Blogs

21 June 2017

Steph Llewellyn, Specialist Speech and Language Therapist, Ambulatory Care for the Older Person (OPAU), Royal Bournemouth Hospital

Steph has shared with her personal experience of being Nil by Mouth for a day as part of Nutrition and Hydration Week 2017.

You can read it in full here

 

17 March 2017

Dr. Faustina Hwang, Associate Professor of Digital Health, University of Reading

The importance of Hydration HEALTH

Most people know the importance of staying well hydrated on a hot sunny day.  However, for vulnerable older adults, ensuring adequate fluid intake day-to-day is key to maintaining mental and physical health and lowering the risk of hospital admission.

A team from the University of Reading has been working in partnership with Perton Manor specialist care home in South Staffordshire to develop Hydration HEALTH (Hydration in Elderly Adults Linked to Temperature and Humidity), a technology-based system which aims to detect risk of dehydration and help care home staff ensure all their clients are drinking enough to stay healthy.

The Hydration HEALTH system monitors the temperature and humidity inside and outside the building as well as the client’s food and drink intake and fluid loss in order to better understand how these factors interact and affect their hydration levels.  The system was designed in collaboration with Perton Manor, and was recently trialed for a week in the specialist care home.  During this pilot study, sensors were installed inside and outside the care home for continuous logging of temperature and humidity, staff used a mobile app to record clients’ food and drink intake throughout a 24-hour period, and six clients gave biological samples to be analysed for biomarkers of hydration.

The project has provided valuable insights about how to design and deploy a hydration-monitoring technology for use in a real-world setting, and has also produced a very rich dataset.  This data is currently being analysed in order to characterise how well the system has worked in practice, and to investigate what features in the data would be most useful for prompting action by care staff.

The project has highlighted the potential benefits of the technology for supporting person-centred care of people with dementia.  Richard Hodgkisson, Nurse Manager, said “Many of our clients are no longer able to verbalise their needs or what they like and dislike.  I would normally need to look across 30 days worth of paperwork to get an overview of their patterns. Having the information available on a computer makes it much easier to tailor for individual preferences.” The project team are discussing possibilities for further developing Hydration HEALTH into a system that could be used in care homes on a regular basis.

Hydration HEALTH is an interdisciplinary collaboration of researchers from the Meteorology, Biomedical Engineering, Food and Nutritional Sciences, and Typography & Graphic Communication Departments at the University of Reading, working in partnership with Perton Manor care home.  We are indebted to the clients who participated in this study and their families.  We also thank the care home staff for their time, participation and support.  This research is supported by an EPSRC Institutional sponsorship grant to the University of Reading.

http://blogs.reading.ac.uk/the-forum/2017/03/16/nutrition-and-hydration-week-the-importance-of-hydration-health/

F O O D: #FishyFriday by @PlainOldPhil
Fish is my main source of protein, hence the reason I love it.

A healthy balanced diet should contain 2 portions of fish a week, one portion of which is oily. Fish is an excellent source of protein, vitamins and minerals. Alongside protein, vitamins and minerals oily fish is a great source of long chain essential omega 3 fatty acids, which can help keep your heart healthy.

White fish – is naturally low in fat and a low source of omega 3 fatty acids.

Shellfish – such as prawns, mussels and scallops are naturally low in fat and a source of selenium, zinc, copper and iodine.

Oily fish – tends be darker in colour such as mackerel, tuna, salmon and trout. Oily fish is high in essential fatty acids (essential meaning we can’t make them in the body so we need to get them from food) and vitamin D – which we could all probably use a little more of in the UK. If you have oily fish with bones such as pilchards, sardines and sprats you will also get calcium and phosphorous.

NOTE: Tinned tuna doesn’t contain essential fatty acids. In the canning process the fatty acids are generally reduced to that of a white fish.

Smoked salmon pate – Quick, easy salmony perfection

If you follow me on Instagram, you’ve probably seen that I regularly eat smoked salmon for lunch. 1) because it is quick but 2) because it is delicious. If you don’t like eating smoked salmon as is, this a great alternative to get the flavour and essential fatty acids in a spreadable form (both my mum and Nathan agree).

Ingredients

150g smoked salmon (I used trimmings because they are cheaper)
150g cream cheese (I choose a dairy free alternative)
2 tablespoons single cream (I used Alpro Soya)
2 stalks dill, roughly chopped (optional)
2 stalks chive, roughly chopped (optional)
½ lemon, juiced
Salt and pepper to season
Step 1 – pop all the ingredients to a food processor and blend until fully combined (the longer you blend the smoother your pate)

Step 2 – plate up and serve with oatcakes or crispbreads

If you prefer plain salmon, swap the smoked salmon for a tin of salmon. This recipe also works well with smoked mackerel so give it a try!

This is how I enjoyed mine – with crispbreads and a fresh salad!

Prawn layered salad

I definitely prefer oily fish and shellfish to white fish. This recipe is for my mum. She was previously buying lunch everyday and trying to pick the healthiest options. She is now getting into the habit of taking lunch to work with her because she understands that she can better control her what goes into her food. This recipe contains 3 of your 5 a day and is packed full of fibrous vegetables to keep you fuller for longer. So here you go mummy, this is a dedication to you.

Ingredients

25g dried wholewheat pasta (cooked according to packet)
50g cooked prawns (I buy frozen because they just needed to defrosted and then they are ready to go)
8 cherry tomatoes (halved)
80g shredded lettuce (I generally use iceberg lettuce or romaine if I’m feeling fancy)
1 grated carrot
½ avocado (if I’m feeling extra optional)
Sauce

1 tablespoon egg free mayonnaise (you can use regular mayonnaise but make sure it is reduced fat if you are concerned regarding your weight)
1 tablespoon tomato ketchup (I used the reduced sugar and salt variety)
Juice of ½ lemon
These portions will depend on the size of your jar. If you only have a small jar reduce the ingredients.

Step 1 – make the dressing by combining tomato ketchup, mayonnaise and lemon juice

Step 2 – Layer:

Cucumber
Cherry tomatoes
Grated carrot
Pasta
Lettuce
If I’m taking my salad in a jar I’ll tend to keep the dressing and prawns separate because at the bottom of the jar I don’t get to enjoy my prawns till the very end.

