Nutrition, Aging the Food Code - nehca.org€¦ · Nutrition for Aging •Follow the DASH eating pattern or MyPlate •Enjoy whole grains, fruits, vegetables, and low‐fat dairy

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Nutrition, Aging & the Food Code

NHCAAssisted Living Administrators TrainingPresented by Kim Lassen, RDN, LMNT

2017

Objectives

• List the nutrition care goals for older adults• Identify barriers to adequate nutrition in older adults

•Determine whether dietary recommendations negatively affect quality of life/disease diagnosis

•Evaluate food safety practices in compliance with NE Food Code

•Dining TrendsAdapted from

www.nutrition411.com

Malnutrition in Older Adults

0 20 40 60 80

Hospital

NursingHome

Community

Rehabilitation

Well nourished

At risk of Malnutrition

Malnourished

91%

38%

67%

86%

Kaiser et al. Clin Nutr 4 (suppl 2): 113; 2009

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Physiological Changes Associated with Aging

•Changes in body composition – muscle, bone, fatoLose lean body mass & water

oSkeletal muscle, smooth muscle & muscle that affects organs

oBody fat increasesoBone density decreasesoDigestive process slows

•Decline in immune system•Changes in gastrointestinaI tract •Dental problems•Sensory losses

Adapted fromwww.nutrition411.com

Other Issues for Older Adults

•Eating alone•Changes in support system and/or environment

•Polypharmacy


Nutrients of Concern for Older Adults

•Fluid•Calories•Protein•Fat•Fiber

•Folate•Vitamin B12 and D

•Calcium•Zinc


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Energy & Nutrient Needs

•Water

•Energy•Protein•Whole grains and fiber‐rich foods

•Fat•Vitamins and minerals


Health Concerns of Older Adults

•Cancer•Heart Disease•Hypertension•Diabetes•Osteoporosis

•Macular Degeneration/vision problems

•Arthritis•Alzheimer’s disease


Common Nutrition‐Related Diseases in Older Adults

Vision problems

•Cataracts ‐ thickening of eye lens•Macular degeneration ‐ deterioration of center of retina, which is responsible for straight‐ahead vision

•Antioxidants in foods may be protective against vision loss


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Arthritis

•Osteoarthritis ‐ cushioning cartilage in joint breaks down

•Rheumatoid arthritis ‐ disease of the immune system with painful inflammation of joints

•Overweight can affect arthritis



Alzheimer’s Disease

•A healthy diet can help promote brain health

•Research on a connection between diet and Alzheimer’s disease is ongoing

•MIND diet may help prevent Alzheimer’s disease• Protective foods: berries, leafy greens and other vegetables, nuts, beans, whole grains, fish poultry, olive oil, wine

• Foods to limit: red meat, butter/margarine, cheese, pastries and sweets, fried and fast food



Osteoporosis• Loss of bone density, resulting in fractures•More common in women than men•Diet and exercise can help treat osteoporosis, but may not prevent it in older adults


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Calcium Sources

•Bok choy•Broccoli•Calcium‐fortified juices and cereals

•Canned fish with bones

•Cottage cheese•Fortified soy beverage•Kale•Milk

•Yogurt


Promoting Bone Formation(all ages)

•Participate in weight bearing activities•Avoid smoking

•Consume calcium‐rich foods or supplements

•Consume adequate vitamin D


Calcium Requirements


AgeCalcium(mg/day)

Equivalent(dairy servings/day)

9-18 years 1300 mg four

19-50 years 1000 mg three

51+ years 1200 mg-Female1000 mg-Male

four

mg=milligram

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Vitamin D Requirements


AgeEquivalent

(IU/day)

19-50 years 600 IU

51-70 years 600 IU

71+ years 800 IU

IU=international unit

Eating Patterns Recommended for Older Adults

Several similar dietary recommendations exist for disease prevention and for management of chronic diseases:

•Dietary Guidelines for Americans

•My Plate

•My Plate for Older Adults

•DASH Eating PlanAdapted from

www.nutrition411.com

Dietary Guidelines

•Scientific general nutrition guidelines•Published every 5 years•Apply to healthy people over age 2

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• Balance calories to manage weight

