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Our research shows 4 in 10 Australians in aged care are malnourished. What can we do about it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/jonathan-foo-1551045">Jonathan Foo</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/marie-claire-oshea-1373994">Marie-Claire O'Shea</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> In the next 40 years <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150-fs.pdf">in Australia</a>, it’s predicted the number of Australians aged 65 and over will more than double, while the number of people aged 85 and over will more than triple. If you’re not really interested in aged care, you should be. Given these figures, you will almost certainly be engaging with aged care services at some stage – either for yourself, or supporting family members or friends seeking aged care. One service you are likely to encounter is residential aged care homes. In the past few years this sector has been under more scrutiny than ever before. Changes to legislation, workforce and funding are in motion. But the question remains as to whether these changes can happen fast enough to meet our ageing population’s needs. One area of need not being adequately met at present is nutrition. In a <a href="https://www.mdpi.com/2227-9032/12/13/1296">new study</a>, we’ve found four in ten older Australians living in residential aged care are not receiving enough of the right types of nutrients, resulting in loss of weight and muscle. This is known as malnutrition. <h2>Good nutrition is essential for healthy ageing</h2> Malnutrition in older people is <a href="https://www.agedcarequality.gov.au/providers/food-nutrition-dining/why-meals-matter">associated with</a> poorer overall health, such as increased risk of falls and infections. This can accelerate loss of independence for older people, including the need for extra assistance with basic activities such as bathing and dressing. Older people are at increased risk of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02612-5/abstract">malnutrition</a> for a range of reasons. These can include decreased appetite, difficulties with chewing and swallowing, and the presence of other chronic diseases such as Parkinson’s disease or dementia. Importantly, ensuring adequate nutrition is about more than just offering healthy foods. We eat not only to meet nutritional requirements, but for enjoyment and socialisation. We each have different preferences around what we want to eat, when and with whom. Food provision poses a challenge for residential aged care providers who must navigate the range of residents’ preferences together with dietary restrictions and texture modifications. This must also be balanced against the practicalities of having the right number of appropriately trained kitchen and mealtime assistance staff, and working within funding constraints. Understanding more about who is malnourished in aged care can help providers better address this problem. <h2>Malnutrition is an ongoing problem in aged care</h2> We looked at more than 700 aged care residents in New South Wales, Queensland and South Australia. We assessed participants for malnutrition using a screening tool that collects data on medical history and dietary intake, and includes a physical examination of muscle and fat. We found 40% were malnourished, including 6% who were severely malnourished. This likely underestimates the true rate of malnutrition, as residents with dementia were excluded. International <a href="https://www.mdpi.com/2072-6643/15/13/2927">studies</a> have shown an average of 80% of aged care residents with dementia are malnourished or at risk of developing malnutrition. Our findings are broadly in line with a synthesis of <a href="https://www.sciencedirect.com/science/article/pii/S0378512219301148">38 international studies</a>, which reported an average malnutrition rate in residential aged care of 52%. In Australia, malnutrition was highlighted as <a href="https://www.royalcommission.gov.au/aged-care">a priority</a> for immediate attention in the 2021 Royal Commission into Aged Care Quality and Safety. Its report cited <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/dairy-food-supplementation-may-reduce-malnutrition-risk-in-institutionalised-elderly/52E93ADD586C634A3913A2AFE9D07847">an Australian study</a> of 215 residents, published in 2017, which found 68% were malnourished or at risk of malnutrition. It’s difficult to directly compare malnutrition rates between studies due to differences in diagnostic measurements. But it’s clear malnutrition is an ongoing challenge in aged care. <h2>What can we do about it?</h2> Since the royal commission, we’ve seen the strengthening of the <a href="https://www.agedcarequality.gov.au/providers/quality-standards/strengthened-quality-standards">quality standards</a> to be included in the new Aged Care Act, anticipated to be introduced to parliament in 2025. The strengthened quality standards provide an important framework to guide action by aged care providers on malnutrition. Key requirements include partnering with residents to design food options, regular assessment and reassessment of resident nutrition requirements, developing systems to monitor and improve satisfaction with food, designing pleasant dining environments, and providing staff with the training they need to achieve all of the above. However, achieving these standards will require investment of money and time. At the moment, <a href="https://kpmg.com/au/en/home/insights/2023/09/australian-aged-care-sector-analysis.html">64% of residential aged care providers</a> in Australia are operating at a financial loss. While we know carers and facility managers want to provide the best care possible, it’s difficult to achieve this when contending with underlying financial problems. As such, our teams at Monash and Griffith universities are focusing on strategies that minimise the burden on staff and providers. We are working on automating malnutrition screening. Current tools take 10–15 minutes and should be used when a new resident moves into an aged care home and regularly during their stay. But anecdotal evidence suggests providers lack the staff and funding needed to routinely carry out this screening. Instead, we aim to use existing data from aged care providers, including quarterly reports from the <a href="https://www.health.gov.au/our-work/qi-program">National Aged Care Mandatory Quality Indicator Program</a>, to detect malnutrition automatically. This will allow staff to focus more on care. Given the complexity of malnutrition, it’s likely that addressing the issue at a national scale will take some time. In the short term, for those with loved ones in aged care homes, we encourage you to be actively involved in their care, including noticing and speaking up if you think more can be done to optimise their nutrition.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235507/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jonathan-foo-1551045">Jonathan Foo</a>, Lecturer, Physiotherapy, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/marie-claire-oshea-1373994">Marie-Claire O'Shea</a>, Senior Lecturer, School of Health Sciences and Social Work, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/our-research-shows-4-in-10-australians-in-aged-care-are-malnourished-what-can-we-do-about-it-235507">original article</a>. </div>

