nutrition, aging the food code - nehca.org...nutrition for aging •follow a health eating pattern...

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Nutrition, Aging & the Food Code

Nebraska Healthcare AssociationAssisted Living Administrators TrainingPresented by Kim Lassen, RDN, LMNT

2018

Objectives

• List the nutrition care goals for older adults• Identify barriers to adequate nutrition in older adults

•Determine whether dietary recommendations negatively affect quality of life/disease diagnosis

•Evaluate food safety practices in compliance with NE Food Code

•Dining Trends

The Role of Nutrition

Our nutrition needs change throughout our lifespan.

1. Prevention – encourage healthy eating to prevent disease

2. Risk Reduction – slow progression of chronic disease with nutrition to maintain quality of life

3. Therapy – Medical Nutrition Therapy to manage chronic disease

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Physiological Changes Associated with Aging

•Changes in body composition – muscle, bone, fat‐Lose lean body mass & water

‐Skeletal muscle, smooth muscle & muscle that affects organs

‐Body fat increases‐Bone density decreases‐Digestive process slows

•Decline in immune system‐slows‐compromised by nutritional deficiencies

Physiological Changes Associated with Aging

•Changes in gastrointestinaI tract ‐loses strength & elasticity‐hormone secretions change‐digestion slows‐can be compromised by nutritional deficiencies

•Dental problems‐tooth loss‐denture fit

•Sensory losses

Other Issues for Older Adults

•Eating alone•Changes in support system and/or environment

•Polypharmacy

•Financial Issues

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Malnutrition in Older Adults

0 20 40 60 80

Hospital

NursingHome

Community

Rehabilitation

Well nourished

At risk of Malnutrition

Malnourished

91%

38%

67%

86%

Kaiser et al. Clin Nutr 4 (suppl 2): 113; 2009

Consequences of Malnutrition

•Unintended weight loss•Dehydration• Infections•Pressure ulcers•Anemia

•Hypotension•Delayed wound healing• Increased incidence of hip fractures•Confusion/impaired cognition

Nutrients of Concern for Older Adults

•Fluid•Calories•Protein•Fat•Fiber

•Calcium•Vitamin D

•Vitamin B12

•Potassium

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Fig. 1

Journal of the American Medical Directors Association 2013 14, 542-559DOI: (10.1016/j.jamda.2013.05.021)

Protein Needs for Older Adults

Journal of the American Medical Directors Association 2013 14, 542-559DOI: (10.1016/j.jamda.2013.05.021) Copyright © 2013 American Medical Directors Association, Inc.

Protein Metabolism slows with age

Protein Needs of Older Adults

• [Healthy] elderly require 1.0‐1.2 g/kg BW high quality protein daily to maintain / gain muscle

•Requirement may be 1.2‐2.0 g/kg BW for repletion

•Adequate [quality] protein intake per meal is important

•25 – 30 gram / meal target / threshold

•At a minimum, main high‐protein meal at midday

Health Concerns of Older Adults

•Cancer•Heart Disease•Hypertension•Diabetes•Osteoporosis

•Macular Degeneration/vision problems

•Arthritis•Alzheimer’s disease

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Common Nutrition‐Related Diseases in Older Adults

Vision problems

•Cataracts ‐ thickening of eye lens•Macular degeneration ‐ deterioration of center of retina, which is responsible for straight‐ahead vision

•Antioxidants in foods may be protective against vision loss

•Zinc may help slow the progression of age‐related macular degeneration


Arthritis

•Osteoarthritis ‐ cushioning cartilage in joint breaks down

•Rheumatoid arthritis ‐ disease of the immune system with painful inflammation of joints

•Overweight can affect arthritis•Decreased physical function can make it difficult to prepare food or use utensils

•Pain meds can cause GI disturbance


Alzheimer’s Disease

•A healthy diet can help promote brain health

•Research on a connection between diet and Alzheimer’s disease is ongoing

•MIND diet may help prevent Alzheimer’s disease• Protective foods: berries, leafy greens and other vegetables, nuts, beans, whole grains, fish, poultry, olive oil, wine

• Foods to limit: red meat, butter/margarine, cheese, pastries and sweets, fried and fast food

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Osteoporosis• Loss of bone density, resulting in fractures•More common in women than men•Diet and exercise can help treat osteoporosis, but may not prevent it in older adults

Calcium Sources

•Bok choy•Broccoli•Calcium‐fortified juices and cereals

•Canned fish with bones

•Cottage cheese•Fortified soy beverage•Kale•Milk

•Yogurt

Promoting Bone Formation(all ages)

