Malnutrition in aged care isn’t a problem to be swept under the rug

When Australia’s most recent study on malnutrition rates in aged care was released in July, the findings revealed four in ten aged care residents are malnourished. Public reaction was understandably negative.

This was partly because food and nutrition has been a hot topic of late, with the research coinciding with media discussions about what’s being done to improve it in aged care.

Television programs such as Maggie Beer’s Big Mission are not necessarily helping individual providers when their narrative does not recognise positive outcomes outside of their own initiative. 

Dr Jonathan Foo, the lead author of Malnutrition Prevalence in Australian Residential Aged Care Facilities: A Cross-Sectional Study, wants aged care to understand that progress is being made, however. 

The Monash University lecturer told Hello Leaders that the sector faces massive challenges to improve food and nutrition, yet the research findings reveal improvements are occurring. 

“Although the rate of malnutrition is higher than we would like it to be, it’s lower than other statistics that have been recorded in the past. That’s a reflection on the aged care provider we worked with, they were keen to improve in the food and nutrition space,” he said.

“We know aged care providers all sit on a spectrum and we think they are doing a good job in some areas. So while it is not a great number by any means, it is within the range of what we expected and even a little bit better than some of the statistics out there.”

Overall, the research revealed that of the 711 residents assessed, 40% were categorised as malnourished (34% mildly/moderately and 6% severely). Dr Foo and the report’s fellow authors said this supports the Government’s call for urgent improvement in the quality and quantity of food provided in residential aged care. 

Dr Foo said the policy changes currently moving through from Government to aged care providers are making a difference, but it’s important that extra support is provided. 

“The new Aged Care Act and the Food and Nutrition Quality Standard will be good tools for setting the standard of what providers should be doing and creating accountability,” he said.

“At the end of the day, this comes back to resources. It is a real challenge because money needs to come from somewhere and unless taxpayers or private individuals are putting more money in, we need to think of ways to effectively run this system.”

Incentivising change

As the sector moves closer to the introduction of a rights-based Aged Care Act and detailed Quality Standards that emphasise food, nutrition and the dining experience, Dr Foo hopes the sector is not over-regulated in the nutrition space. 

Instead, he would like to see more incentivisation for preventative health outcomes. 

“If a resident becomes unwell and they need additional assistance then their funding level will go up. The facility will get an additional assessment done, and then receive more funding for that resident. There is no incentive for the facility to keep people healthier,” he added.

“We know from speaking to staff they want to provide high-quality care but unless you align those incentives it’s hard to change organisational approaches.

“There’s some work being done in this space and it’s been talked about but it would be a radical shift to how we fund healthcare in aged care and more broadly in the Australian sector.”

He also urged providers to look past the potential upfront costs of a dietitian. For example, providers can weigh up expenses associated with an initial assessment, compared to the savings made when a resident receives high-quality care and does not require extra care resources in the future. 

Finding solutions to malnutrition

Dr Foo’s team are currently working on a variety of solutions and processes that can help aged care providers tackle malnutrition in aged care. He said approaches such as automatic detection and malnutrition monitoring can reduce the time and resource burden for providers. 

Another solution that he said is essential is introducing an ongoing valid and reliable malnutrition screening instrument for residents.

“A lot of facilities will screen people for malnutrition when they move in. But it doesn’t occur regularly after that. We know people can be healthy for a long period of time and then have a sudden decline. Being able to identify that change is a challenge,” Dr Foo said.

Through early intervention, he said a provider can tap into appropriate care pathways that lead to a specialist or dietitian being brought in at a critical stage. 

Staff education is another crucial element as their research uncovered some low levels of staff knowledge regarding malnutrition and its signs. He said staff need to be aware that it involves much more than a resident being underweight. 

“What we can see on the ground is some care staff will turn around and say ‘This person’s not malnourished. I don’t believe they need help.’ Overcoming this is an important piece of the puzzle: how do we get the staff to buy into a shared understanding of who is malnourished and what we need to do to help that person?”

Ultimately, Dr Foo’s hope is that this research is not swept under the rug and that malnutrition is seen as an urgent problem to solve when it occurs. He said good nutrition has been neglected for too long and we need to continue spotlighting the issue. 

“Let’s keep talking about this. Let’s keep it on the radar so facilities remain accountable and do the right thing for residents.”