Dietician warns malnutrition of elderly could increase during COVID-19 pandemic

Malnutrition will kill more aged care residents than COVID-19 unless homes mitigate the effects of lockdowns and social distancing, a dietician says.

"We may be looking at a scenario in which residents avoid COVID-19 but succumb to malnutrition, and that would be a tragedy,” Bond University’s Dr Cherie Hugo said.

“Research shows that isolation and loneliness increase malnutrition risk amongst the elderly.

"If homes aren’t acting right now to prioritise the importance of food during COVID-19 restrictions, we will see malnutrition rates rise well above 50 per cent of the aged care population over the next three months."

Dr Hugo is a Semester Teaching Fellow in nutrition and dietetics at Bond University and the founder of The Lantern Project, which aims to improve the quality of life in aged care through the joy of food.

She said aged care homes can flatten the curve with COVID-19 and malnutrition by respecting the importance of the food, nutrition and mealtime experience for residents during lockdown.

The Lantern Project is working to share simple ways aged care homes and loved ones of aged care residents can contribute to reducing malnutrition risk.

“We have researched this space over the past eight years with increased awareness and seen homes making great changes across their food, nutrition and mealtime experience.

"It’s just imperative that particularly during times of crisis like COVID-19, that we prioritise active measures around food and nutrition.”

These are a few of the ideas The Lantern Project is encouraging aged care homes to consider:

Mealtime tips

• Rearrange dining areas to limit two residents per table. Consider staggering mealtimes to allow residents to eat in smaller groups.
• If the home is restricting movement of residents from their rooms, there are great examples of creatively positioning residents in their room doorways with tables for meals and activities to see and engage from a distance with other residents in the surrounding hallway rooms.
• Look to minimise all clinical activities at scheduled mealtimes to ensure food intake is optimised. All staff should be on deck to assist with meal setup and support.
• Encourage all residents, including those on texture-modified diets, to have both a snack and a drink at morning tea, afternoon tea and supper. A poor appetite increases the importance of including midmeal snacks and drinks.
• Consider ways to offer a hot breakfast option daily for residents. Appetites are generally best at breakfast time and research is pointing to spreading quality protein options over breakfast, lunch and dinner daily.
• Consider midmeal smoothies for residents who enjoy milk-based, fruit smoothies. They are a great way to offer extra protein, calories, fluid, fibre and Vitamin C during lockdown.
• Vary fresh fruits for added appeal and cut into easy to enjoy pieces to encourage intake.
• Consider boosting nourishing fluid intake by offering hearty soups at both lunch and dinner ahead of the main meal over the coming months.
• Staff to assist all residents with dementia with hand washing prior to mealtimes. 
• Now is the time to engage with your aged care dietitian to respond most effectively to any residents deemed at heightened risk of malnutrition. Weight is not the only indicator for malnutrition.
• Encourage families to share a Family Facetime or Family Zoom meal with residents who are isolated in rooms. Train staff to position and connect devices as part of the mealtime setup and remotely connect during the mealtime.

Social engagement tips

• Shift language in homes from “social distancing” to “physical distancing”. There are many creative ways to socially engage without working in close proximity and social connection is imperative for overall wellbeing. Diversional therapists and occupational therapists are armed with a wealth of ideas – tap into these ideas now.
• Capture residents' favourite recipes. The Lantern Project is about to launch a national competition across homes for families to engage with their loved ones in this space.
• For residents who have a mobile phone, practice using videocalling (Facetime, WhatsApp, Messenger, CareApp) to add a new dimension to the daily phone call. Encourage grandkids to connect more readily as part of their work from home school activities during periods of isolation. Share old family photos or the grandkid’s artworks as points of discussion on the phone during conversation. Speech pathologists have shared that residents with speech difficulties will often concentrate more and increase their effort to communicate when video calling is displaying – an opportunity to connect and strengthen communication too.
• Encourage family, residents and staff to trial CareApp which is being offered for free during the crisis.
• Residents can read their favourite childhood stories over the phone or videocall to children who may be homebound, or children to practice reading with residents. 
• Set up a Facetime choir across the home or across multiple homes where residents can join in a singalong online. 
• Consider making the most of limited visits by sitting in outdoor garden spaces, if and where available.
• Consider offering all interested residents a pot plant to care for in their room. Connecting with nature, with something as simple as caring for an indoor plant, can offer joy, purpose and may improve wellbeing.
• Consider setting up speaking exchanges during this period of isolation – connecting with a resident to teach or learn a new language.
• Activity can help appetite but will be limited during lockdown periods. Here are some reputable links to simple exercises for room-bound residents (from page 35 onwards) - https://hfwcny.org/wp-content/uploads/Otago_Exercise_Programme-Revised.pdf
• Play noughts and crosses using some coloured tape on an external glass door or window and white board markers. An opportunity for grandkids to connect with grandparents or fellow residents to play together without physical contact. 
• Yale’s Free Online Course on Happiness – look for ways you and your residents may access and focus on this above Netflix, overconsumption of the News and Social media.
• Take residents through the virtual museum tours or encourage families and residents to share a virtual tour together. Here are 10 of the world’s best virtual museum and art gallery tours.