© Borgis - New Medicine 1/2004, s. 5-7
Wojciech Chalcarz, Ewelina Spochacz-Przygocka
Assessment of Daily Food Rations in Care Homes for Older People in Poznań and the Vicinity
Department of Food and Nutrition, University School of Physical Education, Poznań, Poland
Head of Department: Prof. Wojciech Chalcarz, MD, PhD
Summary
Aim. The aim of this study was to assess and compare daily food rations in care homes for older people in Poznań and the vicinity.
Material and method. Daily rations from 5 care homes for older people in Poznań and the vicinity were analysed and included 2 menus for weekdays and one for a weekend day. By means of the Dieta 2.0 computer programme, energy value and chemical composition of meals and daily rations were calculated. Statistical analysis was carried out by means of the SPSS 11.5 PL for Windows computer programme.
Results. The results showed a significant differentiation in daily rations, in the number of kitchen staff per resident and in the educational status of the dieticians. A strong differentiation in chemical composition and nutritional value of meals was noticed. Total daily rations did not differ significantly.
Conclusion. The results show that the daily food rations in the care homes were not in line with the principles of nutrition in the elderly. The main errors included an excessive energy supply for women, too high a percentage of energy from fat, too much protein, fat, cholesterol and phosphorus, and insufficient amounts of calcium, zinc and iron.
1. INTRODUCTION
It has been noticed that during recent decades there has been an ongoing increase in the population of the elderly (1, 2, 3, 4). The studies among this group of people are focused on their dietary habits (1, 2, 5, 6, 7, 8), food preferences (9) and nutritional status (2, 8). However, there has been no research on assessment of the daily food rations in Polish care homes for older people, which house in total as many as 81,000 residents. Although nutrition of those residents is regulated by law (10, 11), there is no information about its practical application.
2. AIM
The aim of this study was to assess and compare daily food rations in care homes for older people in Poznań and the vicinity.
3. MATERIAL AND METHOD
The analysis involved daily food rations prepared in 5 care homes for older people in Poznań and the vicinity during the period between the end of March and the beginning of April, 2003. Number and locations of care homes for older people were as follows: No 1 – Poznań, Bukowska Street, No 2 – Lisówki, No 3 – Psarskie, No 4 – Poznań, Ugory Street, No 5 – Łężeczki.
From every care home 3 randomly-chosen menus were obtained – 2 for weekdays and 1 for a weekend day.
By means of the Dieta 2 computer programme, composition of food rations and compliance with dietary norms for both males and females were calculated. Statistical analysis was performed by means of the SPSS 11.5 PL for Windows computer programme.
4. RESULTS
4.1. Characteristics of the analysed care homes
General information related to the care homes is presented in Table 1.
Table 1. Characteristics of the care homes.
| Parameters | Care Home* |
| No1 | No2 | No3 | No4 | No5 |
| Total number of residents | 155 | 100 | 120 | 166 | 135 |
| Cost of a daily ration | 6.40 | 6.50 | 5.82 | 7.50 | 7.00 |
| Dieticians´ educational status | High school | University | University | High school | High school |
| Catering staff | 7 | 9 | 5 + trainees | 12 | 8 |
| Kitchen staff per resident | 0.05 | 0.09 | 0.04 | 0.07 | 0.06 |
| Menu schedule | 10 days | 10 days | 10 days | 10 days | 10 days |
The population varied from 100 in care home No 2 to 166 in care home No 4. The daily cost of rations varied from 5.82 zl in care home No 3 to 7.50 zl in care home No 4. These differences were caused by different levels of contributions from local authorities, and different pensions among the elderly subjects, which are regulated by Polish law (11).
The dieticians in care homes No 2 and 3 had a university education. In the remaining homes the dieticians had only secondary education.
The kitchen staffing levels were varied and independent of the number of residents. The highest staffing level was in care home No 4, but the highest kitchen staff/resident ratio was in care home No 2.
In all care homes a 10-day menu schedule was used.
4.2. Differences in chemical composition of daily rations
The legislation (11) divides daily rations in care homes for older people into three main meals: breakfast, dinner and supper.
The statistical differentiation of main meals and daily rations by location is presented in Table 2. The statistically significant differences varied from 5 for a daily food ration to 31 for supper alone.
