Best practice food and nutrition manual for aged care facilities.

Best practice food and nutrition manual for aged care facilities

Bartl R. Bunney C. Central Coast Health, Gosford, 2004, 160 pages. $27.50 (plus $10 postage), ISBN 1-74139-002-8

The title accurately describes the purpose of this book. Firstly, it is a reference 'manual' for those responsible for food and nutrition in aged care facilities. Secondly, through its extensive validation with aged care staff and experts around Australia, it aims to reflect current 'best practice' at the frontline of service.

Visually, it is a beautifully presented, high quality publication, illuminated with photos throughout, not of glossy cookbook food, but of the book's focus and intended outcome, happy aged care residents.

Specifically, the manual was designed to assist staff in aged care facilities to address the food and nutrition issues outlined in the Commonwealth Department of Health and Aged Care 'Standards and Guidelines for Residential Aged Care Services' (1998). This, in itself, makes the manual an essential reference, as there is little support material available to assist aged care staff to address the many issues covered by these standards. It is very easy to read, as evidenced by its succinct, practical advice and suggestions, as well as its useful references and contact numbers at the end of each chapter for further information.

The authors, Bartl and Bunney, are widely known and highly regarded for their progressive work in many areas of public health and community nutrition, including health promotion, child care centres and aged care. This manual is the culmination of many years spent advising and assisting aged care facilities on food and nutrition issues and as such focuses on practice, not theory. Throughout the manual, the emphasis is on ensuring there is sufficient appropriate food provided that meets each resident's individual nutritional, psychological and cultural needs. Part of this approach also includes doing away with the restrictive dietary attitude still espoused by some with respect to fat, sugar, salt and alcohol intake. The manual encourages staff to consider the 'quality of life' issues of each resident when making dietary decisions.

There are 22 short chapters, covering an extensive range of aged care food and nutrition issues including hydration needs, glycaemic index, religious and cultural beliefs, assistive devices, swallowing and food texture, dementia, oral health, tube feeding, resident participation, exercise, as well as food service matters such as menu planning, food safety and dining environment. There are also handy dish and snack lists to provide ideas to assist with menu planning. Sensibly, the authors have avoided providing recipes, referring readers instead to '... the many recipe books available for suitable recipes ...'. The appendices contain a number of very useful templates including the Resident's Food and Nutrition Data Card, Notes for Residents at Risk (based on the MAG screening tool). Tube Feeding Checklist, Nutrition Checklist for Menu Planning and Resident Meal Satisfaction Survey.

The manual's limitations are minor. For example, there is no mention of the food safety risks associated with friends and relatives bringing in food from home. As this is often a sensitive issue to address, perhaps a list of 'safer' foods could have been provided. Also, the very useful Nutrition Checklist for Menu Planning, does not include the preferred recommendation that a high vitamin C food be provided at meals where lower iron foods are offered. In addition, given the reduced appetite and intake of many aged care residents, the recommendation to offer five regular serves of vegetables per day seems unrealistic and could result in unnecessary food waste and displacement of other, more nutrient dense foods. The trend in other aged care services is to reduce the vegetable serve sizes or the total number of serves. The menu cover page is another useful feature described in the manual. The suggestion here would be to also request information on what foods are available to residents at all times.

It would have been useful to include a telephone contact number for the DAA, as only the website was provided. Many aged care staff, especially those working food services, would not necessarily have access to the internet, or in some cases, to a computer.

Like most publications that aim to be current in this rapidly changing environment, there are already a couple of issues that will soon be superseded with new information and requirements, such as food safety programs and dysphagia diets. Nevertheless, the information contained is still relevant and appropriate.

The manual is essentially an adjunct to the Commonwealth standards. It does not replace dietetic or food service expertise as it only provides an essential overview of most topics, some of which may appear simplistic to some health professionals. It is ideal for aged care staff that want a single source of information, in plain English, which will assist them, or prompt them, to address all the food and nutrition related standards and guidelines for aged care. It is very reasonably priced and should be added to the resource list on the web site for the Commonwealth Department of Health and Aged Care.

Maria Kokkinakos

Central Sydney Area Health Service