The discordance between policy and practice in the dietary management of diabetes in residential aged care: A mixed methods study

Author: Olivia Farrer

Farrer, Olivia, 2018 The discordance between policy and practice in the dietary management of diabetes in residential aged care: A mixed methods study, Flinders University, College of Nursing and Health Sciences

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The ageing population is set to become one of the most significant social transformations of the 21st century with a global rise in older adults from 15% to 25% of the population by 2050. A national priority for ageing in Australia is health and wellbeing across the life span. It is likely that 98% of the ageing population will have at least one chronic condition. Type 2 diabetes is strongly associated with obesity and ageing, and is a significant burden to health services globally as well as being an independent risk factor for entry to residential aged care in older adults.

Aged care reform has brought about changes to the way in which we approach aged care services. Guidelines are being re-developed with a consumer directed care focus. Currently residential aged care operates under a health model, with food services delivered using bulk catering offering a limited choice menu and set meal timings. Residents of aged care with medical conditions such as diabetes have historically been offered a special diet characterised by limiting added sugar and consistent serve sizes. However, recommendations to remove dietary restriction for all residents in aged care has been called for, in order to increase food choice and optimise oral intake to reduce risk of malnutrition.

In the absence of mandatory guidelines for nutrition in residential aged care, this thesis set out to explore what discordance might exist between the evidence and current recommendations for a liberalised diet for diabetes management, as well as what impact this may be having on what was actually being implemented in aged care facilities. In an explanatory sequence of mixed method studies this thesis identified a limited volume of evidence on which current recommendations for dietary management of diabetes in older adults have been based (chapter 3). In addition, while there are multiple diabetes management documents that include dietary recommendations, none are consistent: and aged care best practice guidelines are at conflict with general management guidelines in their key dietary messages (chapter 4). This discordance appears to be causing diversity in practice. The third study in this thesis identified that half of aged care facilities surveyed were still offering a traditional prescriptive diet (chapter 5). This was somewhat attributed to the lack of mandatory guidelines, differing opinion on how diabetes should be managed in older adults by physicians and dietitians prescribing the diets and a lack of ongoing education for staff in residential aged care (chapter 7).

Chapters 8 highlighted that a lack of guidelines and staff education in aged care is not only impacting older adults with diabetes but also those without. These findings and themes arising from focus groups in chapter 9 support that older adults desire to have control over their diet particularly into their later years, where they lament this may be their last locus of control. Conclusions drawn from the six studies that make up this thesis suggest widely accepted best practice guidelines are required but that a full food system approach to implementation would be necessary.

Keywords: diabetes, residential aged care, food service

Subject: Nutrition thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: Professor Michelle Miller