Letting our guard down on food and nutrition during COVID restrictions could easily lead to a more deadly long-term crisis, writes Ngaire Hobbins.
With this dreadful virus having killed so many worldwide, it might seem sensational to speak of more deadly consequences ahead. But the impact of malnutrition is already real and it will escalate if we don’t put it clearly in our sights.
There are many things aged care providers can put in place right now to avoid its potential impact. In Australia, aged care providers have done a fabulous job keeping COVID-19 out of their homes.
I am devastated for those homes, residents, families and staff impacted because we all care deeply for residents and I know just how hard aged care staff work.
Where it has been kept at bay, and even in homes where an outbreak has occurred, the majority of residents and staff have remained safe.
And that has happened in large part because visitor restrictions have been put in place. But those same essential restrictions leave us with a dilemma. Their potential legacy is malnutrition with all its insidious consequences.
There’s a mistaken belief that achieving adequate nutrition is all about cooking great food. That’s part of it, but eating is about so much more than what is on the plate. Appetites are made or broken by how people feel and how they are treated.
Before COVID-19, visitors brought in treats and special foods, took residents out for family occasions, to cafes for a change of scene and assisted at mealtimes. They also provided distraction, social connection, exercise classes, outings and entertainment.
The value of the resulting activity, interest and variety cannot be understated. Malnutrition’s consequences are commonly underestimated. It has immense impacts on quality of life driving ongoing physical and cognitive decline, lethargy and apathy.
It is also often albeit unintentionally hidden in cause of death reporting. When muscle atrophy leads to a catastrophic fall, cause of death may be recorded as head trauma. When it contributes to dysphagia, death from aspiration pneumonia may result or when it reduces healing capacity in pressure injury, death from sepsis is the finding.
Numerous research studies cite loss of muscle, weight loss or low body mass index with increased incidence of death from heart failure, stroke and more. The European Society of Parenteral and Enteral Nutrition recently published research showing malnutrition increases mortality and morbidity in COVID infection.
At the end of life, eating must cease but preventable malnutrition must not be allowed to accelerate that end or to inflict suffering before then.
The quality indicator for unplanned weight loss acts as a proxy in identifying potential malnutrition. It’s valuable, but it’s a lag indicator.
It’s up to aged care management and every individual staff member to focus on doing everything possible to keep those in their care eating well, not losing weight and getting as much joy from every meal, drink and snack as possible right now.
The Aged Care Quality and Safety Commission recently offered guidance to providers in Aged Care Quality Bulletin #17 including:
- screen regularly for malnutrition using a validated screening tool: designating responsible staff member(s) and increasing weight monitoring where necessary
- maintain dietitian contact ensuring prompt referral, especially on screening and facilitate access face to face with appropriate infection control, remotely or in a designated meeting space on site
- ensuring the dining experience is a good one for all, with staff on high alert for any signs of reduced intake and ready with strategies to assist as necessary.
Preventing malnutrition in aged care is about good food of course, but food cannot be nutrition unless it gets eaten and that is where the impact of visitor restrictions may come in.
Providers are doing lots to compensate for restrictions. But until we can safely reintroduce such flexibility, providers and all staff must keep variety, quality and nutritional adequacy of meals at top of mind to ensure we are not left with a devastating long-term crisis we could have avoided.
Ngaire Hobbins is an Accredited Practising Dietitian and aged care consultant.
This article appears in the current edition of Australian Ageing Agenda magazine