Step 3 – pop it in the fridge for your lunch the next day. ENJOY!

https://plainoldphil.wordpress.com/2017/03/17/f-o-o-d-fishyfriday/

16 March 2017

Catering at the Countess

Sian Williams Deputy Director of Nursing at the Countess of Chester Hospital.

Our catering team are without doubt real unsung heroes at the Countess of Chester Hospital.

We pride ourselves on having a strong sense of community and compassion in everything we do. The catering team embody these core values with staff that are exceptionally motivated, enthusiastic and always searching for ways to make what is already a treasured service even better.

The extensive menu gives so much choice – five hot and cold options at lunch and four at dinner – and this variety provides the home comforts that make people smile at a difficult time. We are very fortunate that while some Trusts have had to scale back, we continue to offer patients two freshly prepared bespoke hot meals a day made from high-quality local ingredients.

It’s the team’s creativity and meticulous attention to detail that allows them to go over and above the call of duty whilst staying within budget. They really have done the most amazing work for both patients and staff.

Chicken curry Tuesdays have become legendary among our employees, while the commitment to giving every patient a hot meal means the kitchen re-opens to call backs at all times.

They boost clinicians by making it possible for patients to have dinners in the discharge lounge if appropriate – also providing food for carers if needed. This means when a doctor says someone can go home after lunch they can eat in a more relaxing environment, which in turn enables our team to prepare that bed space for someone else.

There is a commitment to caring for patients that goes beyond our walls as well, with packed lunches available for those being transferred elsewhere and parcels of essentials for some patients to take home.

Given all these strings to their bow – with around 2,500 meals being prepared, cooked and delivered every day – it would be reasonable for the team to stay closed off in the kitchen, but that couldn’t be further from the truth.

They frequently visit wards, aiming to answer queries within 30 minutes for patients with extra special dietary requirements. A number of initiatives have also been created to make eating at the Countess more inclusive, with full pictorial menus and dementia-friendly crockery making a real difference.

When a patient recently celebrated her 100th birthday here the team sent cupcakes to the ward, while on the hottest day of the year they sent round free lolly ices to help everyone cool down.

This year for the first time the team is planning for all mothers to enjoy a sit-down meal on the wards with their children on Mother’s Day.

These sound like simple touches, but they make the world of difference when people are stuck in hospital.

I couldn’t be more proud of our catering team. As the rest of our hospital looks for ways to both improve services and become more efficient they are a beacon to follow. They are truly a great credit to the Countess, the NHS and the catering industry as a whole.

http://www.coch.nhs.uk/corporate-information/blogs/blogs/catering-at-the-countess.aspx#content
F L U I D: #ThirstyThursday @PlainOldPhil

You often see me posting on #WaterWednesday how I am keeping my hair and body hydrated throughout the day. This is because I can’t stress the importance of keeping hydrated enough. It is so simple and so beneficial to the body. On a hot day there is nothing better to me than a tall glass of water with chunk ice cubes whilst chilling in the sun. But in the winter (I say winter like we ever get a distinction between autumn, winter and spring in the UK) I turn to a cosy hot drink – herbal tea mainly. Our bodies are nearly 2/3 water and therefore it is an essential element of our bodies. Water is healthy (no calories and no sugar), cheap and has so many health benefits:-

Steering off excess eating
Water is an excellent way of staying hydrated and prevents excess eating. I used to remember how thirsty I was when I was on the drive home snacking on a packet of crisps and I’d be sat in traffic like “dayummmmm my throat is as dry as Ghandi’s sandals”. Then I started drinking a cup of tea before I left work. Yes, I was dying for the loo in the traffic thinking if only I had an empty cup I would pee in the car. But no, I didn’t feel hungry. So those empty calories I was consuming in the form of crisps or chocolate were no more. So before you reach for some food, have a glass of water or a cup of tea and you’ll be surprised how quickly you forget about snacking.

Lack of concentration
When I don’t drink enough I can tell immediately. I have a headache, I become disengaged, have no interest in what people are saying and feel REALLY tired all because I am dehydrated. Try not to get thirsty (if you feel thirsty this generally indicates that you are already dehydrated) by having 1.5 – 2litres of fluid a day. These are only rough estimates and you may need more fluid if you are exercising or in hot weather.

Keeps those bowel movements regular
Most people don’t like to talk about their bowels but in my house its regular, every day conversation (much to the dismay of Nathan) and in my line of work if you are talking about what is going in expect people to tell you what is coming out. Water helps the formation of a soft stool and makes passing a stool easier. So if you are constipated or suffering from discomfort passing a stool try to increase your fluid intake.

https://plainoldphil.wordpress.com/2017/03/16/f-l-u-i-d-thirstythursday/

15 March 2017

Catherine McShane Project manager – Healthcare Undernutrition talks about the new programme tackling social isolation and undernutrition in Darlington.

It makes perfect sense to me that social isolation and undernutrition are both a cause and consequence of each other. Most of us have probably experienced a time when we have lived on our own and needed to cook for just ourselves. Making a meal for one person can be a chore; often we choose something which is quick and far less nutritious than it could be. Thankfully for a lot of us this doesn’t happen that often. Unfortunately, there are people for whom this is an everyday occurrence. Social isolation and undernutrition are major problems in the UK, both affecting 10% of people over the age of 65. It can become a viscous circle where you lose the motivation to cook a nutritional meal for yourself; thereafter weight loss can quickly become a big issue as a result of not eating properly. As you lose weight you lose muscle power and gradually over time become weaker and less able, being motivated becomes even harder and so the cycle continues.

Up to now there have been various programmes to tackle social isolation or undernutrition but these have been done in isolation. County Durham and Darlington NHS Foundation Trust (CDDFT) and Age UK Darlington have taken a new approach by teaming up  to tackle both. We were successful in being awarded Health Foundation funding to establish lunch clubs. People who have been identified as being at risk of undernutrition are invited to attend a lunch club as part of their treatment. They will receive a hot nutritious meal, which is provided by the CDDFT catering department. Whilst they are at the lunch club they will be weighed and asked questions regarding their appetite and how they are getting on with their dietary treatment. This important information is entered by a volunteer on to the Health Call Undernutrition app. The health care professional will be alerted about anyone if there are any concerns, for instance if they are losing weight or not taking their nutritional supplements. This information can be fed directly to the patient’s electronic records.