• Increase some foods:• Fruits and vegetables• Whole grains• Lean meats, seafood, and other protein foods

• Reduce some foods:• Sodium• Saturated fat and trans fats• Added sugar and refined grains

• Build healthy eating patternshttp://health.gov/dietaryguidelines/2015/guidelines/

MyPlate

http://www.choosemyplate.gov/

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DASH Eating Pattern

•Dietary Approaches to Stop Hypertension•A diet pattern that meets the Dietary Guidelines for AmericansoHigh in fruit & vegetables oLow in saturated fat oLow in sodiumoHigh in potassiumoHigh in fiber


Nutrition for Aging

•Follow the DASH eating pattern or MyPlate

•Enjoy whole grains, fruits, vegetables, and low‐fat dairy products daily in recommended portions

•Exercise at least 30 minutes most days of the week

•Consume fortified foods – for calcium, vitamin B12 & vitamin D

ofortified cerealsodietary supplements


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Nebraska Assisted Living Food & Nutrition Regulations

A Discussion about diabetes…

NCS/RCS, NSA, Low sugar

There is no evidence to support prescribing diets such as "no concentrated sweets“ or "no sugar added" for older adults living in health care communities, and these restricted diets are no longer considered appropriate.

Most experts agree that using medication rather than dietary changes to control blood glucose, blood lipid levels, and blood pressure can enhance the joy of eating and reduce the risk of malnutrition for older adults in health care communities.

Position of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities.

J Am Diet Assoc. 2010.08.022

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Current Recommendations

Elderly nursing home residents with diabetes can receive a regular diet that is consistent in the amount and timing of carbohydrates, along with proper medication to control blood glucose levels.

The nutrition care plan should include education about appropriate food choices for managing diabetes.

Position of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities.

J Am Diet Assoc. 2010.08.022

The Controlled Carbohydrate Diet (CCHO)or Consistent Carbohydrate Diet

• Limits the amount of carbohydrate provided during meals and snacks

•Follows a regular diet as closely as possible

•Has little or no restrictions which is especially important in the elderly

The Controlled Carbohydrate Diet Continued

•Emphasizes the total amount of carbohydrates rather than the source

• Is prescribed for those with diabetes to aid in maintaining normal blood sugar levels

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The Controlled Carbohydrate Diet and the Elderly in Long‐Term Care

•The main goal is to encourage the elderly to eat.

•Diets that restrict food choices may result in weight loss, poor nutrition and poor quality of life.

Portion Control

1 Computer Mouse1 Small Baked Potato

1 Tennis Ball1 Medium Fruit

Average Woman’s Fist3/4 Cup Cereal

1 Hockey Puck½ Bagel

1 Light Bulb½ Cup Ice Cream

1 YO-YO½ Cup Cooked Cereal

Portion Control

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Nebraska Assisted Living Food & Nutrition Regulations

The Food Code: What’s it all about?

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What is the FDA Food Code?

•Safeguard public health• reference guide for the food industry•Model for FDA to promote uniform implementation of national food regulatory policy among several thousand food establishments

•a model for state and local food statutes, regulations, and ordinances as well as licensing, inspection, and enforcement activities

•Establishes standards for management and personnel, food operations and equipment and facilities

FDA Food Code

•Updated every 4 years•Constantly evolving as science and policy change

•States choose when they adopt•2013 Food Code released inNovember 2013

•NE follows 2009 code

http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm374275.htm

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NE Food Code

Chapter 1 – Purpose & DefinitionsChapter 2 – Management and PersonnelChapter 3 – FoodChapter 4 – Equipment, Utensils and LinensChapter 5 – Water, Plumbing and WasteChapter 6 – Physical FacilitiesChapter 7 – Poisonous or Toxic MaterialsChapter 8 – Compliance and Enforcement

http://www.agr.ne.gov/regulations/foods/09_food_code.pdf

•Safe•Unadulterated•Honestly Presented

NE Food Code

Key aspects of NE Food Code

•Person In Charge (PIC)‐Proper Reporting & Demonstration of Knowledge

•Cold Holding 41°F or less

•Hot Holding at 135°F or greater

NE Food Code

Key aspects of NE Food Code (cont.)•No bare hand food contact of RTE foods for highly susceptible population

•Proper Cooling Time and Temperatures of Cooked Foods (TCS)

•Food & Preparation for Highly Susceptible Populations

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Symptom Reporting to PIC

Symptoms:

• Vomiting,

• Diarrhea,• Jaundice,• Sore throat with fever,• Lesion containing pus or draining, infected wound

* unless lesion can be covered by finger cot & single use glove or on area of body protected by an impermeable cover.

