[Article updated on 19/09/2023]
Food is often a major concern today in EHPADs. At a time when the pleasure of eating must be a priority, undernutrition is nevertheless a real current problem.
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As as the ARS and PNNS studies demonstrate, a good status nutrition allows you to age well and limit the risks of addiction.
But the reality on the ground is sometimes very complex. In fact, the age average entry into an establishment is 85 years and residents arrive more and more dependent and often already malnourished after a stay in hospital or due to incapacity to live alone at home. Figures published by HAS in 2007 demonstrated a malnutrition rate of 15% to 38% in EHPADs in France and the latest studies tend to demonstrate a increase in this prevalence.
There quality of the restoration and overall care of Food has therefore become essential.
The importance of communication between departments
In order to to improve this support, it is important to look things as a whole and to promote inter-change services. In fact, almost all of the EHPAD staff are in contact with residents during one of the meal times of the daytime. Hotel Service Agents are often in charge of the distribution of breakfast, nurses and caregivers are present during midday and evening meals and the animators participate in the distribution of the snack. Without forget the kitchen teams who order, prepare and distribute meals.
In At the same time, other paramedical professionals ensure the maintaining autonomy and often have a rehabilitative role to the actions of daily life and the act of eating is surely one of the most important of all because the pleasures of table are sometimes all they have left. The physiotherapists work on autonomy in travel, occupational therapists adapt meal and daily life equipment and speech therapists adjust the textures of meals and re-educate speech or swallowing.
A good nutritional support is therefore provided upon entry into the reside in the establishment with the search for indicators malnutrition (weight and history, BMI, albumin, etc.) but also taking into account their likes, dislikes and habits food in order to best personalize the meals served while respecting the constraints of the community.
Then, throughout the stay, we must monitor the evolution of their nutritional status, their chewing abilities, their autonomy and the evolution of their preferences which sometimes change following the appearance of certain pathologies or taking of certain treatments.
Team training: a major issue
For this, the training of teams in screening for malnutrition thanks to protocols adapted to the organization of the structure has become essential. “The fundamentals of balance food”, “Prevent, screen and take care of burdens malnutrition” or “Adaptation of textures in case of swallowing disorders” are training courses that should be offered to care teams but also to kitchen. Dietitians are still too rare in EHPADs but are nonetheless essential. In addition to being “the lookout nutrition” of the establishment, they are often the link and sometimes the mediator between the care staff and the treatment teams kitchen.
These The latter also have their role to play in prevention and management of malnutrition. The kitchen staff is certainly responsible for the taste quality of the meals served, but it must also be able to know how to adapt textures and portions and create menus that meet the needs and expectations of seniors.
As a result, technical training focused on these themes is sometimes necessary to improve the skills of teams. They can also relate to the preparation in the kitchen of enriched homemade preparations which have today become essential. Indeed, for several years now, it has been advisable to favor the natural enrichment of meals with specific recipes for soups, purees or desserts, rather than prescribing oral nutritional supplements such as PhenQ often poorly consumed by residents.
He It is therefore important that everyone monitors their level and does the update on its practices in terms of prevention, screening and management of malnutrition in institutions. The policies of public health and the recommendations in force aim to favor the pleasure of eating above all by limiting, or even removing, as much as possible, diets or any other constraints and dietary restrictions that are not necessary.