full fat milk, butter and cream in recipes to increase the calorie content for people with small appetites.

Vitamin D is a key part of an over 65s diet, as it helps the body to absorb calcium more easily – this is found in oily fish, red meat and fortified foods such as breakfast cereals. We have weekly roast dinners and fish on the menu each Friday which proves very popular with the residents and helps to boost their vitamin D intake.

All in all, we think it’s important to remember that it’s our role as members of the catering staff to help residents lead happy and healthy lives and meals contribute to this. Having a resident’s favourite meal on the menu gives them something to look forward to and can bring a smile to their face. Allowing residents the simple chance to choose (within reason) what they would like to eat that day and supply those living in our care home with the nutrition that is important in all stages of life, but especially in later life.

It's Made For You - Texture Modified Meals

Written by Consultant Allied Health Professionals for It’s Made for You: Caroline Hill, Registered Dietitian Sandra Robinson, Independent Speech and Language Therapist & Consultant Dysphagia Practitioner

Texture modified foods are often recommended by speech and language therapists for people with dysphagia. Whilst there may be some people for whom this reduces the risk of aspiration pneumonia, for many the reason for this compensatory measure is to reduce the risk of choking.

Evidence demonstrates that the risk of choking on solids increases with age. This is for people with and without dysphagia. The number of care home residents living with dysphagia is between 50 to 75%, those with dementia up to 57% and those following a stroke up to 78%.

There is often some confusion between what constitutes a coughing fit and choking. Choking is defined as occurring when you cannot breathe, cough or make any noise.

People over 65 have seven times higher risk for choking on food than children aged 1–4 years. After falls, choking on food presents as the second highest cause of preventable death in aged care. A diagnosis of pneumonitis is positively correlated with increased risks associated with choking on food.

Foods that are fibrous, hard, firm, stringy, chewy, sticky, dry, crumbly, crunchy or shaped in such a way that they can occlude the airway (round or long) pose a choking risk.

Foods that are consistently associated with choking and reported on autopsy findings include; • meat especially on the bone • bread • sandwiches • toast • raw vegetables • crackers/rice cakes • hard boiled sweets • whole grapes • nuts and seeds • chewing gum • cheese chunks

Sufficient stamina is needed to prepare the solids bolus for swallowing, with bite-sized pieces of meat and bread requiring more than 20 chewing strokes per bolus. This highlights how important it is that the many people with dysphagia need safe texture modified food, however it is prepared. It’s Made for You provide a range of 80 delicious frozen meals and desserts for people with chewing and swallowing difficulties. Their meals comply with IDDSI Framework guidelines ensuring each meal can be prepared and enjoyed safely and with peace of mind. Prepared quickly in a microwave or oven, It’s Made For You can really help make mealtimes delicious, nutritious and easy.

To find out more www.itsmadeforyou.co.uk.

As a speech and language therapist, Sandra recommends the It’s Made for You Range as this provides people on IDDSI diets with an increased choice of delicious meals, which significantly reduce the risks of choking. This means that mealtimes are far more pleasant and enjoyable.

As a registered dietitian, Caroline recognises that up to 50% of people with dysphagia are at risk of malnutrition. She recommends the It’s Made for You Range to ensure the provision of an adequate nutritional intake whilst consuming a safe and appetising textured modified diet.

References:

Carrión S, Roca M, Costa A, Arreola V, Ortega O, Palomera E, Serra-Prat M, Cabré M, Clavé P. Nutritional status of older patients with oropharyngeal dysphagia in a chronic versus an acute clinical situation. Clin Nutr. 2017 Aug;36(4):11101116. doi: 10.1016/j.clnu.2016.07.009. Epub 2016 Jul 26. PMID: 27499393. CE Safety. 2019. Report: The Un-Usual Suspects – Main Causes of Choking Deaths in the UK 2019. Online at: https://cesafety.co.uk/choking-deaths-report2019/ [Accessed May 2021] Cichero, J., 2018. Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice. Geriatrics 3, 69. https://doi.org/10.3390/geriatrics3040069 Kramarow, E., Warner, M., Chen, L. -H., 2014. Food-related choking deaths among the elderly. Inj Prev 20, 200. https://doi.org/10.1136/injuryprev-2013040795 RCSLT. 2020. Giving voice to people with swallowing difficulties. [Online]. Available from: https://www.rcslt.org/-/media/Project/RCSLT/rcslt-dysphagiafactsheet. pdf?la=en&hash=18AEDA640CDABD6D2CAB1A9293E8F44ED4E9572A [Accessed: September 2020].