Inspirational ideas for elderly diners
Care cooks face huge challenges on a daily basis to cater for the varying dietary and medical needs of their residents. According to the 2011 census, there are around 291,000 people aged 65+ living in care homes across the UK and the proportion of care home residents aged 80+ has increased in line with longer life expectancies. Many are suffering from a variety of medical conditions, such as dementia and dysphagia, and care caterers need to adapt their offering accordingly, whilst also providing nutritious and appealing dishes to their elderly diners.
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Mealtimes are the highlight of the day for many care home residents and are an important part of the decision-making process for families when choosing a suitable home for relatives.
YouGov’s Care Home Catering 2015 report states: “If homes are looking to attract future customers they may need to emphasise food more than they do currently. They also need to remember that older people who are currently only visitors may themselves be looking for a home in the not too distant future. Therefore, knowledge of a home’s food through visitor meals/ snacks may translate into an interest in living there later on.”
With malnutrition in care costing England alone £2.6billion per year to treat and care homes paying thousands of pounds in clinical negligence compensation, the importance of fortification has never been more apparent.
Special diets can also have an impact on what the medical profession is describing as the silent epidemic of the elderly – vitamin D deficiency. With poor diet combined with lack of exposure to ultraviolet light being two key factors, people over the age of 65 are considered at higher risk.
Vitamin D is found in just a small number of foods such as oily fish, eggs, as well as fortified spreads, butter and breakfast cereals, and it can be a challenge for caterers to improve intake through diet alone, especially when factoring special diets.
Dairy experts Pritchitts have been working closely with care homes to overcome the daily challenges many chefs face and recently fortified its Millac Gold Double cream alternative with added vitamin D.
Just 100ml of the high performance cream alternative provides 328 calories, and its versatility means it can be used for cooking, pouring and whipping – it whips up to three times its volume providing superior yield – and is suitable for both sweet and savoury dishes.
Themed cuisine days can add interest and encourage people to try something a little different, says Ben Bartlett, chef and Lion Brand ambassador, but don’t stray too far away from the familiar.
He advises: “As summer is here a ‘Residents’ BBQ Day’ would be top of the list for care homes, with traditional favourites for all like beef/chicken/bean burgers, soft baked potatoes, beans, Cheddar cheese and, of course, fresh salad. Very familiar and easy for dietary needs whether it’s fortifying
or using deep dish ‘Dignity’ plates, and great for dementia residents as it brings back nostalgic memories of English summers.”
Similarly, putting on a curry night is a great way to spice up life in your care home dining room.
Says Paul Wright, UFS’ elderly care development chef: “It’s is a great way to create a sense of excitement and occasion around your evening meal – it’s also an appropriate dish for care homes. As we
get older, our sense of taste begins to fade, so cooking dishes with big bold flavours is key to creating dishes residents will enjoy.
“Curries certainly fit the bill in that respect, and they can be easily blended for residents with dysphagia.”
Ready-to-use sauces can also be used to create delicious and nutritious soups.
Roy Shortland, development chef for Dolmio ready-to-use sauces, explains: “For care home caterers, providing varied, nutritious and tasty meals can often be a challenge when catering for the differing needs of residents within the home; as well as having to save on costs without compromising on taste or quality.
“Residents suffering from dysphagia, for example, will be limited to a pureed diet which can often be un-appetising – resulting in rejection, or simply lacking any nutritional value.
“Homemade soup is much-loved and is perfect for residents with dysphagia; but for caterers, making homemade soups can be a time-consuming and lengthy process that requires many types of ingredients and seasoning.
“Fresh, seasonal ingredients can still be added to the base to provide a consistent quality soup which ensures full flavour and value for money – and which, importantly, is sure to be enjoyed by residents.”
Catering for special diets
With the number of consumers battling food allergies and intolerances on the rise, care home caterers must gear up to meet the growing demand for non-allergenic foods – and there is a plethora of ready-made products on the market which cater for a broader spectrum of dietary requirements.