This is truly unique, not only have we brought together the health and social side of undernutrition and social isolation but digitalising the lunch club using the Health Call Undernutrition app means that information is available to health care professionals.

It is early days with the lunch clubs, but so far they have been well received by everyone who has been and we are encouraged that they keep coming back. Personally it has been lovely to see the people attending meeting up with old friends who they’ve not seen in years. In addition to the really friendly atmosphere the lunch clubs are providing, patients are saying they like the fact that their weight is being monitored while they are there and appreciate the dietary advice that is available to them when needed. There have been other positive and important outcomes such as partners being able to have some much welcomed respite from the caring role they unconditionally provide. For a few hours they can be confident that their loved one is in safe hands.

Patients are able to attend the lunch clubs for free for 12 weeks, as well as having lunch and being weight monitored there will be a program of other activities that will aim to sustain the longer term impact of reducing social isolation. This includes linking in with Barclays Bank and their Digital Eagles – who help in teaching people to better use smart devises for things such as texting, using Skype or Facetime, thus enabling them to keep in contact with family and friends, as well as raising awareness of other activities and services that can be accessed.

This is one small step in trying to tackle two problems that can have such  an impact on some of our most vulnerable patients. But the question remains as to why there is such a poor awareness of the risks of undernutrition amongst the public and also the health and social care professionals. When you talk to people about undernutrition the penny does drop but there is still a lot of work to be done to get the message across that you don’t lose weight as you get older. The message regarding the risk of obesity to health is loud and clear but what role can social media play in trying to have the same importance placed on the other end of the scale?

F L U I D: #GlobalTeaParty @PlainOldPhil

I LOVE TEA PARTIES.

I LOVE AFTERNOON TEA.

I LOVE TEA IN ALL FORMATS.

It is probably the most British thing about me, my insane love for tea. If you follow me on Instagram or know me in person, you know that I am never too far away from a cup of tea.

Why I love tea?

It is low in calories
It is high in polyphenols (which are a source of antioxidants)
IT TASTES AWESOME
Below are some pictures of my favourite teas. They are in separate pictures because I’m living across 2 cities (Birmingham and Sheffield) and I like to have stash at work to keep me going through the day.

Regardless of location, peppermint tea, green tea and mint greem tea are always on hand.

Peppermint tea is quite soothing, I find it helps with digestion, if I feel bloated and if I feel like I have gas (TMI I know but it always helps me). I have been having peppermint tea for as long as I can remember and enjoy it from a teabag but definitely prefer the real thing (there truly is nothing as satisfying as real mint tea from Jamaica).
Green tea – so much research has gone into the benefits of green tea on overall health. Whilst I don’t recommend green teas to improve health, it can be a nice hydrating drink throughout the day so I tend to have it mid-morning and mid-afternoon.
Mint green tea is a combination of 2 of my favourite teas, so if I’m just not wanting one or the other I will go for a combo teabag.
I enjoy all of my teas without milk. I find that milk taints the flavour and I really want to enjoy every drop of my tea. I rarely add sugar / sweetener / honey to my tea. My dad used to make me tea with my breakfast and during my teenage years when my acne worsened we tried everything in an attempt to control it – one thing we tried was reducing my sugar intake. Now I just find the sweetening of tea too overpowering a taste.

I tend to go to Sheffield to relax with Nathan. It’s my recuperation time after a long week of driving and working and I generally have more time and energy to try different teas These are my floater teas – not quite in circulation but dependent on taste and feeling could become regulars.

Lemon and ginger tea should really go on the regulars list. I have it chilled during the summer with ice cubes and a small teaspoon of honey and in the winter when I need warming up from the inside out. Some research has suggested that ginger supplements (including tea) can help with nausea and vomiting. I get car sick when I’m not driving and thanks to my mum (who first told me to try it) lemon and ginger is my go-to drink before travelling.

To date of the boxed packets, I have only tried the Spiced Ginger which is absolutely fantastic. It is refreshing, revitalising and gives me a similar warming feeling to lemon and ginger tea.

Jasmine tea is an acquired taste that I’ve only recently discovered thanks to my colleague who gifted it to me. At first I found it quite bitter but after following the recommended brewing time and trying it at different times of day, I’ve come to really enjoy it.

Peppermint and nettle tea another acquired taste because you get the initial taste of bitter nettle and then a follow up taste of peppermint. In my eyes any tea with peppermint is rarely going to be bad, so it is definitely a winner for me.

Camomile is a really relaxing tea. It is a caffeine free tea that calms me when I’m feeling stressed or nervous and it is a staple part of my bedtime routine.

https://plainoldphil.wordpress.com/2017/03/15/f-l-u-i-d-globalteaparty/

14 March 2017

F O O D: #SuppertimeSnack @PlainOldPhil
Day 2 -focuses on supper-time snacks. During the week, I snack throughout the day but rarely in the evening because I eat dinner around 7pm and then I’m usually asleep or preparing for bed by supper. On the weekend, I eat earlier and stay up later. Therefore supper-time snacks are required!! I like to have snacks that are light but tide me over to breakfast. Below I’ve got my two favourite snacks – one savoury (roasted chickpeas) and two sweet (rice cakes with nut butter and fruit and fruit with melted dark chocolate).

Roasted chickpeas

Ingredients

1 tin of chickpeas – drained
1 tablespoon of olive oil
1 teaspoon chilli powder
Step 1 -Pop the oven on and set the temperature at 200°c or 1
80°c (fan oven)

Step 2 – Ensure that your chickpeas are dry – roll them on some kitchen roll if they aren’t dry enough.

Step 3 – Combine all the ingredients and pop in an ovenproof dish and put in the oven for 20 – 30 minutes.

Step 4 – If you like a softer snack, take out at 20 minutes. If you like a crunchier snack, take out at 30 minutes.

Step 5 – Let them cool and enjoy.

