Dietitians New Zealand Embraces the Challenge to Improve Nutrition in Ageing
  • Older people (65+ years) sustain about 37% of health loss in New Zealand despite making up only 12% of the population. Changes are needed for older people to maintain their independence and quality of life, and increased emphasis on improving the diets of older people is a key priority.
     
    Once the poor cousin to other clinical dietetic specialties; dietitians in New Zealand have embraced changes to improve the nutritional health of older people. Dietitians work in various capacities of prevention services.
     
    Private practice dietitians have been established in the aged care sector since the mid-1980s to 1990s. Although aged residential care facilities are not funded specifically for in-house dietetic services, dietitians offer a comprehensive service to those facilities including:

    1. Menu auditing and planning.  Dietitians New Zealand has a validated menu audit tool to audit menus against Health and Disability Sector standards and to provide ideas for improvement.

    2. Guidelines for the nutrition management of nutrition-related conditions.

    3. Nutrition assessment and interventions for residents with specific nutrition needs, such as malnutrition and enteral feeding.

    4. Staff in-service or training including food safety, food and nutrition issues and clinical topics for nurses and caregivers.

    5. Assistance to implement policies, such as nutrition screening, protected meal times, food control plans.

    6. Help with kitchen design, staffing levels, equipment selection.

    To facilitate networking Dietitians New Zealand formed a Special Interest Group for Nutrition in Gerontology (SING) in 2004. SING publishes quarterly newsletters for its members, where new practice initiatives are highlighted. To raise the profile of Dietitians New Zealand working in the setting, a quarterly e-bulletin is also distributed to over 600 aged care facilities. This features a main topic of interest to the sector (for example, recent changes to the food safety law, oral health, nutrition screening) and a large scale recipe. SING liaises with other health professionals working in older peoples health and similar organisations*, both nationally and internationally (* International Academy on Nutrition and Aging, Gerontology dietitians USA, NAGE UK).
     
    Gerontology nutrition is encompassed by dietitians working in District Health Board funded services including rehabilitation, psychogeriatrics and in the community. Innovations include the Senior Chef programme geared towards providing older people with skills to cook healthy meals, and knowledge of their nutritional needs. Developed using evidence-based research, Senior Chef embraces the social aspect of eating together, and classes share a meal. The Canterbury District Health Board team of
    dietitians who developed this programme has also developed “Seniors Eating Well”; well received by independent living older people. The Hawke’s Bay District Health Board has developed a programme called Eat & Enjoy, for independent living older people in the community. Led by a dietitian, Eat & Enjoy involved workforce development of aged care workers, nutrition screening, presentations to community groups and Senior Chef courses.
     
    Complementary to Dietitians New Zealand, the New Zealand Nutrition Foundation has established a Committee for Healthy Ageing, with a high membership of dietitians. The committee seeks to promote Positive Ageing by co-operating with groups with similar goals and interests in all sectors, especially the food industry, encouraging incorporation of positive images of older people in food advertising. It undertakes activities to increase the knowledge and awareness of health professionals, care providers and the older people themselves towards the nutritional and physical activity needs of this group. Publication and distribution of a quarterly e-Bulletin focuses on current topics of interest to stakeholders.
     
    Research to improve the health of older people actively employs dietitians. Life and Living in Advanced Age: a Cohort Study in New Zealand is a longitudinal study started in 2010. Detailed assessment of food and nutritional intake in this study provides a unique opportunity to understand the trajectories of health and wellbeing with advancing age. Postgraduate research undertaken by dietetic students engaged in university training programmes, has also provided the opportunity to grow the body of evidence to address nutritional needs of older people in community, hospital and residential care settings. The Ministry of Health Food and Nutrition Guidelines for Healthy Older People were developed by dietitians with expertise in gerontology nutrition. It is hoped that the work of dietitians will provide an evidence base for policy advice in the near future.
     
    Carol Wham
    Dietitians New Zealand