Eating well–living well
Community Nutrition Strategy for Older People in Hampshire
2011-2014
Eating well–living well
Community Nutrition Strategy for Older People in Hampshire, 2011-2013
1. Introduction
“Good nutrition is not just about food and meals, but about people, warmth and social inclusion.”
The The International Longevity Centre –UK(ILC UK) report Personalisation, Nutrition and Community Meals, March 2010
This strategy supports the aim of the Ageing Well in Hampshire - Older People’s Well-Being Strategy 2011-2014, “to support older people to live independently and live well for as long as possible”.
This is a community nutrition strategy relating primarily to the 84% of older people not intensively using health or social care services. This equates in 2010 to approximately 235,000 people in Hampshire aged 65 and over.
For older people a good diet is essential for the prevention of a number of health problems including: anaemia; constipation and other disorders of the digestive tract; diabetes and cardiovascular disease. It can also contribute to positive mental wellbeing. For most people aged over 60 years and with a normal appetite, eating a variety of foods in the proportions represented by the Eatwell Plate (appendix 1) will ensure a healthy, balanced diet and help to avoid becoming overweight or obese. Older people can be particularly susceptible to malnutrition, which can contribute to increased mortality, an increased risk of infection and an increased risk of falls and fracture.
2. Principles of the Community Nutrition Strategy
2.1Good nutrition for older people is an integral part of the prevention and early intervention work stream of Adult Services.
2.2Recognition of the social and economic value of supporting older people to remain independent in their own homes with a good nutritional status.
2.3Raise awareness of the need for good nutrition amongst older people and those working with older people to prevent decline in their health and well-being.
2.4Provide a variety of opportunities for older people to access a nutritionally balanced diet, both in their own homes and in social settings, and to promote the importance of meal times in reducing social isolation and loneliness.
3. Nutrition and Health
3.1 Food and ageing
The appetite and food intake of older people can be affected by a variety of factors including physical disability; mental wellbeing; drug-nutrient interactions and socio-economic factors such as an inability or lack of desire and motivation to prepare and cook food; physical access to food and affordability.[i]
As part of the ageing process, there are changes in body composition (such as a decrease in muscle mass); a reduction in functional ability; diminished sense of taste and smell and a reduced ability to chew food. These changes impact individually and collectively on a person's ability to meet their nutritional requirements.
In addition, as ageing occurs, the metabolic rate decreases resulting in a reduction in energy requirements. The requirement for energy continues with increasing age as muscle stores diminish and physical activity declines. This can mean that essential nutrient requirements are not met, leading to a greater likelihood of malnutrition occurring.[ii]
Food and eating bring structure to a day and facilitate social interaction as well as providing essential energy and nutrients. Loneliness, social isolation and depression have been identified as predominant sociological factors leading to a decreased appetite and reduced food intake.[iii]Lone older men have been highlighted as a particular concern - without partner or spouse they are more likely to have reduced social networks, less awareness of services and how to access them, and crucially less understanding of how to shop and cook for a balanced diet.[iv]
3.2 Malnutrition
Malnutrition is essentially ‘bad nourishment’. The term malnutrition refers to both undernutrition and overnutrition. Malnutrition occurs when a person’s diet does not contain enough nutrients to meet the demands of their body and this can be apparent in an overweight or underweight adult. Malnutrition increases the risk of illness and early death and can contribute to a range of poor health outcomes including anaemia, diabetes, cardiovascular disease and bone disorders such as osteoarthritis; osteoporosis and osteomalacia.ii Older people may become malnourished gradually if poor health begins to affect their ability to feed themselves properly. Malnutrition then, in turn, makes their health worse.
The European Nutrition for Health Alliance (2006) estimates that more than 10% of people aged 65 years and over are malnourished and much undernutrition in the UKgoes unrecognised and untreated.[v] It is estimated that 40% of older people admitted to hospital are either malnourished or are at risk of malnourishment.[vi] Malnutrition is frequently undiagnosed in older people who are living at home as the clinical signs can appear late and may present as a sudden illness such as pneumonia.ii
The ILC report of March 2010 highlights a correlation between changes to the eligibility criteria for meals on wheels across the country, and the resulting reduction in the numbers of meals delivered in the last ten years with an increase in undernutrition levels.[vii]
The BAPEN’s Malnutrition Universal Screening Tool (MUST) can assist in identifying those at risk of malnutrition.[viii] It assesses if a person is at low, medium or high risk of malnutrition and enables services to be tailored to better meet their needs before they become malnourished. For example they can have help with shopping, opening packages or receiving meals on wheels. The potential for increasing its use within the community through a variety of agencies can be explored as part of the work programme attached to this strategy.(see section 8).
3.3 Fluid intake
Adequate fluid intake can be a significant issue for older people. Many older people suffer from dehydration due to factors such as a decreased awareness of thirst, forgetting to drink regularly and fear of incontinence. Dehydration can exacerbate conditions such as constipation and can adversely affect kidney and liver function.[ix]
3.4 Alcohol
The Hampshire Alcohol Strategy 2011-15 directly connects the use of alcohol by older people with issues identified in the Ageing well in Hampshire Older People’s Well-Being Strategy 2011-14, such as social isolation and chronic loneliness. The motivation for older people to drink may be fuelled by factors such as the need to keep warm, to aid sleep or simply for enjoyment. However, the potential impact on diet is significant. Alcohol can compromise the nutritional status of an individual in a number of ways: It can cause the body to excrete fat at a higher rate than normal; it can alter metabolism and inhibit the ability to absorb nutrients; older people can forget to eat or drink sufficient water when using alcohol.