Fruit and melted dark chocolate

With melting chocolate and just dipping you run the risk of over eating chocolate. I like to melt 2 cubes of dark chocolate and drizzle over some fresh strawberries. 1 of your 5 a day if you eat 80g (about 7 strawberries)! You can choose whatever fruit you fancy – bananas, raspberries, apple and pears are great alternatives.

Rice crackers with fruit

I love rice crackers – they are low calorie, can be used as a savoury or sweet snack, so versatile and generally very cheap. For supper, I put on any nut butter I have and then some fruit. Apple and almond butter. Pomegranates and peanut butter. Cashew butter with raspberries.

https://plainoldphil.wordpress.com/2017/03/14/f-o-o-d-suppertimesnack/

 

13 March 2017

F O O D: #MondayOatyBreakfast @PlainOld Phil
So today is the first day of Nutrition and Hydration week.

YIPEE!

As a dietitian it is only right that I promote a healthy eating and drinking lifestyle. So this week on Plain Old Phil you can expect a post a day focusing on different aspects of a healthy diet. Monday starts with my favourite meal…breakfast!

I love breakfast. I think if you start your day with a good breakfast it is pretty difficult to ruin the rest of the day. Breakfast is great because you:

Top up your energy stores – our bodies use the energy from our food overnight to repair and renew itself. In the morning you need that energy from your breakfast to get you going again.
Can put yourself in a good mood – I find when I have a good breakfast it kick-starts a good day.
So make time for it. I’m not suggesting anything silly like waking up 10 minutes earlier because I know that nobody can get me out of bed before my alarm. But preparing your breakfast and finding clothes to wear to work the night before reduces the amount of time you’ll spend doing those things in the morning freeing up time for breakfast. If you don’t feel up to it try having something small and over time your appetite at breakfast will gradually increase.

What makes oats a great breakfast?

They are versatile – oats aren’t just for porridge. You can make it into breakfast bars, put it in smoothies and can be used in every meal and snack throughout the day.
It is packed full of soluble fibre, slow release carbohydrates and a plant based protein – therefore it makes you feel fuller for longer, can help reduce cholesterol and gives you a steady release of energy throughout the morning.
They contain vitamins and minerals and are naturally low in fat, sugar and salt
Do I really need to say more?

Below are some great ideas of what you can with your oats to make a lovely oaty breakfast

Porridge – my dad is the one that pushed me into liking porridge 1) because he made me breakfast and if that’s what was made that’s what I was having 2) because he always said that it would keep me full till lunch and he wasn’t wrong.

Ingredients

50g oats
250mls milk (I always use almond or coconut) (use less milk if you want a thicker porridge
On the hob

Step 1 – Put all the ingredients into a saucepan on a medium – high heat

Step 2 – Bring to the boil for 5 minutes and then simmer. Make sure that you stir occasionally to prevent the oats sticking and burning.

Step 3 – Serve

In the microwave

Step 1 – Put all the ingredients in a microwavable bowl and put on high for 3 – 5 minutes (you’ll know your microwave best so adjust timings as you see fit). Make sure that you stir halfway through.

Step 2 – Stir again and let it set for 2 minutes before enjoying.

Personally I find plain porridge absolutely boring. So I always have to add something to it:

Sweeten with…1tbsp of honey or sweet freedom or agave nectar or ½ a chopped banana

Top with….fresh fruit (bananas, diced apple (stewed apple or passion fruit = my favourite toppings), any berries), dried fruit (raisins, cranberries, apricots), nuts, seeds or their butters (1tsp of peanut butter never fails to please) (chia seeds and linseeds also add a different dimension)

Spice it up with….1tsp cinnamon, nutmeg, ginger or ½ tsp vanilla extract

Granola – What I love about granola is that you can add anything that you like to it. It is completely up to you and what you like. Nuts, seeds, dried fruit, anything goes! If you are going to buy it from the shop, ensure that you read the food label first because they can be packed full of sugar. Making it at home is generally cheaper, healthier (because you know exactly what’s going in it) and more fulfilling because you made it with your own fair hands. Nathan’s dad got me making my own granola, he makes his own little concoctions and he was encouraging Nathan to do the same but he’s too stubborn. I love making it because it fills the house with lovely smells; it’s how I imagine Ina Garten’s house smells ALL the time. God I love that woman.

Chocolate granola

Ingredients

250g oats
1 tablespoon cocoa powder
100g dried fruit (I generally use half & half chopped apricots and raisins)
100g chopped almonds (or any chopped nut of your desires)
100g seeds (pumpkin or sunflower)
Step 1 – Pop the oven on and set the temperature at 200°c or 180°c (fan oven)

Step 2 – Combine the oats, cocoa, nuts and seeds

Step 3 – Spread the oats on a baking tray and bake for 5 minutes

Step 4 – Remove from the oven, mix again and bake for a further 5 minutes (I only like granola lightly toasted, if you like yours a bit more done go for 6-10 minutes, don’t burn them though)

Step 5 – Once browned to your liking, remove from the oven and leave to cool

Step 6 – Mix in your dried fruit and store it in an airtight container

Enjoy with your favourite milk (I love mine with hot almond milk) for breakfast or yoghurt for a quick, light snack, or dessert. If you want it more chocolatey add some dark chocolate chips.

My favourite combination – granola + hot almond milk + strawberries + almond butter = perfection

Flapjacks – this came about because I was struggling to get ready and eat breakfast before work. I’m not a massive fan of eating in the car but sometimes needs must.

AAA flapjacks – apple, almond and apricot!! They are soft, chewy and delicious.

Ingredients

250g oats
1 tablespoon melted vegan margarine
2 tablespoons of Sweet Freedom
2 apples, chopped
50g almonds
50g dried apricots

Step 1 – Pop the oven on and set the temperature at 200°c or 180°c (fan oven)

Step 2 – In a food processor, combine the apple, apricots and almonds. The best way to describe it is mushy with chunks of nuts and apricots (dependent on the strength of your food processor you might want to add a couple tablespoons of water to help get the right consistency).

Step 3 – Combine with melted margarine and honey.

Step 4 – Mix the oats, mushy fruit and melted margarine and honey.

