Nutrition of older persons in the community
This toolkit is intended to help local authorities, and other interested organisations, understand the importance of ensuring elderly people in the community have healthy, safe and balanced diets.
It does not focus on those in residential or care homes as Food Vision is aware that there is a great deal of guidance already in place in this area. This toolkit aims to unravel the numerous complexities around nutrition for elderly people in their own homes and to provide ideas as to how, and with whom, practical steps can be taken at a local level to ensure healthy diets are possible and practical.
Food Vision strongly believes in the importance of ensuring elderly people have access to healthy and nutritious food. We believe that local food projects are critical to this aim, though we recognise that such projects can often be complex. We hope this guidance helps inspire and support the development of local initiatives focusing on elderly people; however, we would welcome any case studies to compliment this toolkit to help us achieve these aims. So if you have already acted on this issue and have an innovative local case study please send details to foodvision@lacors.gov.uk and the food vision officer will be in touch.
The toolkit is split into four sections:
1. Why older persons nutrition?
2. Why should I get involved?
3. What action can I take to help tackle this issue?
4. Where can I get further information & ideas?
1. Why older persons nutrition?
Older people make up an increasingly large percentage of the UK population. Over the next 50 years the number of people over 75 years is likely to double (Thomas 1998). While the majority of older people maintain healthy and active lives as individuals, often with the support of their families, it must also be recognised that the older community can also include some of the most vulnerable groups of our society.
Influencing elderly nutrition in the home is complex with activity taking place in a number of different places and a need to transmit a variety of messages (from simple healthy eating advice to dealing with malnourishment). It can involve a large number of issues, such as access to food, cooking skills, budgeting, general nutrition and possible malnutrition. As a result local initiatives are critical when promoting elderly nutrition because they can identify the unique issues faced in that area and target work accordingly.
In extreme circumstances older persons are at risk of becoming malnourished. Whilst much of the current nutrition debate focuses on obesity, especially in the young, at the other end of the spectrum malnutrition is affecting a small number of older people. Among independent older people 3% of men and 6% of women are underweight, and in nursing and residential care, these figures rise to 16% and 15% respectively (Finch et al 1998)
Malnutrition also poses a large economic burden on our society – 7.3 billion per year according to a recent UK study. The report, by the British Association for Parenteral and Enteral Nutrition, said this was more than double the annual bill for obesity-related problems .
Why is older person’s nutrition important?
All groups within society should be encouraged to eat as healthily as possible, however, this is particularly relevant for elderly people as a vulnerable group in society. In addition, many elderly people will have limitations placed on their lifestyle as they get older and will need support to ensure that this does not impact on their general health. The Food Standards Agency has produced some excellent guidance on eating healthily in life’s later years which gives a focus to the specific nutritive needs of this age group.
It should also be noted that in exceptional circumstances poor diet may lead to ill health. Many people think that losing weight and getting thinner is a natural part of the ageing process and families and health professionals may not pay much attention to the potential signs of possible diet related ill health. At first glance, the causes of diet related ill health seem straightforward: too little food, a diet lacking in nutrients or absorption problems. But it is much more complex in the elderly in particular, including social and psychological issues.
Some possible reasons for poor diet in older people living in the community:
- Shopping and preparing food can become more difficult.
- Access to premises selling healthy food, e.g. fresh fruit and vegetables, can become more difficult. Especially where shops are not within walking distance or where public transport is poor.
- Older single adults sometimes don't cook for themselves, due to a lack of cooking skills.
- Limited income, leading to reduced choice
- Lack of motivation to cook for only themselves
When considering a project to tackle diet related health in the elderly it is important to consider which of these possible factors (or others specific to your area) you wish to target. This will also ensure that you are able to set up a suitable measure for evaluation purposes.
2. Why should I get involved?
The following sections outline the current UK national and local policy relating to elderly diet and health. For local government, and other government associated bodies, there is a variety of national and local policy to promote and guide work in this area.
National UK policy
Choosing Health
The Government’s 2004 policy document ‘Choosing health’ sets out for England a cross government commitment to promote a healthy and active life amongst older people. Implied in that commitment however is a push to ensure that the elderly are given the ability and information to enable them to make healthy choices when it comes to diet and that action will come from both central and local government.
Choosing health delivery document, ‘Choosing Health: making healthier choices easier’
Food Vision is aware that there appears to be few examples of UK policy which specifically address the issues of promoting healthy eating for the elderly in their own homes. However, the Food Standards Agency has produced practical guidance, including weekly example menus, to help caterers across the UK provide food that meets the nutritional needs of older people in residential care homes which would also be relevant: .
