Eating well for older people - cwt.org.uk

1 Practical and nutritional guidelines for food in residential and nursing homes and forcommunity mealsREPORT OF AN EXPERT WORKING GROUPTHECAROLINEWALKERTRUSTE ating well forolder peopleSECOND EDITIONP ractical and nutritional guidelines for food in residential and nursing homes and forcommunity mealsREPORT OF AN EXPERT WORKING GROUPREPORT OF ANEXPERTWORKING GROUPTHECAROLINEWALKERTRUSTE ating well forolder peopleSECOND EDITION2 AcknowledgementsThe Expert Working Group would like to thank DGAAH omelife, the Department of Health, and Tesco plc, forproviding the financial support which made the first edition ofthis report possible. The Caroline Walker Trust, 1995 This edition printed in 2004. ISBN 1 897820 18 6 First edition printed in 1995 (ISBN 1 897820 02 X)The Caroline Walker TrustPO Box 61St Austell PL26 6 YLRegistered charity number: 328580 Further copies of this report are available from:The Caroline Walker Trust22 Kindersley WayAbbots LangleyHerts WD5 0DQ Price 15 (including postage and packing).

2 Please make cheque payable to The Caroline Walker Trust .Edited and produced by Wordworks, London W4 by Information Design by Frances text and tables contained in this report (except for materialreproduced with permission from other organisations) can bephotocopied by all those involved in providing food for available:The CORA Menu PlannerA computer program to help plan nutritionally balanced menusfor older people in residential and nursing homes. Includes adatabase of over 800 recipes. Available on CD ROM or 31/2 disks. Price 50. Send a cheque, payable to The Caroline WalkerTrust , to: The Caroline Walker Trust, 22 Kindersley Way, AbbotsLangley, Herts WD5 Well for older people with DementiaA good practice guide for residential and nursing homes andothers involved in caring for older people with dementia.

3 Available from VOICES. Price Send a cheque, payable to VOICES , to: VOICES, Unicorn House, Station Close, Potters Bar,Herts EN6 3JW. Phone: 01707 of the Expert Working Group on NutritionalGuidelines for Food Prepared for older PeopleThese are the members of the Expert Working Group which produced the firstedition of this report. Their affiliations are as at 1995 when the first edition Dillon Roberts(Chair)Director of Public Affairs, National Farmers Union of England and Wales; Trustee of TheCaroline Walker TrustDame Barbara ClaytonHonorary Research Professor in Metabolism,University of SouthamptonJune CopemanChair of the Nutrition Advisory Group for Elderly people , the British Dietetic Association; Senior Lecturer in Nutrition andDietetics, Leeds Metropolitan UniversityDr Louise DaviesConsultant in Gerontology Nutrition and Honorary Senior Lecturer, Royal FreeHospital School of Medicine, LondonMandy DownesDirector of Food Services, Women s Royal Voluntary ServiceDr Anthea LehmannConsultant Geriatrician, Homerton Hospital,Hackney, LondonDorothy Newman National Chair, Advisory Body for Social Services Catering, BradfordMaggie SandersonPrincipal Lecturer in Nutrition, University of North London.

4 Chair of The Caroline WalkerTrustProfessor Aubrey SheihamProfessor of Dental Public Health, University College, LondonKiran ShuklaDistrict Dietitian, Thameside Community NHS Trust, EssexElizabeth WalkerHealth Care Divisional Dietitian, Gardner Merchant, Northwich, CheshireObserversDr Petra ClarkeSenior Medical Officer, Department of Health, LondonSylvia StenhouseMatron/Manager,DGAA Homelife, Rush Court Nursing Home, Wallingford,OxfordshireDr Jennifer WoolfeSenior Scientific Officer, Food Safety Directorate, Ministry of Agriculture,Fisheries and Food, LondonThe first edition of this report was researched by Dr Katia edition was researched and updated by Dr Helen Foreword7 Summary and recommendations9 Chapter 1 Why nutritional guidelines are needed14 Chapter 2 Food prepared for older people : who provides it, and who eats it?

5 17 Food prepared for older people in residential and nursing homesCommunity mealsChapter 3 How a good diet can contribute to the health of older people 21 How the body changes with ageingMalnutritionCommon health problems that can be improved by dietChapter 4 nutritional requirements of older people29 Chapter 5 nutritional guidelines for food prepared for older people40 Food prepared for people in residential and nursing homesCommunity mealsChapter 6 Examples of menus which meet the nutritional guidelines46 Example menus for older people living in residential or nursing homesExample menus for community mealsChapter 7 nutritional assessments51 How to identify older people who might be at risk of malnutritionAssessing food provisionChapter 8 Exciting the appetite60 Providing variety and choiceTiming and frequency of mealsFood presentationSocial occasionsPhysical activityAppendix 1 Recommendations of the COMA report on The Nutrition of Elderly People63 Appendix 2 Care Homes for older people .

