by Tyra Phipps, Ed.D. (tyra.phipps@gmail.com)

Chicken Cordon Bleu served at Goodwill Retirement Community

Mr. Joshua Hershey, Ombudsman, called attention to this research during the 2020 Pandemic that concluded, “65% expressed complaints about the NH {Nursing Home} food service.  Residents who expressed complaints ate less of their meals, had less cognitive impairment, and had more depressive symptoms than those who did not.  This study shows that the majority of NH residents are able to reliably answer questions about their satisfaction with the food service, regardless of cognitive status, and the presence of complaints is related to poor meal intake and depressive symptoms.”  This abstract written by Simmons, Cleeton, and Porchak, appears in the Oxford Journals, Gerontology Series B.  The website is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670252/.

Sixty-five percent is probably low.  There are more behavioral disorders when people are hungry.  There are also more acting out and combative exchanges with aides.  This includes forcing resident to eat foods they do not want or like.  Poorly prepared food, food that is not appetizing, nor makes a good presentation only exacerbates behavioral problems and acting out.  For instance, a resident with a mild demeanor can suddenly throw a food tray across a room.  Sadly, this makes more work for aides and housekeeping staff.  While the medical staff may add Ativan or other sedatives to address the behavioral outburst, the real issue is poor quality of institutional food.  Nursing home food is not usually prepared by a chef. Dietary staff may be hired off the street, paid $11.00 or less an hour, and trained on the job. To make matters worse, large corporations that own these long-term care facilities do not make serving delicious, nutritious meals a priority.

Mr.  Joshua Hershey is a Veteran of the Iraqi War.  In his current role as an Ombudsman, he is actively advocating for families and their loved ones in long-term care.  Mr. Hershey explained, “Pressure has been placed on law makers. Pressure has been placed on CEOs. Perhaps this time of isolation has given us a way to illustrate to executives, lawmakers, food manufacturers, and the general public the disheartening reality of long-term care food.”  Mr. Hershey made the analogy, “Do you remember what it was like in isolation during the pandemic? How awful would it have been to be in long-term care with only a handful of foods to choose from and unable to order out. Imagine living in long-term care and being isolated for months, years, or the rest of your remaining life.  This is the daily struggle for the lives of many residents we isolate to protect.”

In interviews during October and November, 2014, Dr. David R. Press, Emeritus, told the story of his brother, a pharmacist who recently moved to assisted living outside of Chicago.  Dave’s brother first noticed the poor grammar among the staff and that included the registered nurses.  The real concern was for the mistakes in medication and obvious Medicare fraud.  As a pharmacist with no mental problems or dementia of any kind, Dave’s brother felt compelled to keep copious notes about what he saw in overprescribing drugs.  Mishandling of prescription medications posed significant problems for residents.  Additionally, the poor quality of food contributed to an overall feeling of malaise and decline among elderly with dementia, cardiac, and other age-related conditions.  Dr. Press, who is close to age 80 explains, “Caregivers need to pay attention to the New England Journal of Medicine study.”  The study was also published in Johns Hopkins Health Alert from The Johns Hopkins Medicine, Department of Neurology.  It is called the Brain Healthy Eating Plan.

Are there any dietary eating plans that are both heart and brain healthy? Here's one plan to consider …

Recent research strongly suggests that dietary changes -- in particular, the adoption of a Mediterranean-style eating plan -- can help prevent the onset or else slow the rate of cognitive decline.  The Mediterranean diet consists of foods traditionally consumed by people living along the coast of the Mediterranean Sea.  Over the past decade, a number of studies have linked the Mediterranean diet with a reduced risk of cardiovascular disease, diabetes and hypertension.  For example, an important Spanish study on the Mediterranean diet, published in the New England Journal of Medicine, found a 30 percent reduction in heart attacks, strokes and cardiovascular deaths in high-risk people who consumed the Mediterranean diet, compared with those eating a "low-fat diet."   That’s similar to the risk reduction seen with statin drugs.

Not surprisingly, foods that are good for your heart are also good for your brain.  A study published in the Annals of Neurology reported that among 2,258 participants (average age 76), those who closely followed the Mediterranean diet had a 40 percent lower risk of Alzheimer's disease than those with the least adherence after four years.  Partial observation of the Mediterranean diet proved to have benefits, too, reducing the risk by 15 percent.  The Mediterranean diet may also keep those who have mild cognitive impairment (MCI) from progressing to Alzheimer's disease.  A recent study published in the Archives of Neurology reported that among people with MCI, the risk of developing Alzheimer's over a four-year period was 48 percent lower for those who adhered strictly to a Mediterranean diet.  Those who adhered moderately to the diet had a 45 percent lower risk.