4. Population forecasts
By 2016 the number of older people in Hampshire is projected to rise to 20% of the population. The greatest rise will be in the number of over 85s (from 2.9% in 2010 to 3.4% in 2016), often referred to as the ’older old’.
During the same period the number of those suffering with dementia will also increase, with the related difficulties of ensuring a nutritionally balanced diet is available and consumed..
5. Nutrition for those at risk of losing their independence
The need for good nutrition is important to all older people in the community, those living independently as well as those requiring support from Adult Services. This prevention and early intervention strategy must ensure the needs of the most vulnerable are met through its more coordinated approach. The ILC report of March 2010 recommends for both economic and social reasons, that access to a balanced nutritionally complete diet is prioritised as part of an older person’s care package, so that the incidences of malnutrition are reduced.
6. Summary
In the light of the population projections for Hampshire andthe known vulnerability of older people living in the community to malnutrition, there is need for a coordinated and strategic approach to eating well in older life.
Outlined below are eight priorities to develop over the next three years to provide more sustainable county wide services and a network of locally based activities that older people can access. The specific timescales are included in the Ageing well in Hampshire Older People’s Well-Being Strategy 2011-2014 action plan, which is updated annually.
7. Identified priorities
- Community Meals Service
- Meals on wheels
A new meals on wheels service model is due to start from April 2013, which will ensure it will play its part in providing good nutrition. The service will be available to older people over the age of 55 years.The new meals on wheels service plans to develop options for the provision of tea and breakfast meals as it is recognised that older people, especially with a reducing appetite, often take in essential nutrients from snacking throughout the day.
An organised marketing and publicity campaign will support the launch of the new service as part of Hampshire’s prevention and early intervention service.
The providers of the meals will be following the National Association of Community Care (NACC) nutritional guidelines. This ensures that the meals meet the specific nutrition requirements for older people.
- Development of volunteer-led Meals Support Service
The service is required to address the social aspects of good nutrition and to provide more social interaction with older people both in their homes and in the community to create the warm and friendly atmosphere conducive to eating well. Furthermore this service will train volunteers to become a source of wider knowledge for the older person, to keep them linked into their local community and reduce feelings of isolation and inability to cope.
- Health and Adult Services
To explore how, through closer joint working between Health and Adult Services, signs of malnutrition and dehydration can be more easily identified in older people living at home and support appropriate actions.
To consider the feasibility and usefulness of using the MUST malnutrition tool in Hampshire.
- Provision of Information
In order to raise awareness of the value of eating well, specifically designed information for older people will be produced/purchased. It will be made available in a variety of formats to ensure it is readily accessible across the county, for use via statutory and voluntary partnership organisations.
- Shopping
To work withthe existing community transport schemes around the provision and promotion of affordable and accessible transport to shops, to enable older people to choose and purchase their own food.
To explore ways that community computer classes can use internet shopping to support house bound older people.
- Cookery classes
Using the Age UK Fit as a Fiddle model to develop a sustainable structure of cookery courses across the county. This will enable people to learn how to cook simple nutritious meals and provide an opportunity to make friends and become part of their local community.
- Exercise and nutrition
Recognising the importance of regular exercise in maintaining good nutrition, the existing Better Balance for life (BBFL) exercise programme will be promoted through the meals on wheels service and community luncheon groups.
Nutrition information will be introduced into the BBFL community exercise training programme.
- Community eating
To develop, with statutory and voluntary sector partners, imaginative ways of expanding the range of opportunities for social eating for example pie and pint clubs, buddying with neighbours, Extra Care Housing dining rooms etc. To ensure transport requirements are integral to the planning process.
- Intergenerational activities and skills sharing
To use the existing intergenerational schools network to develop “skills swap”projects around cooking skills and gardening.
To work with schools to explore the potential for inviting older people to share in their meal times.
9. Conclusion
By developing a more coordinated approach to nutrition within the community there is an opportunity to reduce the incidence of poor nutrition, malnutrition and dehydration within the older population of Hampshire. This will have a positive impact on the health and well-being of older people, and delay their need for more intensive health and social care.
1
Appendix 1
For further information, see
Alexandra Burn
Hampshire County Council Older People’s Well-Being Team
September ,2011
Amended May 2012
Appendix 2 References
Sections 3.1 to 3.3 written by Jeanette Keyte, Public Health, NHS Hampshire
1
[i] The Caroline Walker Trust (2004) Eating Well for Older People. St Austell: The Caroline Walker Trust
[ii] Jones J, Duffy M, Coull Y, Wilkinson H. (2009) Older People Living in the Community – Nutritional Needs, Barriers and Interventions: a Literature Review: The Scottish Government [online] Available at:
<Accessed 24.05.2012>
[iii] Donini LM., Savina C., Cannella C. Eating habits and appetite control in the elderly; the anorexia of ageing. International Psychogeriatrics, 15 (01), pp. 73-87
[iv] NHS Choices (2011) Malnutrition – causes [Online] Available at: <Accessed 24.05.2012>
[v] The European Nutrition for Health Alliance (2006) Malnutrition among Older People in the Community: Policy Recommendations for Change [Online] Available at: <Accessed 24.05.2012>
[vi] The British Dietetic Association (2011) Mind the Hunger Gap National Campaign [Online] Available at:
[vii]The International Longevity Centre –UK (2010) Personalisation, Nutrition and the Role of Community Meals [Online] Available at: <Accessed 24.05.2012>
[viii] BAPEN (2006) Malnutrition Universal Screening Tool (MUST) [Online] Available at: <Accessed 24.05.2012>
[ix] NHS Choices (2011) Dehydration [Online] Available at: <Accessed 24.05.2012>