Seminars in Ageing: Improving food quality reduces falls, fractures and malnutrition in older adults in aged care

Dr Sandra Iuliano

About the Presenter:

Dr Sandra Iuliano is a nutritionist and internationally renowned researcher from the Department of Medicine at the University of Melbourne. Her work has focussed on food-based approaches to prevent falls, fractures and malnutrition in older adults, specifically those living in aged-care homes. She led a 2-year study that involved over 7000 older adults in 60 aged care homes that demonstrated correcting low intakes of calcium and protein in older adults using milk, yoghurt and cheese resulted in a 33% reduction in fractures, a 46% reduction in hip fractures and an 11% reduction in falls with the intervention being cost-saving for fracture reduction alone. She provided input into the new single framework quality and safety standards for aged care and was summoned to present evidence at the Royal Commission into Quality and Safety in Aged-Care and is a member of the National Aged Care Advisory Council. This work has been pivotal in prompting policy changes in aged care to improve food provision such as the inclusion of nutrition in the new Aged Care Act and the establishment of a Food and Nutrition Quality Standard in Aged Care.  She is a strong advocate for better nutritional care for older adults.

About the Seminar:

Longevity is increasing, but morbidity remains unchanged resulting in a growing proportion of older adults requiring full time assistance in aged care homes. These older adults are often frail with high risk of falls and fractures, with 30% of the community burden of hip fractures arising from aged care homes. Preventing fractures in this high-risk group would likely reduce the community burden of fractures, but any intervention must be effective, safe, and cost saving. Older adults in aged care homes have inadequate intakes of calcium and protein, risk factors for fractures, so correcting these inadequacies may reduce risk of fractures. Milk, yoghurt, and cheese are good sources of both nutrients so improving intact may reduce fracture risk. We tested this notion this over a 2-year period among 7000 residents in 60 care homes, 30 of which included additional milk, yoghurt, and cheese on the menu, while the remaining 30 control sites continued with their usual menus. Dairy intake increased to 3.5 servings daily in intervention residents and was associated with a 33% reduction in fractures, 46% reduction in hip fractures and an 11% in falls. Malnutrition and weight loss were abated with intervention but continued in controls. Compliance with intervention was maintained for two years perhaps as dairy foods are familiar to residents and offerings were based on their preferences. All-cause mortality remained unchanged in intervention residents, so relative to mortality risk the intervention was safe. Malnutrition risk was abated. The cost of the additional dairy foods was $0.66 per resident per day. The study provides evidence to support the provision of high-protein, high-calcium dairy foods to older adults as part of a balanced and nutritious menu in aged care homes and can be used to prompt policy changes in the sector to ensure these types of nutritious foods are available to residents in their care. This food-based strategy was cost-saving to the aged care and health systems but more importantly benefit the older adults living in aged care homes.