•Participate in weight bearing activities•Avoid smoking

•Consume calcium‐rich foods or supplements

•Consume adequate vitamin D

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Calcium Requirements

AgeCalcium(mg/day)

Equivalent(dairy servings/day)

9-18 years 1300 mg four

19-50 years 1000 mg three

51+ years 1200 mg-Female1000 mg-Male

four

mg=milligram

Vitamin D Requirements

AgeEquivalent

(IU/day)

19-50 years 600 IU

51-70 years 600 IU

71+ years 800 IU

IU=international unit

Diabetes

Research shows carbohydrates presented as sugars or starches are absorbed at similar rates in the elderly• No evidence to support “no concentrated sweets” or “no sugar added”

Changing medication dosages is more beneficial than a restricted diet

Monitor blood glucose levelsPosition of the American Dietetic Association:

Individualized Nutrition Approaches for Older Adults in Health Care Communities. J Am Diet Assoc. 2010.08.022

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Diabetes Current Recommendations

Elderly residents with diabetes can receive a regular diet that is consistent in the amount and timing of carbohydrates, along with proper medication to control blood glucose levels.

The nutrition care plan should include education about appropriate food choices for managing diabetes.

Position of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities.

J Am Diet Assoc. 2010.08.022

Diabetes Guidelines

•Offer a variety of nutrient dense foods using appropriate portion sizes (as with everyone)

• Individualize glycemic, blood pressure and lipid goals

•Achieve and maintain body weight goals

•Preference for carbohydrate from vegetables, fruits, whole grains, legumes and dairy over carbohydrate foods that contain added fats, sugar and sodium

Controlled Carbohydrate Diet (CCHO)

• Limits the amount of carbohydrate provided during meals and snacks

•Follows a regular diet as closely as possible

•Has little or no restrictions which is especially important in the elderly

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Controlled Carbohydrate Diet (CCHO)

•Emphasizes the total amount of carbohydrates rather than the source

• Is prescribed for those with diabetes to aid in maintaining normal blood sugar levels

Nebraska Assisted Living Food & Nutrition Regulations

Eating Patterns Recommended for Older Adults

Several similar dietary recommendations exist for disease prevention and for management of chronic diseases:

• Dietary Guidelines for Americans• My Plate• My Plate for Older Adults

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Dietary Guidelines

•Scientific general nutrition guidelines•Published every 5 years•Apply to healthy people over age 2

• Balance calories to manage weight

• Increase some foods:‐Fruits and vegetables‐Whole grains‐Lean meats, seafood, and other protein foods

• Reduce some foods:‐Sodium‐Saturated fat and trans fats‐Added sugar and refined grains

• Build healthy eating patternshttp://health.gov/dietaryguidelines/2015/guidelines/

MyPlate

http://www.choosemyplate.gov/

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Nutrition for Aging

•Follow a health eating pattern •Enjoy whole grains, fruits, vegetables, and low‐fat dairy products daily in recommended portions

•Exercise at least 30 minutes most days of the week

•Consume fortified foods – for calcium, vitamin B12 & vitamin D

‐fortified cereals‐dietary supplements

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Nutrition Care Goals

1. Maintain good health through medical care

2. Promote quality of life

3. Prevent weight/muscle mass loss

Nutrition Screening in Assisted Living

•Potential to identify those most likely to benefit from intervention and prevent transfer to more expensive care

• Lack of regulations•Screening not embedded into process

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Portion Control

1 Computer Mouse1 Small Baked Potato

1 Tennis Ball1 Medium Fruit

Average Woman’s Fist3/4 Cup Cereal

1 Hockey Puck½ Bagel

1 Light Bulb½ Cup Ice Cream

1 YO-YO½ Cup Cooked Cereal

Portion Control

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Nebraska Assisted Living Food & Nutrition Regulations

The Food Code: What’s it all about?

What is the FDA Food Code?

•Safeguard public health• reference guide for the food industry•Model for FDA to promote uniform implementation of national food regulatory policy among several thousand food establishments

•a model for state and local food statutes, regulations, and ordinances as well as licensing, inspection, and enforcement activities

•Establishes standards for management and personnel, food operations and equipment and facilities

