Food Preferences and Nutrition Awareness of 65+ Year Olds in the Barossa Valley

N Bampton, D Cramer, N Keillor, E Rudnik School of Medicine, Flinders University, 2014

BackgroundAging is associated with diminished organ system reserves and weakened homeostatic controls of nutrients.3 For this reason, adequate dietary intake in older adults is crucial for aging well. This includes enjoying a wide variety of nutritious foods, eating at least three meals a day and having adequate water intake.4 Malnutrition in older adults has a wide range of adverse outcomes related to insufficient energy intake and weight loss. These include impaired physical function, longer hospital stays and increased risk of infections and delirium.3 In addition, age related health problems can create specific nutritional needs and further compromise energy intake and weight loss, exacerbating the harm caused by malnutrition. The aforementioned publication by Brownie and Coutts2 made reference to the limited data on primary determinants of nutrition in older adults. Further, there are no comprehensive, up to date Australian nutritional guidelines specifically for older adults. The most recent was rescinded in 2005 and no longer represents the National Health and Medical Research Council position.4 Brownie and Coutts2 recognized that this lack of data is concerning because of the personal and economic costs that result from poor compliance with guidelines and resulting failure to meet nutritional needs.2 The Dieticians Association of Australia published a study in 2012 which identified that between 20-40% of community living older Australians are either malnourished or at risk of malnutrition.5 Participants in our study were over 65 years old and lived independently. The age range of over 65 years is concordant with the Australian Dietary Guidelines 2013 definition of older adults: “healthy people aged 65 years and over, not including frail elderly people”.6 Again for the purposes of the study, ‘living independently’ excludes those who are residents of an aged care home and maintain at least some control over menu planning, food shopping and meal preparation at home.

MethodThe Social and Behavioural Ethics Committee permitted the collection of data via a survey that was developed by students travelling to the various sites. The survey included questions on living arrangement, estimated intake of major food groups, factors determining foods selection and barriers to healthy eating. To participate, the survey was promoted to those who were:

Over 65 years oldLiving independently

The survey was distributed to organizations that were identified as places people over 65 would frequent. Further, consideration was taken to ensure male and females would be equally targeted. Emphasis was placed on distributing the survey to those who live independently and are in control of their food consumption rather than in nursing homes.In the Barossa Valley these locations included:

The Rotary Club of Barossa ValleySoroptomist International Barossa ValleyTanunda Medical CentreNurioopta LibraryCarers LinksTanunda libraryThe Rex Barossa Aquatic & Fitness CentreThe Christian Community HubThe Barossa Community Men’s Shed

The survey included a brief explanation of the purposes of the study and an information page of serving sizes to assist in answering the survey questions. The surveys were left at the above locations for a week and in some cases a day while students waited for them to be completed by participants.

Data AnalysisThe quantitative survey questions were converted to 58 variables and the answers were each given a coded value. Any ambiguous or missing answers were discounted as missing data. The qualitative data was transcribed in full and frequencies in the data were analysed for major themes.

ResultsThe survey yielded 27 responses and the following results were obtained:

Average age of participants 75.5 years oldGender of participants was 13 males, 14 femalesOne participant was semi independent, other participants lived independentlyPerceived understanding of current healthy eating guidelines:

5 = Excellent20 = Good2 = Poor

All participants (n = 27) underestimated the amount of breads, cereals, rice and pasta a person over 65 should be eating Only 2 participants (7%) estimated the correct amount of vegetables a person over 65 years should be eating while the rest underestimated this value Dairy intake recommendations were also underestimated by the majority of participants, with only one estimating the correct amount recommended by the NHMRCThe majority of participants were living with one other person (table 1)The two most important factors for food selection were taste (9 participants (33%) rated this as their number one determining factor) and nutritional value (7 participants (26%) rated this as their number one determining factor)Fish or seafood was the favourite food of 7 of the participants (26%)The majority of the participants (55%) rated their diet as “moderately healthy”The majority of servings of bread, cereals, rice or pasta for the participants were had during the breakfast mealThe majority of servings of vegetables were had during the dinner meal21 participants (78%) thought that their bread, cereals, rice and pasta intake was “just right”The majority of participants (37%) thought that their intake of legumes were inadequate (don’t eat enough)In all of the other categories (vegetables, fruit, dairy, meat and water) the majority of participants believe they are eating the right amount of these foodsOnly 5 of the participants (18.5%) agreed with the statement “my diet is restricted by a medical condition/ medication”No participants agreed with the statements “healthy foods are hard to access in my local area” or “I have difficulties physically chopping, mixing etc.”The majority of participants (52%) would like access to more information regarding recommended food nutrition guidelines for over 65’s in the futureMost participants preferred to receive food and nutrition information via magazines and books (n = 20), TV/ DVD’s (n = 14) and from medical professionals e.g. GP or dietician (n = 13)One participant commented that it might be important to look into how much sugar is consumed per day in future surveys.

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Percentage of participants estimating the correct amount of servings needed for each of the major food groups

Percentage of participants estimating the correct amount of servings needed for each of the major food groups

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NHMRC guidelines for amount of servings for 65+ versus the average serving sizes suggested by participants

Average amount participants suggested (serves)Amount suggested by NHMRC guidelines

DiscussionUnder 10% of the study’s participants possessed accurate knowledge of healthy eating in regard to grains, dairy, legumes and vegetable food groups. This is concerning especially because dairy products and vegetables are important sources of calcium and other minerals, protein and vitamins (including vitamin B12).7 Their consumption may reduce the risk of heart disease, stroke, high blood pressure, some cancers and type 2 diabetes mellitus,and may also contribute to stronger bones.7

The incidence of the aforementioned conditions increases with age8 and the risk of osteoporosis increases with age also. 9 Therefore, particularly for those over 65, a lack of understanding of the recommended daily servings of dairy products (or their alternatives) and vegetables may be particularly detrimental.