6 National Minimum Standards64 Appendix 3 Good sources of nutrients65 Appendix 4 Portion guide69 Appendix 5 Sample nutritional assessment methods for use in the community70 Appendix 6 Useful addresses and further reading746 List of Tables and FiguresTable 1 nutritional requirements of older people30 Table 2 nutritional guidelines for food prepared for older people in residential or nursing homes41 Table 3 nutritional guidelines for community meals for older people44 Table 4 Example menus for older people living in residential or nursing homes47 Table 5 Example menus for community meals for older people49 Table 6 Examples of community meals suitable for older people from Asian and Afro-Caribbean backgrounds50 Table 7 Weight loss score56 Figure 1 Estimating height from ulna length52 Figure 2 Measuring from mid upper arm circumference53 Figure 3 The Malnutrition Universal Screening Tool (MUST)54 Figure 4 BMI score (and BMI)557 ForewordThe Caroline Walker Trust isdedicated to the improvementof public health by means ofgood food.

7 Established in 1988 tocontinue the work of Caroline Walker,and in particular to protect the qualityof food, it is a charitable trust whosework is wholly dependent on grantsand Trust has produced a number ofpublications, training materials andcomputer packages which providepractical guidance on Eating well forthose who care for vulnerable peoplein our society. The Trust s first ExpertReport nutritional Guidelines forSchool Meals,1published in 1992, hasbeen widely used as the basis forquantitative standards for school mealsand is provided as guidance by theDepartment for Education and Skills inits nutritional guidelines for and nutritionalguidelines have also been produced forunder-5s in child care3in 1998, and forlooked after children and youngpeople4in 2001.

8 More informationabout these documents and theiraccompanying training packs andsoftwarecan be found on the CarolineWalker Trust website: 1995 the Trust produced the firstedition of this publication EatingWell for older of theworking group responsible for thatreport were also involved in theVOICES report Eating Well for OlderPeople with Dementia,6produced in1998. A computer program called theCORA Menu Planner,7produced inresponse to the publication of the firstedition of Eating Well for older people ,has provided a practical tool for thoseplanning menus for older people and isnow extensively used across the this report was first published, ithas been widely used in residential andnursing homes, and in the community,both to raise the profile of Eating wellfor older people and to providepractical guidance for those who workin this sector and for those who adviseand support the first edition of the report waspublished in 1995, the last nationalsurvey of the nutrition of older peopleavailable to the Expert Working Groupwas over 20 years old.

9 The Committeeon Medical Aspects of Food andNutrition Policy (COMA) hadrecognised this lack of information intheir reports on Dietary ReferenceValues8and on the Nutrition of Government respondedto COMA s recommendations, andcommissioned a nutrition survey ofpeople aged 65 years and over inGreat Britain as part of the NationalDiet and Nutrition Survey (NDNS)programme. The results werepublished in 1998,10, 11after the firstedition of this report had beenpublished. More recently, theGovernment has also published aNational Service Framework for report on Eating Well for OlderPeopleremains in high demand. It isnow five years since the NDNS surveyof people aged 65 years and over waspublished. The Trust recognised that itwould be appropriate to ensure thatthe report took account of this morerecent information and of the NationalService Framework for older people ,and thereforedecided to produce anew Trust is delighted that many of itsrecommendations have beenincorporated into the new NationalMinimum Standards for Care Homesfor older People13and this new reportwill hopefully be a good starting pointfrom which nutritional standards canbe Trustees would like to thank theoriginal Expert Working Group, andparticularly Anne Dillon Roberts theChair, for their work in compiling thefirst edition of this report.

10 They wouldalso like to thank Dr Helen Crawleyand Rosie Leyden for updating thisreport and June Copeman and AnitaBerkley for their useful comments onthe text for this hope that this second edition ofthis report will be as well used as itspredecessor and provide practicaladvice to all those who have animportant role to play in the care ofolder Martin WisemanChair, Caroline Walker TrustForeword8 References1 Sharp I. 1992. nutritional Guidelinesfor School Meals. Report of an ExpertWorking : The CarolineWalker Available from: The Caroline Walker Trust. 1998. EatingWell for Under-5s in Child : The Caroline Walker The Caroline Walker Trust. 2001. EatingWell for Looked After Children andYoung people .