Diagnosis of:

• Norovirus,• Hepatitis A virus,• Shigella,• Enterohemorrhagic or shiga toxin‐producing E.Coli,

• Salmonella Typhi * time frame parameters are given for each diagnosis.

Food Employee or Conditional Employee shall report certain symptoms or diagnosis to the PIC

Highly Susceptible Populations (HSP):

"Highly susceptible population"means PERSONSwho are more likely than other people in the general population to experience foodborne disease because they are:

• (1) Immunocompromised; preschool age children, or older adults; and

• (2) Obtaining FOOD at a facility that provides services such as custodial care, health care, or assisted living, such as a child or adult day care center, kidney dialysis center, hospital or nursing home, or nutritional or socialization services such as a senior center.

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Age Makes A Difference!2011 US Foodborne Estimates

Source: CDC 2011. http://www.cdc.gov/foodnet/factsandfigures.htm

0

0.5

1

1.5

2

<5 5-9 10-19 20-64 65+Ca

se:F

ata

lity

Ra

tio

Age Group

Deaths

© 2016 Ecolab USA Inc. All rights reserved. Used with Permission, Ecolab St. Paul, MN

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U.S. Foodborne illness estimates (annually) 48 million cases The equivalent of sickening 1 in 6

Americans each year. 120,000 hospitalizations 3,000 deaths The USDA estimates that foodborne

illnesses cost $15.6 billion each year.

Who’s at risk? Older adults residing in nursing homes are

ten times more likely to die from bacterial gastroenteritis than the general population

Our changing immunity

AgePeople with cancerPeople with diabetesTransplant recipientsPeople with HIV/AIDS

Food Safety Today in the U.S

http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets

http://www.cdc.gov/foodsafety/outbreaks/index.html


http://www.foodsafety.gov/risk/olderadults/index.html

Guidelines to follow for HSP:

•No bare hand contact with RTE foods.

•Time cannot be used alone as a health control measure (temperature must also be used).

• Juice must be pasteurized

Guidelines for HSP (continued):

•No raw or undercooked foods and no raw sprouts.

•Pasteurized eggs or egg products should be substituted for unpasteurized shell eggs in foods such as Caesar salad, meringue, hollandaise sauce, and other foods where raw eggs are used but may not be fully cooked.

*Exception: shelled eggs combined for immediate service if cooked to 145°F and served immediately.

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CDC Contributing Factors to Foodborne Illness

USA 2014, Reported data

Source: CDC http://www.cdc.gov/foodsafety/pdfs/foodborne‐

outbreaks‐annual‐report‐2014‐508.pdf

Improper Holding, 22.7%

Poor Personal Hygiene, 26.9%

Contam. Equipment/Environment,

11.7%

Inadequate Cooking, 15.2%

Unsafe Source, 17.3%

Other, 6.3%


Norovirus Annual burden of illness

#1 cause of acute gastroenteritis

# 2 cause of hospitalization

# 4 cause of death

Annually, contributes to: > 50,000 hospitalizations > 500 deaths, mostly among the young and older adults

Norovirus exhibits strong winter seasonality. 80% of outbreaks occur between November and April Also known as winter vomiting disease

Source: http://www.cdc.gov/norovirus/php/illness-outbreaks.html..


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Settings of Norovirus Outbreaks, US, 2009‐2013 (n=3,960)

Source: Vega, et al. 2014 J. Clin Micro 52:147.