Body

Obese yet malnourished toddler mummy sheds light on life in 17th century aristocratic Austria

In a creepy discovery published, a collaboration of German scientists have performed a ‘virtual autopsy’ on a mummified toddler’s body, found in a 17th century Austrian crypt. Buried in a wooden coffin that was slightly too small and deformed the skull, the young child’s body appeared to be both obese and malnourished. Researchers say the findings might provide a rare insight into historical Austrian aristocratic society. By using CT scanning, scientists were able to perform a ‘virtual autopsy’ on the mummy which was naturally mummified in the conditions of the crypt. Well-preserved soft tissue showed the child was a boy, overweight for his age, and radiocarbon dating suggests a date of death between 1550 and 1635 CE. By examining the formation and length of the body’s bones, plus evidence of tooth eruption, the researchers were able to estimate that the child was about one year old when he died. The bones also showed that despite being well-fed, the boy was malnourished, with his malformed ribs displaying signs of rachitic rosary. This condition presents in a pattern of prominent bony knobs at points where the rib joins cartilage and results from diseases associated with specific vitamin deficiencies such as rickets (vitamin D) and scurvy (vitamin C). Vitamin D is found in foods like salmon, tuna, mackerel and beef liver and egg yolks, but we typically only get around 10% of our required Vitamin D from our diets – the rest is made by our bodies when exposed to ultraviolet B (UVB) from the sun. “The combination of obesity along with a severe vitamin-deficiency can only be explained by a generally ‘good’ nutritional status along with an almost complete lack of sunlight exposure,” said Dr Andreas Nerlich of the Academic Clinic Munich-Bogenhausen and lead researcher. The child appears to have died from pneumonia, judging by the evidence of inflammation in the lungs. Rickets is known to make children more vulnerable to pneumonia, suggesting that, sadly, not only was the child malnourished, but that this condition may have also led to his untimely demise. “We have to reconsider the living conditions of high aristocratic infants of previous populations,” said Nerlich. Relatively little is known about aristocratic childhood in the late Renaissance period, so these mummified remains give key insights into life in Europe of a period generally known for its fervent creativity and intellectual development. “This is only one case,” said Nerlich, “but as we know that the early infant death rates generally were very high at that time, our observations may have considerable impact in the over-all life reconstruction of infants even in higher social classes.” To understand more about this period, researchers scoured historical records of the crypt and the family to whom the crypt belonged. Curiously, the child was buried in a simple, unmarked, wooden coffin, although he was dressed in an expensive silk hooded coat. The unmarked coffin appeared to have been slightly too small for the body such that the skull became deformed and was the only infant buried amongst the identifiable adult metal coffins in the crypt. Historical records of renovations on the crypt confirmed the radiocarbon dating, indicating the child was likely buried sometime after 1600 CE. The crypt belonged to the Counts of Starhemberg and traditionally was kept exclusively for the burial of heirs to their titles, and their wives, making the body likely to be that of the first-born (and only) son, Reichard Wilhelm, of Count Starhemberg. “We have no data on the fate of other infants of the family,” Nerlich said, regarding the unique burial. “According to our data, the infant was most probably [the count’s] first-born son after erection of the family crypt, so special care may have been applied.” This article originally appeared on <a href="https://cosmosmagazine.com/history/toddler-mummy-17thcentury-austria/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Clare Kenyon. Image: Andreas et al. (2022)

