Optimal nutrition is fundamental to supporting quality of life and encouraging the best possible health outcomes in the aged care population.
Undernutrition is generally more of a concern than over-nutrition in this population group and therefore restricted diets are not recommended for the aged unless absolutely necessary.
The prevalence of diabetes is increasing, with diagnosis more frequent in older adults (>65yrs).
Reports show that 25% of residents in aged care facilities have a diagnosis of Diabetes.(6)
Diabetes is a condition where the body is unable to control the level of glucose in the blood. High levels of glucose in the blood stream over a period of time can lead to complications.
These complications include blindness, kidney and heart disease, strokes. Glucose is however, an essential energy source for the body, and therefore needs to be included in the diet in moderation.
Glucose is classified as a carbohydrate. The carbohydrate group includes sugar, starch and fibre. Examples of carbohydrate foods are breads and cereals, rice, pasta, potato, dairy, fruit, cakes, biscuits, soft drinks, juices. These all break down to form glucose.
The management of diabetes in RACF’s is becoming less prescriptive, with evidence showing that a more liberalized diet has no negative impact on diabetes management, including BGL control, and may reduce malnutrition risk.(4)
The priority for diabetes management in aged care is to achieve a balance between controlling BGL’s and promoting quality of life for residents. It is recommended that added sugar be included in the diet in moderate amounts for all residents alike.
Evidence suggests that the unnecessary restriction of carbohydrate foods can not only place residents at increased risk of malnutrition and associated consequences such as infections and pressure injuries but can also impact on their social and emotional health.
It is suggested that the menu provide good variety, including adequate amounts of protein, kilojoules (kcals), vitamins and minerals to meet the overall nutrition needs of the residents.
The following points outline the recommended dietary goals for residents in aged care with diabetes.
A separate diabetic menu is not required.
- Consume regular meals and snacks throughout the day, including consistent amounts of carbohydrate with each meal. Examples might include (a) offering oats at breakfast, pasta/rice/potato/sweet potato/wholemeal bread etc with lunch and evening meals. (b) offering fruit/yoghurt/sandwiches/ cakes/biscuits for snacks. Snacks can be an important source of energy and nutrients for those residents who consume only small meals and are at risk of weight loss. Not all residents with diabetes are at risk of low BGL’s, however if they are prone to low BGL’s overnight, residents may also need a late night snack.
- Incorporate a “low glycaemic index” carbohydrate as part of each meal. The GI is a measure of how quickly or slowly a carbohydrate food is digested. Low GI foods are absorbed more slowly and therefore result in slower increases in BGL’s . Examples of foods that are absorbed more slowly include wholemeal breads, oats and sweet potato, milk and yoghurt.
- Added Sugar does not need to be avoided. Inclusion of sugar in jams, honey or 1 teaspoon in tea/coffee and in regular desserts is unlikely to impact greatly on BGL levels provided it is added in moderation. The exception is when residents consume these foods in excess. Foods with large amounts of added sugar including soft drinks and lollies will have a negative impact on BGL’s. In these situations, low joule or diet options may be more appropriate.
- Low fat foods are not recommended. Encourage unsaturated fat and oils where possible. Full fat foods help to maintain nutritional status.
- Fortify foods for those residents at risk of malnutrition. For example, add extra protein and fats to foods in the form of butter, cream, cheese and milk powder.
- Encourage high fibre foods. These foods slow down the release of glucose in to the blood stream, assisting with balancing BGL’s, and also help regulate bowel function.
Offer residents wholemeal cereals and breads, offer cut-up fruit, add legumes to soups.
- Encourage 2 pieces of fruit each day. While fruit contains some natural sugar it is also high in fibre and nutrients such as vitamins, minerals and antioxidants. As for all residents, it forms part of a healthy diet but should not be eaten in excess.
- Encourage 5 serves of vegetables each day as part of a healthy diet to assist with vitamin, mineral, antioxidant and fibre intakes.
- Encourage 3 serves dairy each day. Dairy is generally a low glycaemic food and provides good amounts of protein and also calcium, to assist with maintaining bone health.
- Encourage appropriate amounts of fluid each day including water where possible. As above, if consumed in small amounts/ moderation, juice, cordials and soft drinks should not have a negative effect on BGL’s.
- Being overweight can have a negative effect on BGL control. Referral to an APD Dietitian for individual advice is encouraged.
In the same way, where a resident’s BGL’s are difficult to control, they may require a more regulated amount of carbohydrate with each meal and would benefit from a consult with an APD Dietitian to develop a more individualized plan.
In conclusion, for those residents in aged care facilities who have diabetes and have well controlled BGL’s, a regular diet with moderate amounts of added sugar included, should not have a negative impact on their BGL control.
- South Australia, Healthy Eating & Diabetes: A Guide for Aged care facilities published in 2012.
- Healthy Eating for Older People with Diabetes, Diabetes Australia – NSW, 2004
- Position of the American Dietetics Association: Liberalisation of the diet perspective improves quality of life for older adults in long term care, JADA, 2005.
- Olivia Farrer et al, Systematic review of the evidence for a liberalised diet in the management of diabetes mellitus in older adults residing in aged care facilities, Diabetes Research and Clinical Practice, vol 108, Issue 1, April 2015, pages 7-14. (www.flinders.edu.au/sohs/fms/sites/nutrition_and_dietetics)
- Prevalence and management of diabetes in residential aged care facilities in north-east Victoria, Australia, Australian Family Physician, vol45 no.12. December2016, pages 908-911 (http://racgp.org.au/afp/2016/december/)
- Olivia Farrer, Aged Care Menu Guidelines for Diabetes, powerpoint, (www.flinders.edu.au/sohs/fms/sites/nutrition_and_dietetics)