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Nutrition for the Over 65s in Wales, a Food Inquiry

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Friday 18th March 2005, 10am ‚ 1pm Wales Centre for Health, Cardiff

Nutrition is not just about health promotion, but is a serious issue of utmost importance. The nutritional status of older people is crucial to their independence, physical and mental well being and their ability to recover from ill health.

We have seen a steady increase in the older population with the older population itself growing older, who will continue to live primarily in the community and, in the earlier years of retirement, a fair proportion will be relatively self-sufficient. If they are to remain within the community they will come to rely increasingly on outside assistance, with protocols for investment in health gain related to nutrition.

You are warmly invited to attend this informal workshop aimed at policy makers who are able to impact upon improving the nutritional status of those over 65 years. The purpose of the inquiry will be in light of the UK governments Older Peoples Nutrition and Diet Survey (1998) to:

1. Raise the importance of nutrition and diet for continuing health in older age, as highlighted in the UK Older Peoples Nutrition and Diet Survey.

2. Actively support a range of Welsh Assembly Government policies and strategies aligned with protocols for investment in health gain related to nutrition and diet.

3. Consider responses to a small number of questions, for different public bodies, which can be found at Appendix One. An Inquiry briefing paper ëNutrition for the over 65s in Wales A Food Inquiryí ‚ will be circulated to participants in due course.

This invitation only workshop is being organised by the McCarrison Society for Nutrition and Health, the Welsh Food Alliance and Public Health Alliance Cymru; and aims to build upon much recent research, including the last of two national food surveys undertaken by the Welsh Food Alliance, comprising 466 responses. Details of the latter can be found at Appendix Two.

The range of factors influence the dietary intake of older people reflect policy areas of participants invited from different aspects of government in Wales. These can be found at Appendix Three. Aspects include: a range of disabilities, rheumatism, and inadequate dentures (physical); loneliness, institutionalisation, type and location of housing, access to and type of shopping facilities, planning decisions, access to public and private transport, reduced income, access to practical support services (socio-economic); depressive, bereavement, and individual preferences (psychological).

The outcome of the workshop will be made available to participants for comment. The final report will be sent to participants, the Age Alliance and the proposed Public Service Improvement Board to support the development of the five-year action plan.

The input of older people is crucial, since the only way to improve services is by seeing how policy works in practice on the ground, and how it connects in a meaningful way with their difficulties. The final report will therefore inform a further consultation with Older People and their organisations, at a workshop to be held on the 24th June 2005 (See Appendix Four). This will be supplemented by qualitative research in institutional and community settings.

We trust that you will be able to participate in what we hope will be a fruitful inquiry. Correspondence should be sent to Anderley Lodge, 216 Stow Hill, Newport, NP20 4HA. E-mail: - This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Yours sincerely,

Hilda Smith

Hilda Smith
Older Peoples Food Inquiry
Appendix One
Questions to decision-makers: -
In terms of the greater emphasis being placed on keeping people healthy and independent, through initiatives and measures to prevent ill health or other crises which threaten well being and independence; and following the Kings Fund Centreís report: ëA positive approach to nutrition as treatmentí (2002), ëMaking nutrition in hospital: a recipe for quality, the Nuffield Trust (1999), and the Food and Well Being Strategy (2003): -

Welsh Assembly Government
1. There are nutritional requirements within national standards, for example, National Service Frameworks. How are these standards to be achieved within service requirements, and how will they be monitored?

2. What explicit coverage is given in policies and strategies to follow good nutritional practice to prevent ill health and support older people to remain in their own homes?

3. At the (a) local level, and (b) the national level, what operational networks are being encouraged, and developed, and with what evidence base?

NHS Trust Chief Executives
1.There are nutritional requirements within national standards, for example, National Service Frameworks and the NHS Nutrition and Catering Framework, and the Unified Assessment guidance - assessment of nutritional need can be undertaken or prompted by, the District Nurse within the community, or on a ward setting. How are these standards to be achieved within service requirements, and how will they be monitored?