National policy and local policy working together
National indicators, local priorities.
The Government has produced a list of 198 national indicators designed to measure progress on national priorities where they are delivered by local councils acting alone or in partnership through their LAA. These targets are set within four themes and those within the Adult health and Wellbeing section are relevant to elderly nutrition in the community, specifically:
NI 119 Self-reported measure of people’s overall health and wellbeing DH DSO
NI 120 All-age all cause mortality rate PSA 18
NI 121 Mortality rate from all circulatory diseases at ages under 75 DH DSO
Each local strategic partnership must negotiate up to 35 targets for its LAA from this list.
Including older persons food and nutrition in local area agreements (LAA)
Local elected members, quite rightly, focus their interests on the objectives set out in the Local Area Agreements themes. If you work in a local council, to secure a commitment to tackling older persons diet, you will need to show how it contributes to the targets in the ‘healthier communities and older people’ theme in your local LAA.
The table below shows examples of actions which some authorities have included in their LAA to tackle food/malnutrition issues within the older persons theme, and some which Food Vision believes could be included.
| Area | Outcome | Indicator |
| Leicester LAA | Increasing the numbers of older people who have access to low level support e.g. gardening, cleaning, shopping, and good neighbours/ befriending | % of older people accessing support |
| Cornwall LAA | Creation of ‘Can Do’ - a service that will deliver low level practical support for vulnerable and socially isolated elders. The Can-Do teams will offer forms of support that are not readily available within localities. This support might include befriending, transport, spring cleaning, shopping, leisure activities, etc |
% of people participating in ‘Can Do’. |
| Suffolk County Council | Creation of Older peoples partnership board to find out what older peoples priorities and needs are locally. http://www.onesuffolk.co.uk/POP | N/A |
| Sheffield City Council | The Sheffield Strategy for an Ageing Population will be the framework through which Sheffield will provide inclusion for Older People. This includes the full range of factors related to older people, e.g. education, employment, leisure, transport, community safety, healthy lifestyles, and civic involvement. |
|
Other Outcomes and Indicators suggested by Food Vision
| Outcome | Indicator |
| Increasing the number of shops selling fruit and vegetables within walking distance of older persons, via planning process | % of older persons living within 2.5 miles of a shop selling F&V |
| Increasing the number of older persons who have access to food shops. E.g. by providing bus services. | % of older person supported to visit shops offering suitable food choice |
| Increasing the number of older persons who have received cooking, shopping and budgeting skills training to ensure healthy choices can be made. | % of elderly persons receiving food choice training/cooking skills training. |
| Reducing the number food poisoning cases in older persons. | Numbers of older people recorded with food poisoning. |
3. What action can I take to help tackle this issue?
Local authorities can help lead the way in tackling healthy eating/nutrition issues in older persons by taking action in the community.
Which parts of local government can be involved?
As with any issue there are areas in which council services interact directly with older persons, such as social services and care homes, which can be tackled relatively easily. Food Vision has many case studies which show how local councils and PCTs have worked innovatively across boundaries in other areas. Councils should think laterally across their services to see where there is the opportunity to work with and/or access older people, or where their partners are working with the elderly.
Table A shows where standard service provision, and possible partnerships, can consider the needs of the elderly and promote healthy diets. Table B shows possible special projects.
It is recommended that councils undertake a specific older persons review across all service areas to ensure that day to day services contribute to promoting elderly nutrition and protect the vulnerable in this area.