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FDA Food Code

•Updated every 4 years•Constantly evolving as science and policy change

•States choose when they adopt•2013 Food Code released inNovember 2013

•NE follows 2009 code

http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm374275.htm

NE Food Code

Chapter 1 – Purpose & DefinitionsChapter 2 – Management and PersonnelChapter 3 – FoodChapter 4 – Equipment, Utensils and LinensChapter 5 – Water, Plumbing and WasteChapter 6 – Physical FacilitiesChapter 7 – Poisonous or Toxic MaterialsChapter 8 – Compliance and Enforcement

http://www.agr.ne.gov/regulations/foods/09_food_code.pdf

•Safe•Unadulterated•Honestly Presented

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NE Food Code

Key aspects of NE Food Code

•Person In Charge (PIC)‐Proper Reporting & Demonstration of Knowledge

•Cold Holding 41°F or less

•Hot Holding at 135°F or greater

NE Food Code

Key aspects of NE Food Code (cont.)•No bare hand food contact of RTE foods for highly susceptible population

•Proper Cooling Time and Temperatures of Cooked Foods (TCS)

•Food & Preparation for Highly Susceptible Populations

Symptom Reporting to PIC

Symptoms:

• Vomiting,

• Diarrhea,• Jaundice,• Sore throat with fever,• Lesion containing pus or draining, infected wound

* unless lesion can be covered by finger cot & single use glove or on area of body protected by an impermeable cover.

Diagnosis of:

• Norovirus,• Hepatitis A virus,• Shigella,• Enterohemorrhagic or shiga toxin‐producing E.Coli,

• Salmonella Typhi * time frame parameters are given for each diagnosis.

Food Employee or Conditional Employee shall report certain symptoms or diagnosis to the PIC

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www.statefoodsafety.com/

Highly Susceptible Populations (HSP):

"Highly susceptible population"means PERSONSwho are more likely than other people in the general population to experience foodborne disease because they are:

• (1) Immunocompromised; preschool age children, or older adults; and

• (2) Obtaining FOOD at a facility that provides services such as custodial care, health care, or assisted living, such as a child or adult day care center, kidney dialysis center, hospital or nursing home, or nutritional or socialization services such as a senior center.

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Age Makes A Difference!2011 US Foodborne Estimates

Source: CDC 2011. http://www.cdc.gov/foodnet/factsandfigures.htm

0

0.5

1

1.5

2

<5 5-9 10-19 20-64 65+Ca

se:F

ata

lity

Ra

tio

Age Group

Deaths

© 2016 Ecolab USA Inc. All rights reserved. Used with Permission, Ecolab St. Paul, MN

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U.S. Foodborne illness estimates (annually) 48 million cases The equivalent of sickening 1 in 6

Americans each year. 120,000 hospitalizations 3,000 deaths The USDA estimates that foodborne

illnesses cost $15.6 billion each year.

Who’s at risk? Older adults residing in nursing homes are

ten times more likely to die from bacterial gastroenteritis than the general population

Our changing immunity

AgePeople with cancerPeople with diabetesTransplant recipientsPeople with HIV/AIDS

Food Safety Today in the U.S

http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets

http://www.cdc.gov/foodsafety/outbreaks/index.html


http://www.foodsafety.gov/risk/olderadults/index.html

Guidelines to follow for HSP:

•No bare hand contact with RTE foods.

•Time cannot be used alone as a health control measure (temperature must also be used).

• Juice must be pasteurized

Guidelines for HSP (continued):

•No raw or undercooked foods and no raw sprouts.

•Pasteurized eggs or egg products should be substituted for unpasteurized shell eggs in foods such as Caesar salad, meringue, hollandaise sauce, and other foods where raw eggs are used but may not be fully cooked.

*Exception: shelled eggs combined for immediate service if cooked to 145°F and served immediately.

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CDC Contributing Factors to Foodborne Illness

USA 2014, Reported data

Source: CDC http://www.cdc.gov/foodsafety/pdfs/foodborne‐

outbreaks‐annual‐report‐2014‐508.pdf

Improper Holding, 22.7%

Poor Personal Hygiene, 26.9%

Contam. Equipment/Environment,

11.7%

Inadequate Cooking, 15.2%

Unsafe Source, 17.3%

Other, 6.3%


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Norovirus Annual burden of illness

#1 cause of acute gastroenteritis

# 2 cause of hospitalization

# 4 cause of death

Annually, contributes to: > 50,000 hospitalizations > 500 deaths, mostly among the young and older adults

Norovirus exhibits strong winter seasonality. 80% of outbreaks occur between November and April Also known as winter vomiting disease

Source: http://www.cdc.gov/norovirus/php/illness-outbreaks.html..


Settings of Norovirus Outbreaks, US, 2009‐2013 (n=3,960)

Source: Vega, et al. 2014 J. Clin Micro 52:147.