Step 5 – Pack the mixture into a lined ovenproof dish and bake in the oven for 20 minutes (if you don’t want as chewy a flapjack, bake for an extra 10 minutes)

Step 6 – Once cooked, remove from the oven and cool for 15 minutes. Then turn out on to a chopping board and cut into squares.

ENJOY!!!

 

https://plainoldphil.wordpress.com/2017/03/13/f-o-o-d-mondayoatybreakfast/

10 March 2017

Nourish by Jane Clarke

You can now read Jane’s blog about Nutrition & Hydration Week https://www.nourishbyjaneclarke.com/blogs/latest-news/eat-drink-and-change-the-world

Improving nutritional care and oral nutritional supplement prescribing for adults in the community

 

Susan Sheridan, dietitian

 

“Malnutrition – it’s one of the hidden problems in our society. When a person is malnourished it has an effect on many other aspects of their health and wellbeing. A typical example I see is malnutrition causing frailty. When a person is frail, they are more at risk of falling, consequently they are more likely to end up in hospital with complications.

Here in Bradford, we wanted to change the perception of malnutrition so that it is identified and treated in a way that means that we are giving the right care, in the right place at the right time.

Therefore, the two CCGs in Bradford funded a two year pilot project to look at how we can improve malnutrition care and oral nutritional supplement (ONS) prescribing for adults in the community. This involved setting up a malnutrition project team to works across the different health and care organisations in Bradford.

The project team started by looking at the main areas of concern around malnutrition. We knew that prescribed oral nutritional supplements are clinically effective and cost effective in treating disease related malnutrition. However, there is an issue – locally and nationally – around whether the use of ONS is appropriate and effective. This relates to medicines waste, through people receiving medicines and not taking them as directed, and the increasing costs of prescribing.

But prescribing costs were just one side of the coin. We wanted to look at the full process, from how malnutrition is actually identified through to reviewing and monitoring.

The project group worked in consultation with clinical leads and patient representatives to develop a new malnutrition care pathway using a template on our clinical IT system, SystmOne. It was clear that although our clinicians felt that they weren’t experts in nutrition and that they wanted clear straightforward guidance from which they could build and develop their knowledge. Getting their clinical feedback was imperative to getting the template right. We made sure that it clearly details a step-by-step approach from the all important first step of identification and screening through to monitoring. The template contained links to information leaflets, websites and local specialist services. It also helps address concerns around prescribing with a limited ONS formulary which helps clinicians prescribe the right supplement if it is needed.

It does take time and a lot of legwork, but it is worth it! I am currently going out to our GP practices to meet with staff and show them how to use the template. The feedback has been really positive so far. GPs say how much better it is to identify patients who need to be screened for malnutrition, they say the template is easy to use and has become almost like a portal for essential information and best practice. Patient feedback has also been fantastic, they appreciate having the support of a dietitian who can give personalised advice.

The template has been used for about six months now and one of our next steps is to do a more formal evaluation of its use. But even in this short time we can see that it is already reducing prescribing costs around ONS which also indicates that people are benefitting from a ‘food first’ approach, receiving better advice and guidance around nutrition.

I really have a passion for promoting improved nutritional care to patients and the need to identify those at risk early so having the chance to work on this project has been fantastic. It’s great to hear such positive feedback and I’m excited to see the benefits that this will bring to our patients for the future.”

About Susan

Susan Sheridan has worked as a specialist community dietitian for Bradford Teaching Hospitals NHS Foundation Trust for 12 years, primarily visiting patients in their homes to tackle malnutrition and witnessing first-hand the effects the condition can have. She has a passion for promoting improved nutritional care to patients and early identification of those at risk of malnutrition.

Susan currently leads the Bradford community malnutrition project alongside Tracey Gaston, Medicines Management lead pharmacist at NHS Bradford City and NHS Bradford Districts Clinical Commissioning Groups (CCGs).

For further information please contact communications@bradford.nhs.uk

 

Encouraging society to adapt taste enhancement as nutritional care strategy for older adults

Vivian Wong from FOODIE at Reading University has share this great blog with us.

I still remember after my grandma fell ill, it slowly became more and more difficult to arrange meals and help her to get enough nutrients. When we thought the foods were fine, she would find the meals were bland. Most of the time she would have a poor appetite and ate very little. We were really worried about her losing weight too quickly and becoming more prone to illness. Reduced taste sensitivity happens in healthy older adults too. My neighbor is well and very active in her 80’s. Sometimes we will have lunch together and I realise she would put a lot of salt in her food because she can’t taste the flavour. These seem to be common observations among the older population, whether they are healthy or frail.

Deteriorated taste perception is an age related physiological change. As we grow old, our taste sensitivity will reduce gradually. Some older adults may have endured the change and some may not even notice it. Many studies have found that taste thresholds of older adults are significantly higher than for younger adults [1]; so, for example, more salt is needed for food to taste salty. Many older adults have at least one or more chronic health conditions; their medications and illnesses can also contribute to the taste impairment [2].

Although their salt taste deteriorates, it is not reasonable for older adults to add more salt to their foods as this can increase the risk of hypertension and cardio-vascular disease [3]. If older adults find their meals are lacking in flavor and unpalatable, it’s likely that their enjoyment of food, and their appetite, will reduce. Consequently, they may start to eat less and such decreased nutritional intake can contribute to malnutrition.

You may have heard about the basic five tastes: sweet, sour, bitter, salt and the fifth taste Umami being described as a “savoury” “meat -like” taste. The umami taste can be derived from an amino acid called glutamate, which was first isolated from Konbu (a type of Seaweed) by Dr. Ikeda in Japan 100 years ago, as well as from ribonucleotides [4].

Recent research suggested umami taste compounds naturally present in foods, such as glutamate and inosine monophosphate, can be used instead of salt to increase savoury taste and enhance savoury flavour perception [5,6]. Studies have shown that umami taste enhancement can be used to increase appetite and food consumption [2, 7, 8]. Umami taste stimuli can also increase salivary secretion, which may help to relieve the discomfort of oral dryness, a common health problem among older adults [9, 10]. Sasano et al. suggested the increased salivary flow can help in overcoming dysphagia and facilitate food swallowing [11].

