Malnutrition is one of the primary dangers for older adult residents living in long-term care settings. Defined as the state of not having adequate food and micronutrient intake, malnutrition is common among elderly patients and can damage physical and cognitive functioning. Nursing home and assisted living facility staff must protect their patients from inadequate micronutrient intake in order to help maintain their quality of life and avoid increasing their risk of morbidity and mortality. Multiple factors at the patient (e.g., dementia), staff (e.g., training, staffing levels during meals), and home (e.g. quality of meals) levels interact and contribute to the increase in risk of poor food intake. Substantial research has shown that inadequate nutrient density of food is one of the top 10 deficiencies in nursing homes. These facilities must improve their quality of meals in order to promote food intake and enhance nutritional status and quality of life of their patients. Studies that have focused on micronutrient needs for improving the health and quality of life of residents in long-term care have found that even at the meal planning level, much improvement is needed in regards to nutrient density.
Currently, oral nutritional supplements (ONS) are often prescribed for long-term care residents with poor food and fluid intake to treat malnutrition and improve health outcomes. However, the use of this form of treatment in long-term care is costly and promotes “compliance, taste fatigue, and wastage”. Vitamin-mineral supplementation is also used often. Vitamin D supplementation can enhance the health status of older adults living in care facility settings. Yet, this strategy also presents challenges, including more costs to the resident, staff management time, polypharmacy, interactions between drugs and nutrients, and compliance. Moreover, a risk of toxicity also exists and the clinical benefits of single-nutrient supplementation are questionable. Both of these treatments are often used to improve deficiency.
Food fortified with nutrients has been proposed as a “food first” strategy to enhance nutrient intake of long-term care patients and could improve nutrient density in main foodstuffs, without increasing calories. Fortification addresses prevention rather than treatment of nutrient deficiency; therefore, fortification has been studied to evaluate its effectiveness in promoting nutrient density for all elderly residents in long-term care.
A recent study that examined the evidence on micronutrient food fortification methods found that fortification is an effective approach for enhancing nutrient density of foods provided in residential care. In general, vitamin D and calcium were the main micronutrients fortified by using dairy products, margarine, bread, and pureed foods as fortification vehicles.
Staff in long-term care facilities must strive to prevent or treat micronutrient malnutrition in their vulnerable older adult residents. Research has shown that micronutrient content in food can be improved using a fortification approach. This approach may be effective in preventing older adult patients from malnutrition and further physiological decline. If you or a loved one has experienced malnutrition due to the inadequate care of nursing home or assisted living facility staff, such as one in Westlake Village or Whittier, California, contact us today for a free consultation.