1. Improving Resident Nutrition and Reducing Supplement Needs PACAH 2015

2. Goals for today A. Examine Nutrition TRENDS among the elderly in America B.Think about SUPPLEMENT USAGE in the long term care setting C. Consider ideas to implement a FOOD FIRST approach

3. Aging in America The elderly population in the United States is growing. The population 65 and over has increased from 35.9 million in 2003 to 44.7 million in 2013 (a 24.7% increase) and is projected to more than double to 98 million in 2060. (Administration on Aging)

4. Facts about Older Americans Persons reaching age 65 have an average life expectancy of an additional 19.3 years (20.5 years for females and 17.9 years for males). (Administration on Aging)

5. Nutrition Snapshot It is estimated that more than 22% of the population over the age of 65 is malnourished. Malnutrition in the elderly is often not recognized or diagnosed. (Nestle Nutrition Institute, MNA website)

6. ( (Furman,, E.F. Journal of Gerontological Nursing.) Elderly in the Community: 5 – 10% are malnourished. Elderly in the Hospital: 60% are malnourished. Elderly in Long Term Care: 35 – 85% are malnourished

7. Causes of Malnutrition Physical Aspects of aging Social Situations Depression Medical Conditions Financial Concerns Hospitalization

8. What’s your Go-To approach? Is it a Food First Approach? VS

9. Are supplements evil? Or are they good?

10. Step up to a Better Dining Experience

11. 1.Assess the Individual 2.Upgrade the Dining Program 3.Implement Quality Food Programming Steps to Success

12. Food Preferences Food Texture Personal Schedule Eating Environment Assess the Individual

13. The Dining Room Why is a Well Designed Dining Room Program so important? Greater choice Greater attention from staff Socialization Lighting & atmosphere Staff observation and cues Staff notices declines faster Food can be served in “courses” Seconds & alternates are more available Better able to eat with family & visitors “Copy - cat” : people eat more when they see others eating. Positioning improves

14. Need for Assistance Impact of Medications Medical Conditions & Pain Assess the Individual

15. Borun Center for Gerontological Research

16. Isolation Helplessness Boredom Grief & Loss Assess the Individual

17. 1.Assess the Individual 2.Upgrade the Dining Program 3.Implement Quality Food Programming Steps to Success

18. Upgrade your Dining Program What’s HOT What’s NOT!

19. Upgrade your Dining Program Decentralization Greater Food Availability More Food Choices Staff Crossover Hot…

20. Upgrade your Dining Program Medical Model Assigned Seating Limited Choices Strict Meal times Limited areas of access to food

21. 1.Assess the Individual 2.Upgrade the Dining Program 3.Implement Quality Food Programming Steps to Success

22. Always Available Menu For your dining pleasure… Puree Program Fortified Foods Program Finger Foods Program Menu Alternates Quality Food Programming

23. Puree Food Program “We saw a dramatic increase in our resident’s food consumptions. The nursing staff also really enjoyed telling the residents what they were eating.”

24. Puree chocolate peanut butter delight Puree lasagna, garlic bread and spinach

25. Fortified Foods Regular Mashed Potatoes 120 calories, 2 g protein Fortified Mashed Potatoes 252 calories, 9 g protein Regular Oatmeal 150 calories, 5 g protein Fortified Oatmeal 534 calories, 9 g protein Whole milk 150 calories, 8 g protein Fortified Milk, 218 calories, 19 g protein

26. Variety Eye Appeal Soup to Nuts Nutritional Density Finger Foods Core Concepts

27. Finger Foods make Eating Easier

28. Alternative Dining Selections Menu

29. Special Food Events

30. Summer Crab Bake!

32. Special Food-Related Events Like Cookouts and Farmer’s Markets

33. Chef Displays, Dining Discoveries and Cooking Classes

34. Holidays, Special Events and Themed Meals

35. Taste Test Time! Chicken Salad Sliders Chocolate Peanut butter Pudding