Whereas some studies have shown no significant effect of taste enhancement on appetite, nor liking, of meals by healthy older adults [12] the review of numerous studies by Song et al. concluded that taste enhancement has a positive effect on frailer older adults’ food preference [13]. Dermiki et al. found the natural umami taste enhanced meals, increased food preference among the older hospital patients [14].

The effect of umami taste enhancement in improving older adults’ food intake and nutritional status is debatable, because it is not a ‘one size fits all’ solution. Dependent older adults usually have health problems and more impaired taste perception. This may explain why we see umami taste enhancement to positively influence food liking of frailer older adults, while those with less taste impairment may find enhanced meals overpowering [15]. More research is needed to understand how to apply umami taste enhancement appropriately to derive its maximum benefits for older adults and tailor for their different nutritional needs.

Nevertheless, if we can adopt taste enhancement into our cooking and add a twist of umami, this can boost the pleasant savoury flavour, whilst avoiding high salt levels in food. By doing so we can help to encourage our older adults to enjoy their food again and eat more.

Introducing novel foods that are mismatched with the older adults’ memories can lower their food acceptance and liking [16]. However, many umami- rich nature ingredients are already well known.

If you enjoy having a roast dinner on Sunday or a spaghetti Bolognese for tea now and then, you are already having umami- rich meals. Tomato puree, Parmesan, Worchester sauce, roasted beef and mushrooms, these are all umami- rich foods [4, 5, 17]. Why not give it a try to taste a small sip of tomato puree? Can you feel the increased salivary secretion at the side of your mouth? That’s your natural reaction to the stimuli of umami taste compounds.

You may not have recognised umami taste before, but umami has been used in cooking throughout history and in different cultures. Garum is a fish sauce (fermented from mackerels) which was used as a seasoning back in Ancient Greek and Roman times. Anchovy paste and sauce is the modern version. Tomato and Parmesan are the foundation of Italian cuisine and loved throughout generations. In Asia, they also have a long history of using fermented products, such as Chinese soy sauce and Japanese miso, in their cuisine to increase the umami taste. [18]

The umami synergy of matching different umami combinations, between the umami tasting amino acid with ribonucleotides, is still applied in modern culinary to maximise the umami sensation. For example:

Spaghetti Bolognese = Tomato (246 mg glutamate/100g food) x Beef (70 mg inosinate/ 100g food)

Chicken Cesar salad =Parmesan (1680 mg glutamate/100g food) x Chicken (201mg inosinate/ 100g food)

So how about adding some shavings of Parmesan to taste enhance your spaghetti Bolognese next time and see if you can notice the flavour has differed?

Taste enhancement can be applied together with the other nutritional care strategies in a flexible system to help meet older adult’s individual needs, preferences and overcome their barriers to adequate nutrition. We ought to tackle the problem now to prevent older adults becoming malnourished. Are you worried that the older adults you are caring for are not getting adequate nutrition? Why not give taste enhancement a try?

[A taste enhancement recipe booklet is available to download here]

Reference

  1. Methven, L., Allen, V. J., Withers, C. A. & Gosney, M. A. (2012) Ageing and taste. Proceedings of the Nutrition Society, 71(4), 556-565.
  1. Schiffman, S. S. (1998) Sensory enhancement of foods for the elderly with monosodium glutamate and flavors. Food Reviews International, 14, 321-333.
  1. McGuire, M. & Beerman, K. (2007) Nutritional Sciences: From Fundamentals to Food. Canada: Thomson Wadsworth.
  1. Ninomiya, K. (2002) Umami: a universal taste. Food Reviews International, 18 (1), 23-38.
  1. Dermiki, M., Mounayar, R., Suwankanit, C., Scott, J., Kennedy, O.B., Mottram, D.S., Gosney, M.A., Blumenthal, H., and Methven, L. (2013a) Maximising umami taste in meat using natural ingredients: effects on chemistry and sensory perception. Journal of the Science of Food and Agriculture, 93(13), 3312-3321.
  1. McCabe, C. & Rolls, E.T. (2007) Umami: a delicious flavor formed by convergence of taste and olfactory pathways in the human brain. European Journal of Neuroscience, 25, 1855–1864.
  1. Yeomans, M.R., Gould, N. J., Mobini, S. & Prescott, J. (2008) Acquired flavor acceptance and intake facilitated by monosodium glutamate in humans. Physiology & Behavior, 93(4-5), 958-966.
  1. Dermiki, M., Prescott, J., Sargent, L. J., Willway, J., Gosney, M. A. & Methven, L. (2015) Novel flavours paired with glutamate condition increased intake in older adults in the absence of changes in liking. Appetite, 90,108-113.
  1. Uneyama, H. & Yamada, Y. (2009) Possible Applications of Umami Taste to Improve Eating Disorders. Journal of Health Science, 55(5), 699–700.
  1. Schiffman S. S. & Miletic, I. D. (1999) Effect of taste and smell on secretion rate of salivary IgA in elderly and young persons. The Journal of Nutrition Health and Aging, 3 (3), 158-164.
  1. Sasano, T., Satoh-Kuriwada, S., Shoji, N., Sekine-Hayakawa, Y., Kawai, M. & Uneyama, H. (2010) Application of umami taste stimulation to remedy hypogeusia based on reflex salivation. Biological and Pharmaceutical Bulletin, 33 (11), 1791-1795.
  1. Doets, E. L. & Kremer, S. (2016) The silver sensory experience – A review of senior consumers’ food perception, liking and intake. Food Quality and Preference, 48, 316–332.
  1. Dermiki, M., Willway, J., Sargent, L., Kidman, J., Anderson, C., Kennedy, O. B., Gosney, M. A. & Methven, L. (2013b) Preference and consumption of a taste enhanced meat meal by older hospital patients: A pilot study. Nutrition and Aging, (2)1, 69–75.
  1. Song, X., Giacalone, D., Bolling Johansen, S.M., Bom Frost, M. and Bredie, W. (2016) Changes in orosensory perception related to aging and strategies for counteracting its influence on food preferences among older adults. Trends in Food Science & Technology, 53, 49-59.
  1. Stubbs, R.J. & Whybrow, S. (2004) Energy density, diet composition and palatability: influences on overall food energy intake in humans. Physiology & Behavior, 81, 755–764.
  1. S. Fuke, T. Shimizu (1993) Sensory and preference aspects of umami. Trends in Food Science and Technology, 4, 246–251.
  1. Taylor, A. J. & Hort, J. (eds.) (2007) Modifying Flavour in Food. Cambridge: Woodhead Publishing Limited.

