Bone health degeneration is a fact of ageing. As we get older, we all experience a higher likelihood of falling and fracturing weakening bones. There are life-changing potential impacts: patients often have another fall, are admitted to hospital, or even die, within 6 months.
Bone density cannot be regenerated, but as new research published in the British Medical Journal shows, we can make changes that will reduce the risk of falls and fractures.
Dr Sandra Iuliano led a team of researchers from the University of Melbourne, Austin Health and other institutions, looking at the impact of diet on people in residential aged care, where about 30% of all hip fractures occur. They worked with 60 facilities across Victoria to introduce changes to the nutritional intake residents were receiving, in this instance using dairy foods.
Of the facilities studied, half received an extra 1.5 serves of dairy per person through changes to their existing menu, in the form of foods such as milk, yoghurt and cheese, increasing their intakes to 3.5 serves per day. “It was incorporated into what they usually eat,” Iuliano says. “The remaining 30 had their usual intake.” The goal was to observe the effects of these foods on residents’ risk of falling and rate of fracture.
“We can swap out the sweet biscuit for a tub of yoghurt, or a cheesy muffin or scone. Simple steps can lead to profound changes in bone and muscle health.” says Joel Feren, aged care dietitian.
Without increasing calorie intake – made difficult by lower appetites, decreasing sense of taste and textural challenges – Iuliano’s study boosted the nutritional content of the menus. Existing food items were modified with additional dairy (for example, skim milk powder was added to soup), while discretionary options such as cake and biscuits were replaced with nutrient-dense dairy options such as cheese and crackers, increasing the amount of calcium and protein in residents’ diets.
Over two years, Iuliano’s team monitored all falls, fractures and mortality among both groups. “We know as people age, everyone gets pushed up to a higher risk of fracture,” she says. “We can slow bone loss, we can’t reduce it, and that’s where something like the calcium works. So, what we’ve done, in introducing more dairy, is slowed how quickly the intervention group moved into a higher risk category – we have kept them at moderate risk for longer.”
The key findings showed great improvement in the dairy-supplemented group. They had 33% fewer fractures, 46% fewer hip fractures and 11% fewer falls over the two-year period.
Aged care dietitian Joel Feren says aged care practitioners can learn from this study. “We need more of certain nutrients as we get older – things like protein, vitamin D, vitamin B12, vitamin B2, as well as calcium,” he says. “But if you look at the data uncovered during the [2018 Aged Care] Royal Commission, the average spend on someone’s nutrition is $6.08 per day. The quality, if you’re sticking to those tight budgets, is poor.”
A 2017 study led by Iuliano found that 68% of aged care residents were malnourished or at risk of malnutrition.
Feren says numerous factors affect how older Australians eat. “We know they’re more at risk of poor bone mineral density. They have muscle wastage. They might have poor taste or smell, loose-fitting dentures, mood, mental health issues, other comorbidities. All these factors tend to influence nutritional intake.”
But Feren suggests practitioners can make simple changes to improve the fall and fracture prospects of older Australians. “The take-home message is to ask how we can double the dairy intake of people living in aged care. We can swap out the sweet biscuit for a tub of yoghurt, or a cheesy muffin or scone. Simple steps can lead to profound changes in bone and muscle health.”
With practical options available for increasing dairy intake, Feren says everyone in the sector has the potential to spread and support the message.
“It’s a dietitian’s role to be more mindful of someone’s food choices and to be pushing more dairy. But I think there’s an opportunity for everyone in the aged care sector to be a nutrition champion. That includes management, to the kitchen team, to care staff, to other allied health professionals. For example, even if you’re a physio looking at pain or improving mobility, there might be an opportunity to have a discussion around food.”
A man in a blue and white checked shirt pours a glass of milk from a glass bottle while standing in front of a kitchen bench with wooden board and open newspaper. The head is not visible Photograph: Steffen Pedersen/Dairy Australia
The key findings showed great improvement in the dairy-supplemented group. They had 33% fewer fractures, 46% fewer hip fractures and 11% fewer falls over the two-year period.
It’s relatively easy to incorporate tasty dairy foods into residents’ diets, Feren says, and comprehensively boost their nutritional intake at the same time.
“I can have so much impact with an older resident when they tell me they like dairy. The list is endless. You’ve got milk drinks, milkshakes, smoothies, yoghurts, custards, cheese, and you can sneak it into so many different recipes: mashed potatoes, scones, muffins, adding yoghurt to cereals, desserts, custards and ice cream as well.
“It’s such a fabulous source of nutrition. It’s so much more than the source of calcium – it’s got protein, phosphorus, magnesium, zinc, vitamin A, vitamin B2, vitamin B12. And it’s got low GI carbohydrates, which are going to sustain you for longer.”
For Feren, this new research is proof of something he has known for a long time: “Dairy is a wonderful, wonderful gift for your skeleton, as well as your muscles.”
Learn more about the research and the role dairy can play in nourishing older adults at Dairy.com.au/ageing
