Nutritional status and its consequences in low level aged care: implications for aged care accreditation standards and guidance.

Across Australia and the world, populations are ageing, due to reduced fertility rates and increased longevity. For governments, this raises concerns about how a dwindling labour force will be able to support the health and care needs of older citizens. Although most older Australians live in the community, any rise in numbers of older Australians, particularly those with disability and disease, will increase demand for and spending on aged care services. Under-nutrition in the elderly in care greatly increases the risk of adverse health and psychological effects for the individual and contributes to higher costs for homes and governments. In Australia, a relatively high prevalence of under-nutrition in aged care has been reported over the past 30 years and even after the introduction of care standards in Australia, this prevalence has not changed. The studies conducted for this thesis aim to examine nutritional status in elderly people living in low level aged care, and to determine how nutritional status in elderly in low level aged care relates to physical functioning, immune function and mortality as well as to explore the role of accreditation standards in addressing nutritional risk in elderly in low level care. The findings confirm the high prevalence of under-nutrition in low level care, with 64% of participants having two or more indicators of under-nutrition with one of the contributory factors being a dietary offering that did not meet recommended dietary intakes for a number of essential nutrients. The findings also indicate a relatively high prevalence of sarcopenia and loss of muscle strength and that this is associated with poorer physical functioning. Poor dietary intake also resulted in weight loss and this was associated with either a move to higher levels of care (with concomitant higher expenditure for care) or with mortality. Some markers of nutritional status were also found to be associated with immune status and immune status related to mortality in this group. The aged care facility practices, particularly relating to the food service, are a predictor of nutritional status. Accreditation standards are meant to ensure quality of care but in this study, they failed to sufficiently ensure a high standard of nutrition. A number of factors were found to explain this, including lack of prescriptive standards, poor staff knowledge and attitudes, very stringent budgetary constraints, and a general failure to perceive the importance of nutrition as a part of clinical care. Recommendations for addressing the identified issues, drawing on a number of overseas studies, are presented for consideration.