FOOD, the menus, preparation, and delivery are serious issues to consider when making the transition to assisted living, nursing or dementia units.  The picture with this blog was real food served at Goodwill Retirement Community in Grantsville, Maryland during November, 2014.  More pictures of disgusting food served for the main meal appear on my Facebook page with comments such as, “UGH,” or “How can we help?”  On November 4, 2014, Andrea Dennison wrote, “More attention and action are needed.  If I were the First Lady, I would make this a part of my healthy meal program.  It’s not just school children who should be the focus of healthy eating, but also elderly living in long-term care facilities.  I wish some celebrity would take this issue on-or one of the Super Chefs!”

Poor food and dementia issues lead to other serious digestive and elimination problems as noted by Mr. Jeff Kelly Lowenstein representing The Center for Public Integrity.  One case in particular was that of Edna Irvin residing in the Arkansas Health Center in Benton, Arkansas.  Ms. Irvin had been placed there by Lisa Sanders, her youngest daughter, after a family friend found the then-80-year-old lying on the floor of her home in Magnolia, Arkansas, on January 18, 2012.  She decided to move her mother to Little Rock and, after a couple of months, into the Chenal Heights home.  The daughter assumed the care her mother was to receive there would match the neighborhood’s attractiveness.  After just one week Irvin was hospitalized for a bowel obstruction.  Sanders said she arrived at the home to find her mother sitting in her own feces.  The nursing home, which has since been renamed as part of an ownership change, declined to comment (November 12, 2014).

Over processed food and food that is poorly prepared lead to poor nutrition.  The average lifespan in nursing facilities is three years and much of that can be contributed to actuarial sciences.  People transition to continual care facilities at an elderly age and/or declining state of health.  However, how much of a role does bad food play in facilitating and speeding up the process of decline in a resident?  It plays a very big role!!!

Questions for Consideration:

1.  On November 3, 2014, Ms. Cande Craven wrote, “Who governs these facilities?  We all might very well end up in one.  We better try to change it.”  Try to find out who owns the facility before ever moving into it.  Emeritus has a horrible reputation nationwide with training staff only eight hours and then moving them onto the floors.  Golden Living is another national chain.  The national chains have been under scrutiny by the government agencies, and nonprofit agencies such as ProPublica, or The Center for Public Integrity.  Even if you are not considering moving to one of these facilities in the immediate future, be prepared and try to improve the situation before your time arrives.

2.  Try to keep your loved ones well supplied with a variety of food.  On November 3, 2014, Ms. Gail Stroud Billings wrote, “My friends and I were just talking about food in nursing homes yesterday.  It’s just disgusting.  She takes her mom food.”  Too often, I have seen people bring in sugary or sweet items for residents.  Sad to say, when the residents cannot be satisfied with good quality food, they turn to the desserts, or Sara Lee pastries, or worse.  Consider vegetable soup, or other fruits besides bananas, apples, and oranges.  Those three fruits are a mainstay in long-term care facilities.  Try bringing in a cut up avocado, mango, or papaya.  Think Mediterranean diet.

3. October 12, 2014 Sound Medicine on NPR, there was discussion about the statistic that women age 65 have a 20 year life expectancy and men age 65 have a 17 year life expectancy.  Dr. Ezekiel Emanuel, Professor and Ethicist at the University of Pennsylvania discussed his wish to not prolong life after age 75.  Dr. Emanuel is the author of Why I Hope to Die at 75.  He intends to refuse life-prolonging drugs.  He does not wish for his children to remember him as anything other than productive.  Declining mental skills and increasing dementia are likely after age 75 for everyone.  How do you feel about Dr. Emanuel’s suggestion?  Is this something you wish to consider for your lifelong planning?

4.  During the month of May, 2011, I heard the Manager of the Frostburg Nursing and Rehab Center state, “Somebody has to take care of these people!”  She made a very good point.  Nursing homes, dementia care units, rehabilitation, and assisted living facilities are necessary with the aging population in America and elsewhere.  There are 24,000 falls each year in America leading to the necessity of rehabilitation and in many cases long-term care (Falls in America, November 3, 2014).  It may not be dementia, Alzheimer’s or Parkinson’s disease that puts you in a long-term care facility, but in all likelihood somebody will need to help you if you live long enough.  Try to improve these potential living situations while you are young enough with good energy and can make a difference.

5.  There are good people working in continual care facilities.  However, there is a problem. Far too many of the people who work in these facilities are generous but uninformed individuals.  They can be minimally educated as in a drop out from high school and still become a nursing aide.  They may be motivated by a paycheck or some sort of security, yet not be truly caring of individuals coping with a disability whether it be physical, mental or any combination of problems.  Be sure you investigate what type of people work in a long-term care facility before you ever make up your mind about moving a loved one into the facility.  After you find a facility with good people working in a spirit of harmony, bring your loved one healthy Mediterranean-style food when you visit.

April, 2020