Table A
Council service |
Opportunity for action |
| Community services – including adult social care, community centres, housing, benefits services |
• Services that have contact with elderly residents on a regular basis should be trained in how to be aware of the signs of dietary issues and have systems in place to respond to any issues. • Linking isolated older people with support services that enable them to access healthy food, including community groups, home help or voluntary services. • Work with planning, transportation and regulatory services to identify food deserts and respond accordingly. • Have information available on healthy eating, specifically for the elderly |
| Food Procurement |
• ‘Meals on Wheels’ contracts should ensure that the meals provide a balanced and appealing diet. |
| Planning | • Consider food access as major planning applications are processed, specifically whether levels of food access can be increased. • Encourage appropriate food businesses to be established where access to food is low. • Work with transportation, social and regulatory services in the council to establish levels of food access within elderly communities and respond accordingly. |
| Libraries | • Have information available on healthy eating and safe cooking methods, specifically for the elderly |
| Regulatory services | • Providing advice and guidance on healthy eating and safe cooking methods, across council services, but also for specific projects. |
|
PCT & Community Dieticians |
• By ensuring healthy eating messages are taken to the isolated elderly. • By providing healthy eating messages as part of GP visits. |
| Local third sector groups | • Help the Aged, Age Concern, and others, provide services to the elderly and seek to help older people in the community where they can, partnerships with these groups can help identify areas of need, and establish evidence upon which to base actions. • Community groups may also be aware of a local need and can often be effective in making links with those needing help, or have ideas which may work locally. |
| Private Sector |
• Retailers can be involved to help a sector of society which is not able to reach their stores. |
Possible special community food projects to tackle elderly malnutrition. Table B
Theme |
Project Ideas |
| Provision of door to door services |
|
| Assisted shopping schemes |
|
| Social Interaction & intergenerational schemes |
|
| Practical advice on healthy eating |
|
| Practical advice on food safety and hygiene |
|
First steps
The following are possible first steps if you are considering taking action on nutrition issues for elderly in the community (for more information on project planning go to http://www.foodvision.gov.uk/pages/project-planning )
1. Identify a need and target for action; talk to local council departments (identified above) and /or local groups such as Age Concern or Help the Aged to determine evidence for areas or types of need. For example:
- a) Any statistics on the needs of elderly people within the community can target the approach taken. Local health evidence could show a high level of high blood pressure and heart disease in single older males. A target could be to reduce those levels, or measure a proxy, and an appropriate action/project devised.
- b) Anecdotal evidence from a local older persons support group might suggest a particular area where older persons are finding it difficult to access healthy food locally. Further food mapping work will help to provide the evidence to take this forward.
- c) Consultation with local older residents, through panels and visits etc, may reveal areas which lead to innovative and effective projects.
2. Identify the partners you might need to develop an approach to those issues.
Consider the public, health, third and private sectors. Consider both the practical needs of your proposed action and the funding needs it will have both in monetary, knowledge and practical terms. For example
- a) A local public health campaign to raise awareness of the dangers of high levels of salt in the diet could be targeted thorough a partnership with adult social care, the local PCT community dieticians, GP surgeries, local community groups inc social, working men’s clubs, allotment associations etc.
- b) A project to provide better access to healthy food for the elderly might include, adult social care, regulatory services (to identify retail premises), local retailers, local food coops, school with allotments, etc.
3. Discuss and agree an approach with those groups and develop measures for your success. See Food Vision guidance on evaluation http://www.foodvision.gov.uk/pages/evaluation .
4. Ensure sufficient and/or sustainable funding is agreed. See Food Vision guidance on gaining funding. http://www.foodvision.gov.uk/pages/funding
4. Where can I get further information and ideas?
The following links take you sources of information which will help develop policies and practices to help reduce food related health inequalities in older people.
General older person’s healthy eating advice
Food Standards Agency
• The Food Standards Agency’s Eatwell website contains information on healthy eating for older people at: http://www.eatwell.gov.uk/agesandstages/olderpeople/
• The Food Standards Agency “Good Life” booklet: This booklet contains nutritional advice for men and women over 50 http://www.food.gov.uk/multimedia/pdfs/publication/goodlife1007.pdf
• Food Standards Agency Wales have launched a recipe booked called Recipe for Life to help people over 50 achieve a healthy balanced diet. http://www.food.gov.uk/news/newsarchive/2008/may/recipeforlife
NHS Direct
• NHS Direct have healthy eating tips for older persons on their website. http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1132 and http://www.nhsdirect.nhs.uk/questions/category/index.aspx?categoryId=51
World Health Organisation
For general information about older person nutrition and some guidance on practical steps to treat it. http://www.who.int/nutrition/topics/ageing/en/index1.html
BBC Health
Gives a number of useful contacts for health information for the over 50s. http://www.bbc.co.uk/health/health_over_50/usefulcontacts_index1.shtml
Help the Aged
For general advice on healthy eating for this age group.
http://www.helptheaged.org.uk/en-gb/AdviceSupport/HealthAdvice/HealthyAgeing/HealthyEating/default.htm
Bristish Nutrition Foundation
General tips on healthy ageing from BNF healthy ageing task force
Information specific to residential and care homes:
Food Standards Agency: Guidance for food served to older people in residential homes
The Food Standards Agency issued their Guidance on food served to older people in residential homes: http://www.food.gov.uk/multimedia/pdfs/olderresident.pdf
Department of Health
Improving Nutritional Care Action Plan:
National Association of Care Caterers (NACC)
The National Association of Care Catering has produced practical guidance for people who cater for older people in care homes (i.e. Menu planning & special diets manual), day care, or who are responsible for community meals (A recommended standard for community meals).