 

22 August 2016

Andy Jones recently had this published in the Health Service Journal and we thought we would share it with you as it the idea is forming part of our NHS Fab Change Day challenge on the 19th October…………

Food, glorious food: can trust chiefs eat hospital meals for a week

Andy Jones throws down a challenge to trust chief executives not to walk a thousand miles in their patients’ shoes but to share their culinary experiences for a week…

One area that always seems to “light up” media and social media is hospital food! To me as a facilities specialist and past chair of the Hospital Caterers Association (HCA) it’s an area that we all have to focus on more, after all – Food is the Best Form of Medicine.

Take a cue

One trust in Ottawa, Canada, took up the challenge and this is the reason for the recent media flurry. The senior management team ate nothing but hospital food for seven days, giving them a better understanding of the complexities involved, how hard the catering teams work and the importance of good food in the care and recovery of the patients.

It resulted in change, investment in food budgets and training standards for the catering teams

The outcome was remarkable: instead of what many thought would be a tick box exercise, it resulted in change, investment in food budgets and training standards for the catering teams, one of which is at the ward end of the service.

The Hospital Food Plan (HFP), which is now embedded in NHS England’s contract, ensures all trusts have a food strategy in place to reflect the HFP and that a member of the board is responsible for this and reported every six months. So we have it right up there at the top.

Some trusts have really taken the plan and invested in the food and drink service and taken the mantra Eating for Good Health as one of its core ethos. However, we still see media reports on poor food and drink

So here’s a challenge, can we get a trust’s CEO and/or senior teams to eat patients’ food for seven days – or better still for the length of the menu cycle – and feed back to HSJ the findings and any changes that they will make?

Showing commitment

The ideal situation would be similar to prisons where all the food is sampled daily before it’s served, this could be done by say senior matron, catering supervisor, dietitian and patient? Also to see the food served at ward level. That would show commitment and develop a platform to ensure changes happen if needed.

Some small changes you could make today have patient food including drinks served at the following

  •  Board meetings
  •  Inductions

High on agenda

Why should food and drink be high on a trust’s agenda when trust have more pressing issues and after all it should be right. Well, what Canada has found by investing in food more is that it can reduce costs of medicines, reduce length of stays, reduce the need for food supplements (in some cases they are needed for medical reasons), reduce readmissions, reduces waste, including plate waste, enhances recovery, enhance morale, reduces turnover – and many more.

If we have good food and drink, then patients will go home quicker well-nourished and likely not to be readmitted again

We know people arrive at hospital with many issues, and one of the concerns is malnutrition, which needs good food and drink to assist the medical care. If we have good food and drink, then patients will go home more speedily, well nourished and likely not to be readmitted again – all saving the trust finance pressures, short and long term.

One area I am passionate about is the ward end service as often this is where good food can be spoilt. We have seen protected meal times work well and not so well!

So what is needed is MealTimes Matters, which says what it is! Ensuring staff are ready for service, patients are made ready for meals, a loved one or carer or dining companion.

Finally, as you start your week-long eating of the patients’ food with your catering team or nutritional link nurse, are they members of the Hospital Caterers Association – this is the only professional association which represents caterers and hospital food in the UK; it drives standards and training. The review should encompass that they join the HCA.

 

29 February 2016

We are now just 2 weeks away from Nutrition and Hydration Week 2016 and, as ever, I am totally amazed by the amount of support we have for the week. It is really inspiring to know that so many people will be taking part in an event that aims to make to difference to the people we provide care for.

Over the last week it has been really interesting to see how different organisations are now looking to use Nutrition and Hydration Week to improve they health and well-being for their staff – this is a real shift from our original aims but one which we are delighted to support. We all need to make sure that we eat the right things and drink enough….

We have been busy trying to make sure that we capture all of the brilliant plans for the week so that we can share them on our website https://nutritionandhydrationweek.co.uk/events/ and in future editions  of our newsletter.

We have also been collating some lovely resources that have developed by different organisations https://nutritionandhydrationweek.co.uk/campaign-resources/ – there is a lovely World Tea Party invitation that has been designed by colleagues at St Peter’s.

You may have noticed that we have some special offers available for Nutrition and Hydration Week 2016 – these offers will be finishing very soon so you might want to check out https://nutritionandhydrationweek.co.uk/campaign-resources/ were you will find further information.

There are a couple of events that I am particularly looking forward to sharing with you.

The first will be happening on Monday 7 March 2016 when I will be with some amazing chefs who have nearly completed the first ever NVQ Professional Cookery Healthcare course. We will spending the afternoon preparing a celebratory buffet for some invited guests. I am planning on testing out some of my newly learnt food photography skills so hope you will the results on twitter @NHWeek. We will also be filming the event and will be aiming to get the photo published on the website during Nutrition and Hydration Week.

The second event that I am looking forward to is the Mouth Care Matters WebEx session on the 17 March 2016 at 09.00. The session will talk about the importance of good oral hygiene and the impact on improving nutrition and hydration. It’s a free event and I would love lots of people to join. You can register now at https://fs2.formsite.com/patientsafetyfirst/form199/index.html

I know that Nutrition and Hydration Week 2016 is going to amazing and I am really looking forward to hearing about everyone’s plans and, of course, seeing all the photo’s.

Don’t forget to share your week with us on twitter @NHWeek #NHW2016

Well that’s all for now but I hope your plans go well.

Caroline

8 February 2016

Last week was busy week and we had lots of great news which I thought I would share.

The week started with a meeting with colleagues at Hospitality House who will be hosting our Nutrition and Hydration Week 2016 Chef Event. We will be spending the 7th March with the students currently involved the NVQ Professional Healthcare Cookery qualification pilot. The students will be nearing the end of the course so we will definitely be having a celebration!!!

To add to this the event will be filmed by the Barnet & Southgate Media students – which I hope will be a great experience for them.

I hope this will be an amazing event which we can share with you all during Nutrition and Hydration Week.