Taste was considered the most important factor in food selection, followed by nutritional value, price and convenience. This suggests that making healthy food palatable and pleasurable to eat is very significant in its promotion. Appearance was listed most commonly as the 3rd most important factor in food selection which suggests that although it may not be a major determinant of food preferences, it is not insignificant. Texture, and packaging were not considered as important in the results and this implies that such factors should not be the focus of campaigns to enhance nutrition in those over 65.

The results showed that participants generally found that the barriers to healthy eating listed in the survey had a minor contribution to their diet. All participants disagreed with the statement:“Healthy foods are hard to access in my local area”The Barossa Valley is well known for the wide range of produce in the region and other regions may not yield the same accessibility results. 18.5% of participants considered that their diet was restricted by a medical condition. This is likely an underestimation of the population level, because statistics demonstrate that 17% of those over 65 have high cholesterol, 35% have hypertension10 and 27.9% have Type 2 diabetes mellitus11, all conditions that would in some way restrict diet. The results suggest that these barriers to healthy eating do not hinder the majority of participants from eating healthily. Rather, the most significant barrier to healthy eating is a lack of understanding of the nutritional guidelines and underestimation of appropriate number of daily servings.

References1 National Health and Medical Research Council, Australian Dietary Guidelines, Department of Health and

Ageing, Commonwealth of Australia 2013 pp118 2 Brownie S and Coutts, R, Focus group interviews with older Australians to explore their awareness of

the national age-adjusted dietary recommendations and their suggestions for assisting them to meet these dietary targets, Australian Journal of Primary Health 2014

3 Ritchie C, Geriatric Nutrition: Nutritional issues in older adults, Wolters Kluwer Health July 10, 20144 National Health and Medical Research Council, Eat Well for Life, A practical guide to the dietary

guidelines for older Australia, Department of Health and Ageing. Commonwealth of Australia 2003, rescinded 2005 page 1 assisting them to meet these dietary targets, Australian Journal of Primary Health 2014 page182

5 Rist G, The presence of malnutrition in community living older adults receiving home nursing services, Nutrition and Dietetics 2012 69 page 46

6 National Health and Medical Research Council, Australian Dietary Guidelines, Department of Health and Ageing, Commonwealth of Australia 2013 pp146

7 National Health and Medical Research Council, 2013, Eat for health. Australian Dietary Guidelines. Summary, Australian Government, NHMRC, Department of Health and Ageing, retrieved online from <https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55a_australian_dietary_guidelines_summary_131014.pdf>

8 World Heart Federation, ‘Cardiovascular Disease Risk Factors’, ©2014 World Heart Federation, retrieved online from <http://www.world-heart-federation.org/press/fact-sheets/cardiovascular-disease-risk-factors/>

9 Warming L, Hassager C and Christiansen C, 2002, Changes in bone mineral density with age in men and women: a longitudinal study, Osteoporos Int., 13(2);105-12

10 Australian Bureau of Statistics, Health Status, 1301.0 - Year Book Australia, 201211 Australian Instritute of Health and Welfare, How Common is Diabetes, Authoritative information and

statistics to promote better health and wellbeing analysis of Australian Bureau of Statistics National Health Survey 2013

ContactNatalie Bampton: bamp0017@flinders.edu.auDaniel Cramer: cram0045@flinders.edu.au

Natasha Keillor: keil0013@flnders.edu.auDr Elena Rudnik: elena.rudnik@flinders.edu.au

IntroductionThe Australian Dietary Guidelines r e c o g n i z e t h e i m p o r t a n c e o f considering changes in nutritional needs to promote aging well in adults over 65.1 Flinders University has built upon a study undertaken by Brownie and Coutts2 which found a general lack of understanding amongst individuals aged 60 years and over with regards to government-endorsed dietary guidelines and nutritional recommendations relevant to older people.2 In addition to investigating such awareness, factors that influence food preferences and barriers to healthy eating were also studied in people aged over 65 from the Barossa Valley.

ConclusionQuite substantial differences were found between elderly people’s understandings of recommended daily servings of major food groups and those proposed by the NHMRC guidelines for individuals aged 65 years or more. Such discrepancies were greatest for breads, cereals, grains, vegetables and legume food groups, whilst those for fruit and lean meat, fish and poultry food groups were less salient. The first step in promoting a healthy diet in elderly individuals is thus to enhance their awareness of what such nutritious eating habits entail. Whether such an awareness will actually lead to healthy eating is determined, at least in part, by an interplay between factors which influence food preferences and barriers to incorporating healthy practices into one’s diet. The most important factor in deciding food preferences was identified as taste, which may suggest its key role within nutrition campaigns aimed at the elderly. Given that the overwhelming majority of participants denied the significance of the proposed barriers to healthy eating (relating to food preparation knowledge and ability, access, cost, preferences, time and medical conditions), this study highlights the greater issue of a lack of nutritional awareness over the presence of such barriers amongst individuals aged 65 years and older. Thus, access to information on healthy eating is suggested as a priority. The three key avenues for distribution of such knowledge are presented here as magazines, books, TV/DVD’s and medical professionals. Whether an improvement in elderly people’s understanding of healthy eating will lead to an improvement in their diet is an area for further research.

Figure 1. The Barossa Valley is a rural community north-eastof Adelaide, most known for its wine and food production industries. The Barossa Valley encompasses numerous smalltowns with a total population of approximately 20,000 residentsspread over an area of about 912km2. Photo credit: Natasha Keillor, 2014