2.To what extent does the concept of nutrition, as a means of promoting and sustaining health, feature in your clinical governance arrangements?

3. If yes, to what extent does this address the needs of older people, in contributing to the prevention of known health risks?

4. In contributing to the prevention of known health risks, what arrangements are in place within acute hospitals and secondary care to meet the nutritional needs of those belonging to other cultures?

 Directors of Social Services
1.There are nutritional requirements within national standards, for example, Creating A Unified and Fair System for Assessing and Managing Care. How are these standards to be achieved within service requirements, and how will they be monitored?

2.To what extent does the concept of nutrition, as a means of promoting and sustaining health, feature in your (a) social care service delivery, care assessment arrangements and Intermediate care arrangements, and (b) commissioning plans or service specifications?

3. If yes, to what extent does this (a) address the nutritional needs of older people, in contributing to the prevention of known health risks, and (b) what arrangements are in place to meet the nutritional needs of those belonging to other cultures?

4. What strategies exist within the provision of Intermediate care services across the health and social care community to include the provision of effective nutrition for older people, as part of integrated intermediate care package?

Chief Executives local Health Boards
1. To what extent are the issues raised in our question to NHS Trusts included in your commissioning frameworks?

2. What mechanisms can you use to allocate budgets for the promotion, awareness raising and monitoring of nutritional issues?

3. What plans do you have to allocate budgets for the prevention of known health risks?

4. In what ways have you considered innovative planning and examples of good practice to promote healthy food?

5. What role is intended for GPs and other primary care contractors such as dentists, who obviously play an important role in early identification of nutritional deficit?

Local Authority Older Peoples Champions and the Older Peoples Strategy Co-ordinators
Nutrition is an excellent place to examine the whole systems approach: -

1. In what way is nutrition a component of the local Strategy for Older People development plan?

2. Has nutrition been brought to the attention of Older Peoples Forums as a discussion item, for example, in the context of intermediate care?

3. Are there any working groups / planning groups looking at for example, nutrition in relation to shopping and transport for older people, and does the membership include, for example, Trading Standards Officers, or Environmental Officers?

In people age from their 60s upwards, the risk of several disorders increases sharply. These include osteoporosis, bone fractures, insomnia, rising blood pressure, stroke, heart disease, certain forms of cancer, depression and neurodegenerative disorders.  Whilst familial history and genetics contribute to risk, such gene related risks cannot be altered at this time. However, adverse nutrition contributes to the cause of all the disorders mentioned.

With much experimental data, epidemiological evidence, several positive clinical trials and the nation-wide success of the health programme in Finland, we need to ask what action is being taken to (a) empower the older people with knowledge to make their own decisions about nutrition and health in those who are able and (b) to support the less able, older people, especially those in hospital, institutions or already suffering from one or more of the nutrition/age related disorders, with nutrition targeting the specific condition.

From 1998, the Welsh Food Alliance have identified and targeted two priority areas for action to improve the: (a) Nutritional status of elderly people, and thereby promote and sustain the independence and (b) the quality of life at home, and Nutritional status of patients awaiting hospital treatment or surgery, and patients discharged from hospital to reduce the risk of readmission
Appendix Two
Older Peopleís Food Survey
This second survey anticipated World Health Organisation advice that "In addition to the human dimension, maintaining the health and functional capacity of the increasing elderly population will be a crucial factor to reducing the demand for and cost of health services"  (November 2003).

We have an ageing population. Food is important to them, and the barriers they face are not reflected in the policy development process. 2000 forms were distributed, primarily through older personís organisations throughout Wales. Of the 466 people responding, 21% lived in a rural area, 25% in a semi-urban area, 40% in an urban area and 14% were unstated.

We do not claim the survey is statistically valid. However, it is a rich source of anecdotal information about the needs of older people, with widely varying circumstances. It helps shine a spotlight on how people have to cope in the absence of basic services. Our findings were as follows.

Practical help and services
They are very sensible and knowledgeable about their dietary needs. As distinct from "more professional guidance" they require practical help and services in accessing affordable good food. 62% thought it difficult to afford a healthy diet. 13% found fish and meat, and 9% fresh fruit and
vegetables as the most expensive food items.