We have also been contacted by several organisations that are offering free training and resources for Nutrition and Hydration Week – this is brilliant as it really supports our commitment to on-going education for everyone. Watch out for information in our newsletters and on the website.

Continuing the learning theme I will hosting a WebEx session with our colleagues at Mouth Care Matters. The session will provide you with the opportunity to hear about a project that is aimed at improving oral hygiene for hospital patients – good oral hygiene is an essential if we are going to encourage people to eat and drink.

The WebEx will be held on Thursday 17th March from 09.00 – 10.00. You will need to register to join this event which you can do now at http://bit.ly/1NZSTwF. Once you are registered I will be sending out joining information – really hope that you can join us.

Finally we, the Nutrition and Hydration Week team, had a great face to face meeting last Friday to talk all things Nutrition and Hydration Week. Why was this so brilliant – well we actually rarely get together……….. We normally only never have our ‘meetings’ over the phone once we have finished the day job!!!

We have decided to streamline how people can contact us. So if you want to pledge your support, register for regular email updates, contact us or share information and photos we have one point of contact – info@nutritionandhydrationweek.co.uk

Thanks so much for all of  your support

Caroline

 

29 January 2016

It’s been another busy week with lots of activity and discussions around what’s happening for Nutrition and Hydration Week 2016.

The idea of attempting some official world records has created a storm!! Apparently there have been so many applications for the multi-site record that colleagues at the Guinness World Records have now asked that applications stop and that we, Nutrition and Hydration Week, put in one application to include everyone. We have been hastily contacting people in person, via a newsletter and on the website to let them know. For more information check out https://nutritionandhydrationweek.co.uk/worldwide-afternoon-tea/

We will be sharing more information over the next couple of weeks but a huge thank you to everyone. Your support is truly amazing.

I have also had a really helpful chat with some colleagues around what we could do for our 2016 Chef Event. Now this is a bit of a Nutrition and Hydration Week tradition and is something that I personally love being involved with. I think I am probably a frustrated chef at heart……

We so frequently hear and read the negative stories around the standard and quality of the meals served across health and social care and, whilst I agree that there are some areas that really could do better, I believe we also have some of the most amazing chefs in the sector. So for me the Nutrition and Hydration Week Chef Event is an opportunity to shine a light on some of the best.

We have some really great ideas for this event and I am hoping to get some firm plans together next week but why not have a look at what we have done in previous years. This is from 2014 https://nutritionandhydrationweek.co.uk/events/videos-meet-our-chefs/ but I think my favourite is the 2015 event https://nutritionandhydrationweek.co.uk/events/nutrition-and-hydration-week-2015-chef-event/ – it was slightly bonkers!!!

I have also had some really great conversations with different campaigns and companies who are all looking to link into and support Nutrition and Hydration Week 2016. We are hoping that new learning materials and a range of different resources will be available but are just waiting final confirmation – as soon as we have any information to share it will be on the website.

I hope you have noticed the special offer that is available for some great learning resources – The Nutrition Game and The Dysphagia Game – you can get a pretty good discount if you purchase them before the end of Nutrition and Hydration Week – https://nutritionandhydrationweek.co.uk/campaign-resources/

A final plea – please let us know what your plans are so that we can share them with your colleagues –  this is a great way of inspiring others to get involved and we all know who really benefits.

Huge thank you for all of your support

Caroline

 

22 January 2016

As we drawer closer to Nutrition and Hydration Week 2016 I have been reflecting on some of the amazing things that have happened over the last couple of years. I thought I would share a couple with you.

From a background of a single week focused on nutrition and hydration patient safety issues the week has been a truly global event with countries from around the world getting involved. A recent review of our website stats showed that we had visits from 119 different countries – we may not know if or how all of these countries actually get involved in the week but we certainly know that many people are looking at many of our resources.

Now I was never one for numbers but I do find it really interesting to find out who is visiting our website and must admit to being really surprises (and very delighted) that we are currently reaching about 400 views a day and that 23% of those views happen at around midday on a Wednesday!!!

It is also really interesting to think about how Nutrition and Hydration Week is now being used in so many ways. Of course our vision and aims remains very much linked raising awareness of the importance nutrition and hydration across health and social but we have seen some really inspiring ideas.

Take the Junior Hydration Champions that our friends from PROSPER in Essex introduced last year. Local school children were involved in designing a posters to encourage care home residents to drink more with the winning poster being used in some care homes – I think it was the hardest thing I have every judge.

We also had our Junior Nutrition and Hydration Week Ambassadors who have now sent nearly a year engaged in range of different activities including having their own stall at their school fair, meeting with their school meals providers and developing food fact files. What is so brilliant about this is that all of the activities are link to specific skills and learning. You can read a short case study at Junior Nutrition and Hydration Week Ambassadors

We would love to see initiatives like these spread as this can only help in supporting children understand the importance of good nutrition and hydration throughout their life.

Thanks for all your support

Caroline

15 January 2016

It’s hard to believe that we are really just weeks away from Nutrition and Hydration Week 2016 – the dates for your diary are 14th – 20th March.

Over the last few years we have seen some really amazing events, initiatives and celebrations occurring which has been so inspiring and have really demonstrate that there are some amazing people providing care to people in hospitals, care homes/facilities and in their own homes. The thing that I find so inspiring is that every time I hear about someone or an organisation getting involved in the week they are making a difference and that they care.

I am continually impressed in the amount of innovation and creativity that often goes into planning for Nutrition and Hydration Week – I think the Global Tea Party really highlights this. Seeing all of your amazing photos is just brilliant.

Over the last few months we have been developing our ideas to take Nutrition and Hydration 2016 to a different level.

We have identified some different themes for each day of the week – Theme of the day 2016 – we hope this gives you some ideas for a range of activities that you could get involved.

We also had a crazy idea – let’s keep the Global Tea Party (you love it and so do we) but let’s try and gets some Official World Records – Worldwide Afternoon Tea

We have put together some information to support you with your Continual Professional Education  which we hope you find useful.

I really hope that you will be able to join us for Nutrition and Hydration Week 2016 and I very much look forward hearing about all of your plans and seeing your photos.

Thanks for all of your support

Caroline