These are available by visiting the website www.thenacc.co.uk, or phoning 0870 748 0180.
NICE guidelines on adult nutrition
The NICE clinical guideline on nutrition support in adults covers the care of patients with malnutrition or at risk of malnutrition, whether they are in hospital or at home.
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=10978
Royal College of Nursing: Nutrition now
Nutrition Now is a clinical campaign launched by the RCN to raise standards of nutrition and hydration in hospitals and the community. Food and water are essential elements of care - as vital as medication and other types of treatment. The campaign gives nurses the practical tools, support and evidence they need to make nutrition a priority in the area where they work.
Publications associated with this campaign include the RCN Principles for Nutrition and Hydration and Our Hospital Hydration Best Practice Toolkit, which has been produced in partnership with the National Patient Safety Agency (NPSA).
Water UK – Hydration in older people
Water UK offer advice and practical guidance on improving hydration in older people in care homes. The Hydration Best Practice Toolkit for Care Homes is available to download from their site, along with support information, medical evidence and advice on policy development and good practice.
British Association for Parenteral and Enteral Nutrition
BAPEN have developed, along with their partners a screening tool to help spot malnutrition called MUST 'Malnutrition Universal Screening Tool' available from their website. http://www.bapen.org.uk/must_tool.html
Caroline Walker Trust – Eating well for older people
The Caroline Walker Trust has produced practical guidance for people who cater for older people in care homes, nursing homes or at lunch clubs, or who are responsible for community meals. It has also produced similar guidance specifically for those looking after those with dementia. http://cwt.org.uk/publications.html#older
Advice relevant particularly to elderly in the community:
Food Standards Agency:
The Food Standards Agency commissioned research to develop and evaluate community-based peer-led food clubs for older adults from socially deprived areas. A wide range of resources including questionnaires, training materials, recipes and list of important information sources were used and developed and can be obtained free of charge from the FSA. Please contact Vivien Lund at: Vivien.lund@foodstandards.gsi.gov.uk for more information.
Central Office for Information
The COI has produced guidance as part of its Common Good research programme which aims to consider the best ways of communicating messages to older people group. http://www.coi.gov.uk/
Association of Public Health Observatories (APHO)
The Association has published a document which focuses on the specific indicators of public health in older person which draws comparisons across the regions and sets out a base line of evidence. http://www.apho.org.uk/resource/item.aspx?RID=44315
Further regional evidence can be found at your regions PHO website.
Royal Society for Public Health- Preventing malnutrition
This document outlines the outcomes of a conference to discuss the best ways to prevent malnutrition in the community. Its recommendations will help inform those thinking of setting up a project. http://www.riph.org.uk/pdf/preventing_malnutrition.pdf
National Institute for Health and Clinical Excellence (NICE) – Effectiveness of interventions to promote healthy eating in elderly people living in the community
This review document reviews literature on current interventions and outlines what it believes are the key steps which need to be taken to make an effective project in this area.
Welsh Consumer Council – Food poverty and older people
This research document outlines some of the key reasons for older person’s food poverty and also suggests some projects which would help reduce food poverty in the community.
Age Concern –Hungry to be heard
A campaign to stop older people becoming malnourished in hospital http://www.ageconcern.org.uk/AgeConcern/hungry2bheard.asp
Local Age Concern charities also offer support through a variety of services, dependent on their size and local need. The sort of services a local Age Concern might offer includes the following: Activities such as day care, lunch clubs, outings, learning and leisure opportunities, including computer training are available at many local offices.
Women’s Royal Volunteer Service – Challenging loneliness campaign
WRVS brings human contact to potentially isolated people through food related projects such as Meals on Wheels, lunch clubs, community centres, Books on Wheels, Home from Hospital schemes and social transport. These services reduce loneliness and give people the opportunity to be a part of their local community.
Greater Glasgow Health Board and Glasgow Royal Infirmary
The Health of Older People (HOP) project is a systematic, fully indexed, searchable database, free recourse summarising the evidence of effectiveness of interventions including nutrition interventions in healthcare and rehabilitations of older people. http://www.effectiveolderpeoplecare.org/
References
1) Thomas AJ. 1998. Nutrition and the Elderly. Nursing Times - Nutrition in Practice 10
2) Finch S; et al. 1998. National Diet and Nutrition Survey: People aged 65 Years and Over: Volume 1: Report of the Diet and Nutrition Survey. London, The Stationery Office
This toolkit was added 15/5/09