Child Care Centers1%

Correctional facilities

1%

Cruises, Vacation

3%

Hospitals4%

Long term care facilities

62%

Parties & events5%

Restaurants10%

Schools6%

Unknown8%


Kitchen Sanitation Inspection Form

Full version provided at end of handouts

https://www.cms.gov/Medicare/Provider‐Enrollment‐and‐Certification/GuidanceforLawsAndRegulations/Nursing‐Homes.html

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Food Code Questions?

Great Expectations…Trends in Dining

Aging Population

•By 2030, 20% of the population will be 65 and older with accelerated growth in the 85+ population

•By 2050, 88.5 million Americans will be 65 and older

•Seeing a trend of 80+ years old moving back to Midwest to be with family

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Quality Dining Programs are Essential!

•90% say foodservice is among the most important factors when choosing a facility

•Meals are a large part of the daily social time

•Focus on Hospitality – emphasizing your residents EXPERIENCE with food service

•Utilize well established training programs

•Purposeful Health•Be aware of changing senses

Generational Tastes

The Silent Generation (1945 & before)

Simple & Traditional• 3 areas of the plate• Roasts (Beef, Turkey, Pork), Meatloaf, Mashed Potatoes, Simple Veggies

Baby Boomers (1946‐1965)

Traditional & Global flavors • Fish & Seafood• Global: Chinese, Mexican

• BBQ Food

2017 Foodservice Director Magazine


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Food Service Expectations

•Baby Boomers will demand specialty foods and restaurant style varietyBetter educated, more money, more sophisticated

•Will spend money of self‐focused comfort

•Shopping Mall ExpectationsEverything under one roof

•Choice, choice, choice!!!• Increased demand for better taste, texture, flavor and variety

•Health Conscious

Foodservice Expectations

Increased Wellness Trends•Heart Healthy, Low Cholesterol, Low Sodium

Accommodation of Special Diets• Liberalized menus•Sodium and Fat Controlled•Sugar Free Desserts•Nutrition Counseling Available


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•Flexible hours/access•Concept areas:Coffee ShopsBistrosGrab & Go

• International CuisineMore diverse dinerWell‐traveled diner

•Comfort Foods still important


Dining Ambiance• Linen•Fine china, glassware, flatware•Upscale atmosphere•Controlled seating


Restaurant Style Service• Trained, professional staff• The appeal of food begins with its appearance & service

Accommodations for Guests and Catered Family Events

Flexible meal times

Room Service

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Keys to Meeting “Great Expectations”

Demonstrate that you care about and will respond to resident preferences

•Surveys – families and residents•Comment Cards•Resident Involvement through a food council

Keys to Meeting “Great Expectations”

Keep menu interesting•Try new recipes• Introduce new items with flair•Variety is important• Incorporate theme meals or events

Strive for Consistency•Standardized Recipes•Consistent preparation methods

Meeting “Great Expectations”

Presentation is Key• Appearance of food on plates Color, Balance, Texture, Shape, Simplicity, Placement

• B.U.F.F. – Culinary Institute of America Balance, Unity, Focal point, Flow

• Cleanliness of china, utensils and dining area•Hot food Hot! Cold Food Cold!•Garnishes that are attractive and edible•Menus – formalized, printed•Menu Boards – not handwritten

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Meeting “Great Expectations”

Create and Maintain a Professional Staff•Appearance is Key

•Uniforms•Hygiene•Name Tags

•Formalize training of wait staff• Eye contact, greeting, introduction

•This is your residents home• Allow residents the right of way• Avoid interruptions

Demonstrate Professionalism

Maintain a Hospitable Environment

Make Residents Feel Important and Appreciated

5 Dimensions of Service

1. Reliability: Make an effort to provide what was promised with accuracy, honesty and dependability

2. Assurance: Demonstrate your knowledge, courtesy and ability to express trust & confidence

3. Tangibles: Ensure physical facilities and personnel look appealing

4. Empathy: Provide a high degree of care and individual attention to each resident

5. Responsiveness: Be willing to help residents and provide timely service

‐Jill Griffin, Customer Loyalty

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Foodservice Outreach

Market Your Dining Service•Kitchen Tours•Recognize special events in resident lives –birthdays, etc.

•Work with Marketing Staff •Sample meal for prospective residents•Special Events•Sample menus in marketing packets

Resources:

Nutrition411.com

FDA Employee Health and Personal Hygiene Handbook

National Restaurant Association’s Servsafe® Program

www.servsafe.com

FoodService Director.com

Are You Ready for the Challenge?

Thank You! Questions?

[email protected]

402‐421‐5245

nutrition, aging the food code - nehca.org...nutrition for aging •follow a health eating pattern...

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