40% found distance from food shops a problem; taxis were expensive and 43% had to rely upon public transport. Surprisingly, only 11% received family help to assist. 63% had difficulty in carrying home heavy items. One respondent said, "Imagine carrying home the required five portions of fruit and vegetables, for one or two people, for seven days a week.

To the question: "do you enjoy other community activities that include a meal church group, or luncheon club", 45% said yes, and 43% said no. But many meet only weekly, or monthly.

Home sweet home
Older people require practical assistance in remaining independent in their own homes, and service provision, that makes this possible. 31% had
difficulties with shopping, preparing, cooking and carrying equipment. Some had family help, others none at all.

Many have difficulty reading labels, opening vacuum packed products, and ëscrew oní top bottles. It is difficult to purchase smaller packs of food. Buying smaller packs and tins costs more! Very many object to ëtwo for the price of oneí - goods they do not need, and cannot carry. Many have transport problems.

Reading labels is an issue. 45% said it was, 51% not. 28% felt the print size was too small.  37% had difficulties obtaining the right size of food item, and 32% had difficulty in using facilities inside shops. 15% mentioned high and low shelves, and 3% disabled access.

ëMeals on wheelsí
Obtaining and carrying home shopping when people are ill, or in inclement weather is a major issue. When asked "Do you have difficulties going out shopping"? 24% said always, 32% in bad weather and 40% when unwell.

We asked ëDo you use ëmeals on wheelsí if so do you like them? 8% responded yes. 63% no and 14% had never used this service.  We also asked "during bad weather / illness would you use meals on wheels if available"? 35% said yes, and 57% said no.

Hospital food
We explored hospital catering, with interesting replies. We identified pockets of good and bad experience. We had 92 positive (21%) and 71 (16%) negative comments. We are very aware that people are unlikely to complain when they are captive consumers. Assessing satisfaction after a hospital experience is therefore recommended.

Feedback from one hospital in Cardiff was good, in another it was poor. A similar pattern emerged in Valley areas, but it was not always clear to which hospital comments referred. Rural areas provided a positive experience. Patient dissatisfaction could arise between different systems, such as cook freeze, cook chill, or prime production for on site consumption; food budgets, food purchasing specifications, poor investment in food service, and staff training. This requires further investigation. (Extract from the Welsh Food Alliance  Newsletter, Volume 3, Issue 3, Summer 2004).

Appendix Three
Our aim is to involve policy makers across all policy areas, including:

1) Making the Connections ‚ delivering better services for Walesí - how do we promote prevention and synergies between public services,
2) National Service Framework for Older People, including the Health Promotion Action Plan for Older Peopleí,
3) 3.National Service Framework for Diabetes,
4) National Service Framework for Coronary Heart Disease,
5) National Service Framework for Mental Health,
6) Strategy for Older People in Wales "Next Steps" conference report,
7) Draft Hospital Discharge Planning Guidance,
8) Healthcare Standards ‚ Standards for NHS Care and Treatment in Walesí
9) Food Standards Agency UK Nutrition Action Plan,
10) Extending national guidance in Creating A Unified and Fair System for Assessing and Managing Care"(April 2002) to include food and drink,
11) Future development of regulation and guidance in Domicilary Care, with reference to nutrition, well being and physical activity,
12) Community and supported accommodation, extra care housing, and service provision, including food, socialisation and well being,
13) The implications for health care regulation of those offering preventive advice.
14) The development national approaches to Expert Patient Programmes in terms of embracing the significance of nutrition and diet,
15) Health and social care occupational frameworks and standards to underpin appropriate nutritional knowledge and understanding to support recovery and promote and support health and well being,
16) Further development in terms of National Minimum Standards for Older People: Regulations and Standards (2002),
17) The next phase of the implementing the Community First programme, and revised guidance for Community First Partnerships,
18) Further refinement and national guidance for the NHS Nutrition and Catering Framework (2002), and
19) The current Inquiry into Mental Health and Well Being of Older People.