Anna Massie, senior category marketing manager at Macphie, said: “When cooking in a busy residential care home kitchen it’s important to use ingredients that are suitable for a variety of purposes given the diverse needs of residents.
“Ingredients have to be versatile and tolerant to a range of inclusions such as flavours and creams, suitable for dysphagia and soft diets, and also have a high calorific content. Products and ingredients for vegetarians and those with a gluten-free diet are equally important and should be offered each meal-time.”
Mark Lyddy, Tilda’s head of foodservice, adds: “Rice is one of the foods that is least likely to cause allergies. It is easy to digest and is among the first foods suitable for adults who have gluten intolerance or coeliac disease.”
With this in mind, Tilda has created Brown ‘n’ White, which combines the benefits of brown and white rice to help caterers serve up a more healthy rice offering.
As older people tend to have less of an appetite, it’s important to offer regular snack and drinks to avoid dehydration and ensure they are getting their daily intake of calories. The Food Standards Agency recommends that residents should be offered a hot drink and snack mid-morning, for afternoon tea and at bedtime. Snacking suggestions include scones, doughnuts, biscuits, custard tart, soft cheese or jam sandwiches, malt loaf and custard tart, along with a piece of fruit.
Kerrymaid’s nutrition expert Caoimhe McQuaid has teamed up with Matt Dodge – NACC 2015 Care Cook of the Year finalist and head chef at Coombe Hill Manor in Kingston – to share these top tips:
Catering for dementia
- To encourage eating for people suffering with dementia, it is important to cater to all of their senses. Surround them with the smells of bread, strong coffee, fresh herbs and grated lemons to encourage eating
- Be careful not to lay tables with white tablecloths or napkins when serving dementia residents as many suffer with an altered perception of colour and can get easily confused with what’s being placed in front of them
- Try to cook in front or near residents with dementia. The smell of the dish cooking will entice them and encourage eating
- Enhance the dining experience for people suffering with dementia by creating a family dining set-up. Carers should eat at the same time so the focus moves away from people eating with dementia giving them a sense of connection
- To help with food recognition for those suffering with dementia, serve meals on lightly coloured plates – pale colours such as yellow, green and pink work particularly well but avoid white plates
- Because of poor appetite, concentration problems or changes in how food tastes, people with dementia will not always be able to eat a large meal in one sitting. In this instance, frequent and smaller meals may be the answer. Hosting regular afternoon teas are a good idea as smaller cakes and finger foods are more attractive
- Many sufferers of dementia forget to eat and drink so introduce a routine for patients so they eat at the same time every day
- Play music during mealtimes to create an engaging atmosphere. Try playing lively music at breakfast, country and western at lunch and classical music in the evenings
Catering for dysphagia
- People with dementia can also develop difficulty with swallowing, a condition that is known as dysphagia.
If the person is suffering with dysphagia, avoid giving them hard-to-chew foods, such as raw vegetables. Instead, puree cooked vegetables and mix with cream for a safer texture. A dysphagia diet limits foods to certain textures making it safer and easier for patients to swallow; residents are restricted to either a thin purée, thick purée, pre-mashed and fork mashable diet. The two most common in the care environment is thick purée and fork mashable for dysphagia diets
- A dry mouth interferes with chewing and swallowing so think about adding creamy sauces or gravy to meals. The added flavour of sauces and gravy can help stimulate the taste buds and encourage eating
- When making pureed desserts such as trifle or gateaux, serve in glasses and layer them so residents can see the distinctive layers – it is great for recognition but also helpful for effective portion control
Dignity in dining
As part of its industry-leading Healthcare Solutions Programme, Premier Foods have created a number of appetising texture-modified recipes and supporting dietary guidance to help caterers deliver a safe, nutritious and varied diet and to ensure dignity in dining for individuals with dysphagia.
You can download the guide online at premierfoodservice.co.uk/wp-content/uploads/2014/10/Premier_Healthcare _Brochure_11803.pdf