The challenges facing residential aged care homes to participate in quality food and nutrition research.

BACKGROUND: There is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens. METHODS: Qualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in-depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches. RESULTS: Four themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples. CONCLUSIONS: Several challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions.

Can foodservices in aged care homes deliver sustainable food fortification strategies? A review.

Food fortification is used as a nutrition support strategy in aged care homes, for residents who are malnourished or at risk of malnutrition. The aim of this review was to determine the scope and strength of published works exploring relationships between food fortification strategies, mode of delivery and sustainability in aged care homes. Literature from four databases and grey literature was searched. A total of 3152 articles were screened. Seventeen studies were included. Results showed that the majority of studies used pre-made food fortification, rather than fortifying foods on-site. There was heterogeneity across studies, including the mode of delivery and ingredients used for food fortification. Only two studies measured any aspect of costs. No clear sustainable strategies for implementing food fortification in this setting could be identified. Research is required to provide further insight into the acceptability and sustainability of food fortification interventions.

Meal choice for residential aged care is not yet defined: A scoping review of policies, standards, reports and guidelines.

AIM: For residents in residential aged care, making choices in relation to food and mealtimes are opportunities to maintain a sense of self and autonomy. It is unknown, however, whether the concept of choice is adequately addressed in texts relating to residential aged care. The purpose of this review is to examine whether residents' right to make choices regarding the meals they eat, is discussed in grey literature including, policies, standards, reports and guidelines, which all impact practice in residential aged care. METHODS: Grey literature was located utilising; Google, Google Scholar and hand searching. Texts had to be in reference to residential aged care and were assessed using the Appraisal of Guidelines for Research and Evaluation II and Joanna Briggs Institute tools. RESULTS: Twenty-nine texts were included in the final review, consisting of, 12 policies and standards, 12 guidelines and 5 reports. Choice was discussed broadly in the majority of texts, with no definition included for the level of choice that should be provided by residential aged care. The use of alternative meals to provide choice was discussed; however, texts varied in their requirements and recommendations as to what constituted an adequate alternative. CONCLUSIONS: The ambiguity surrounding choice affects the practices within residential aged care and ultimately the service provided to residents. With most recommendations being only general in nature, residential aged care homes are not provided with sufficient guidance for meal planning. To ensure residents' right to make choices in their meals is guaranteed, more definitive requirements and recommendations are needed.

Costing Foodservices in Aged Care Is More Than Food Alone: The Development of the FCT.

Foodservices in residential aged-care homes (RACHs) play a vital role in providing meals and maintaining residents' health through good nutrition. However, foodservices are often required to work within a budget, and the costs involved in foodservices are often misunderstood and underestimated. The aim of this work was to design a costing tool that included all relevant costs of a foodservice. A systems approach was used to inform the development of the Foodservice Costing Tool (FCT). Eight domains were identified, including costs that are both directly and indirectly associated with foodservices. The tool was piloted and trialled in the Australian aged-care setting and compared to currently available national estimates of costs. Through four pilots and subsequent trials, the FCT was able to capture the costs of a foodservice system in a small sample of RACHs, although the low response rate may have biased the sample toward those homes that had fewer problems with the FCT. The results highlighted the limitations of currently reported estimates, which underestimate total costs, as they fail to encompass the complexity of foodservices and to recognise that costs extend beyond the kitchen. The FCT is a useful tool and has the potential to be used by RACHs to both measure and understand their costs at a more granular level to ensure cost effectiveness and accountability. Further research is required to validate the tool and investigate the implementation of the FCT on a larger scale.

Food and Nutrition Champions in Residential Aged Care Homes Are Key for Sustainable Systems Change within Foodservices; Results from a Qualitative Study of Stakeholders.

The role of foodservices in aged care is difficult to understand, and strategies to improve the nutritional care of residents are often unsustainable. In particular, food-first strategies such as food fortification are poorly executed in everyday practice and its execution relies upon the foodservice system in aged care homes. The aim of this study was to explore the perspective of staff on the role of foodservices in aged care and gauge the level of skills, education, access, time, and ability to deliver food fortification. Semi-structured interviews were conducted with foodservice managers, foodservice workers, dietitians, carers, and other managers who work in aged care homes across Australia. Participants were recruited purposively through email and through snowballing. Interviews (n = 21) were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Three themes and six sub-themes were identified. The three themes include the role of foodservices being more than just serving food, teamwork between all staff to champion nutrition, and workplace culture that values continuous improvement. These themes identify how staff perceive the role of foodservices in aged care and provide an important perspective on the long-term sustainability of food fortification strategies and how to improve current practice.

Impact of television on nutritional intake in communal dining room settings among those with acquired brain injury: A pilot study.

AIM: Those with acquired brain injury (ABI) experience impairments in executive function, attention and concentration that may contribute to or exacerbate poor nutritional intakes. This is frequently observed in long-stay rehabilitation settings. This investigation aimed to identify the specific impact of the dining room television as a factor that exacerbates poor intake and nutritional status among those with ABI. METHODS: Routine meal audits were completed (six television on, six television off) over four non-consecutive days. Each individual's protein and energy intake per meal and day were assessed, and the differences were examined through paired t-tests. Dining room decibels were measured, with means, peaks and minimums recorded. RESULTS: Complete data for 12 meals were collected for seven individuals. Clinically, but not statistically significant increases in 48-hour protein and energy intake occurred with television off compared with on, including those requiring texture modified diets. CONCLUSIONS: This pilot investigation highlights that television may have a detrimental impact on nutritional intakes among those with ABI. Given the negligible costs and risk, minimising disruptive influences by turning the television off may become a recommendation for ABI in long-care rehabilitation settings.

Menu Planning in Residential Aged Care-The Level of Choice and Quality of Planning of Meals Available to Residents.

BACKGROUND: Choice of food is an imperative aspect of quality of life for residents in Residential Aged Care Homes (RACHs), where overall choice and control is diminished upon entering a home to receive care. The purpose of this study was to examine the current strategies of menu planning in a range of RACHs in Australia, and whether this facilitated appropriate levels of choice for residents receiving texture modified and general diets. METHODS: The study comprised a National Menu Survey using a new survey instrument collecting general information about the RACH and foodservice system, menu information and staffing information (n = 247); a national menu analysis (n = 161) and an observational case study of 36 meal environments. RESULTS: Choice was low for the entire sample, but particularly for those receiving pureed texture modified diets. Evidence of menu planning to facilitate the inclusion of choice and alternatives was limited. DISCUSSION: Regulation and monitoring of the Australian Aged Care Accreditation Standards needs to be strengthened to mandate improvement of the choice and variety offered to residents, particularly those on pureed texture modified diets. Further research on how menu choice and a lack of variety in meals affects the quality of life residents is needed in this context, but current evidence suggests the effect would be detrimental and undermine resident autonomy and nutritional status.