Travel Trouble

Malnourished teens found locked up in Brisbane home

Two teenage boys with autism were found malnourished and naked in a Brisbane home where police found a man dead. Police had been responding to the discovery of a 49-year-old man’s body in the front yard of a Stafford property on Wednesday morning when they found the teenagers, aged 17 and 19, after hearing sounds from a locked bedroom. The 49-year-old man, whose death is not being treated as suspicious, was understood to be the father of the pair. Neighbours said the boys had been living in squalid conditions. Photos and footage obtained by the <a href="https://www.abc.net.au/news/2020-05-28/department-of-child-safety-notified-brisbane-teens-locked-house/12297766">ABC</a> dating back to October 2018 show the teenagers wearing only nappies in a room with smeared excrement on the walls and the floor. A neighbour said she contacted the Department of Child Safety in February but was told there was nothing they could do. She said her family had witnessed the man’s “disgusting” mistreatment of the boys over the past 18 months and recalled seeing the teenagers being locked outside “in nothing but a nappy”. “I rang [the department] because to me, I couldn’t believe how hot it was, that you would leave a child outside,” she told the ABC. “[The department] basically said because they technically have shade, and they technically are in an enclosed yard, there’s nothing that they can do, which doesn't sit well with me being a mum. “They didn’t even ask me for the address.” Another neighbour said it was “extremely difficult to see it, hear it, know it all the time and not being able to do anything about it and to try and get things done about it … but just not being heard by people who could change it.” A Queensland Ambulance spokesman said the teenagers were being treated at Prince Charles hospital. Queensland’s minister for child safety Di Farmer said her “thoughts are with these two young men who are getting the support and care they need”. The Department of Child Safety, Youth and Women said it could not confirm whether they were investigating the situation. “The strict provisions of [the Child Protection Act] make it illegal to disclose publicly whether an individual or family is known or not known to the department,” it said.

News

Pete Evans slams vegan parents after tragic case of malnourished baby girl: “This is so sad”

Celebrity chef Pete Evans has criticised those who force their children to follow a strict vegan diet, after a couple from Sydney were convicted over the malnourishment of their baby girl. The parents were sentenced to 18 months prison yesterday, but still managed to escape time behind bars. Although, after police discovered their 20-month-old girl severely malnourished and suffering from rickets, their remaining children were taken away. Her diet consisted of just oats, bread and a few mouthfuls of vegetables a day for months after the mother became “increasingly fixated” on veganism. The young girl looked like a three-month old, weighing only 4.89kg. She was unable to crawl or sit up with help, had zero bone development and suffered from swollen legs due to fluid build-up. But after switching up her diet in April 2018 and provided extra support, she began to grow and her teeth emerged. The My Kitchen Rules judge had a few things to say about the incident, saying it was wrong for depriving a young child of meat. “This is so, so sad,” said the paleo chef in a Facebook post. “I will repeat it again and again. Humans are omnivores and we are designed to eat meat in our diet. Children should not be on a vegan plant-only diet.” The 46-year-old pleaded with parents to “please use common sense”, especially when it came to their kids’ diets. “If you choose to eat a plant-based diet as an adult then that is your choice and go for it … but please, please be wise with choices of what you feed your children.” But not everyone was happy with the chef’s choice of words, saying it had nothing to do with veganism, and was simply due to neglect. “The fact the diet was ‘vegan’ really has nothing to do with it. It was simply inadequate,” wrote one user. “There are vegan diets of crap pizza, pasta and chips … and vegan diets of wholesome organic vegetables and produce. There is a HUGE difference,” said another.

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