Child Care Centers1%

Correctional facilities

1%

Cruises, Vacation

3%

Hospitals4%

Long term care facilities

62%

Parties & events5%

Restaurants10%

Schools6%

Unknown8%


Kitchen Sanitation Inspection Form

www.nutrition411.com(CMS inspection form is in Nutrition Management Section Blank Foodservice Forms Kitchen/Food Service Observation CMS Form 20055)

Full version provided at end of handouts

Other Resources/References:

FDA Employee Health and Personal Hygiene Handbook

http://www.fda.gov/food/guidanceregulation/retailfoodprotection/industryandregulatoryassistanceandtrainingresources/ucm113827.htm

National Restaurant Association’s Servsafe® Program

www.servsafe.com

Iowa Extension – Assisted Living & Food Safety

http://www.extension.iastate.edu/Publications/PM2038.pdf

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Food Code Questions?

Great Expectations…Trends in Dining

Aging Population

•By 2030, 20% of the population will be 65 and older with accelerated growth in the 85+ population

•By 2050, 88.5 million Americans will be 65 and older

•Seeing a trend of 80+ years old moving back to Midwest to be with family

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Nebraska’s Aging Population

Aging Creates Need for Assisted Care

Changing role of women as caregivers• 20% in workforce in 1915•Women are now the majority of the workforce in the USA: 51% of managerial and professional jobs

• 70% of American women with children under 18 are earning a paycheck while raising their children

Continued increase in older people who live alone•Women outlive men•Higher divorce rates•More people who don’t marry

Why Assisted Living?

Emerging way to make healthcare more affordable•Cost per‐diem averages about 2/3 of cost of equivalent room in nursing home

Increased net worth of older people• Increased ability to afford assisted living

Source: Claitas, Inc. (Demographics firm)

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Food Service Expectations

•Baby Boomers will demand specialty foods and restaurant style varietyBetter educated, more money, more sophisticated

•Will spend money of self‐focused comfort

•Shopping Mall ExpectationsEverything under one roof

Foodservice Expectations

•Choice, choice, choice!!!• Increased demand for better taste, texture, flavor and variety

•Spa‐style cuisine menusOrganicVegetarianAntioxidant‐rich meals


•Ala Carte Dining •Concept Restaurants• International CuisineMore diverse dinerWell‐traveled diner

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Dining Ambiance• Linen•Fine china, glassware, flatware•Upscale atmosphere•Controlled seating


High Quality Foods•Pastries, Desserts•Fresh meats and fish•Fresh vegetables, salads•Grilled meats•Gourmet Coffee •Specialty Coffees ‐ Cappuccino

Comfort Foods still important


Increased Wellness Trends•Heart Healthy, Low Cholesterol, Low Sodium

Accommodation of Special Diets• Liberalized menus•Sodium and Fat Controlled•Sugar Free Desserts•Nutrition Counseling Available

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Restaurant Style Service•Trained, professional staff•Executive Chef in residence

Accommodations for Guests and Catered Family Events

Flexible meal times

Room Service

Keys to Meeting “Great Expectations”

Demonstrate that you care about and will respond to resident preferences

•Surveys – families and residents•Comment Cards•Resident Involvement through a food council

Keys to Meeting “Great Expectations

Keep menu interesting•Try new recipes• Introduce new items with flair•Variety is important• Incorporate theme meals or events

Strive for Consistency•Standardized Recipes•Consistent preparation methods

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Meeting “Great Expectations”

Presentation is Key•Appearance of food on plates•Cleanliness of china, utensils and dining area

•Hot food Hot! Cold Food Cold!•Garnishes that are attractive and edible•Menus – formalized, printed•Menu Boards – not handwritten

Meeting “Great Expectations”

Create and Maintain a Professional Staff•Appearance is Key

•Uniforms•Hygiene•Name Tags

•Formalize training of wait staff

Meeting those “Great Expectations”

Market Your Dining Service•Kitchen Tours•Recognize special events in resident lives –birthdays, etc.

•Work with Marketing Staff •Sample meal for prospective residents•Special Events•Sample menus in marketing packets

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Are You Ready for the Challenge?

Thank You! Questions?

[email protected]

402‐421‐5245

Documents

Nutrition, Aging the Food Code - nehca.org€¦ · Nutrition for Aging •Follow the DASH eating pattern or MyPlate •Enjoy whole grains, fruits, vegetables, and low‐fat dairy