Table 2. Significant differences in chemical composition of daily rations by meal.
| Meal | Number of significant differences* |
| Breakfast | 15 |
| Lunch | 16 |
| Dinner | 31 |
| Total food ration | 5 |
Daily rations varied in their content of vitamin A, b-carotene and fatty acids 18:4, 20:5, and 22:5. Suppers varied in their content of potassium, magnesium, iron, copper, manganese, b-carotene, vitamin E, thiamine, vitamin B6, vitamin C, vitamin D, fatty acids 14:0, fatty acids 14:1, fatty acids 15:1, fatty acids 22:6, water, total protein, animal protein, cysteine, arginine, plant protein, alanine, asparaginic acid, glycine, proline, serine, starch, dietary fibre, folic acid, and total carbohydrates.
The greatest difference between nutrient content in daily rations and breakfasts was found in care home No 2. Dinners and suppers were most differentiated in care home No 5.
Statistically significant differences in the chemical composition of breakfasts were found for calcium, phosphorus, copper, riboflavin, vitamin C, fatty acids 20:5 and 22:5, animal protein, lysine, tryptophan, valine, proline, sucrose, vitamin B12, and lactose. Dinners differed in their content of ash, sodium, magnesium, total energy, fatty acids 19:0, 20:0, 14:1, 15:1, 17:1, 18:3, 18:4, 20:5, 22:5, and 22:6, total fat and total carbohydrates.
In Table 3 and 4 the percentage content of rations by constituent, by sex and by location is shown against the recommended values.
Table 3. Average nutritional norm compliance for women.
| | Care Home* |
| No 1 | No 2 | No 3 | No 4 | No 5 |
| Energy total [kcal] | 113.2 | 116.0 | 122.2 | 124.8 | 151.6 |
| Energy from protein [%] | 103.9 | 119.4 | 107.7 | 96.8 | 107.4 |
| Energy from fats [%] | 131.4 | 130.8 | 123.5 | 120.3 | 131.6 |
| Energy from carbohydrates [%] | 94.9 | 91.7 | 97.6 | 101.5 | 94.1 |
| Protein total [g] | 119.4 | 136.2 | 132.6 | 120.6 | 166.6 |
| Fat [g] | 142.7 | 144.3 | 143.3 | 149.8 | 196.8 |
| Carbohydrates total [g] | 96.5 | 97.0 | 107.5 | 112.7 | 124.6 |
| Cholesterol [mg] | 120.0 | 135.8 | 154.7 | 108.6 | 148.6 |
| Potassium [mg] | 87.5 | 104.5 | 99.9 | 122.2 | 118.6 |
| Calcium [mg] | 56.4 | 78.0 | 69.0 | 56.8 | 66.2 |
| Phosphorus [mg] | 161.1 | 191.1 | 180.9 | 168.9 | 210.0 |
| Magnesium [mg] | 96.2 | 116.3 | 109.8 | 115.6 | 139.9 |
| Iron [mg] | 96.4 | 97.8 | 101.9 | 106.4 | 113.6 |
| Zinc [mg] | 93.2 | 95.7 | 96.3 | 90.8 | 120.7 |
| Vitamin A [?g] | 127.7 | 75.8 | 106.3 | 171.8 | 87.9 |
| Thiamine [mg] | 105.1 | 119.5 | 121.5 | 158.8 | 136.8 |
| Ryboflavin [mg] | 77.4 | 104.3 | 103.2 | 95.7 | 107.7 |
| Vitamin B6 [mg] | 78.1 | 91.6 | 83.5 | 105.4 | 99.5 |
| Vitamin C [mg] | 128.4 | 89.3 | 81.5 | 116.1 | 174.7 |
* No 1 – Poznań, Bukowska Street, No 2 – Lisówki, No 3 – Psarskie, No 4 – Poznań, Ugory Street, No 5 – Łężeczki.
Table 4. Average nutritional norm compliance for men.
| | Care Home* |
| No 1 | No 2 | No 3 | No 4 | No 5 |
| Energy total [kcal] | 108.1 | 110.7 | 116.7 | 119.2 | 144.7 |
| Energy from protein [%] | 112.6 | 129.4 | 116.7 | 104.9 | 116.4 |
| Energy from fats [%] | 131.4 | 130.8 | 123.5 | 120.3 | 131.6 |
| Energy from carbohydrates [%] | 95.0 | 91.7 | 97.6 | 101.5 | 94.1 |
| Protein total [g] | 119.4 | 136.2 | 132.6 | 120.6 | 166.6 |
| Fat [g] | 126.5 | 127.9 | 127.1 | 132.8 | 174.4 |
| Carbohydrates total [g] | 96.5 | 97.0 | 107.5 | 112.7 | 124.6 |
| Cholesterol [mg] | 120.0 | 135.8 | 154.7 | 108.6 | 148.8 |
| Potassium [mg] | 87.5 | 104.5 | 100.0 | 122.2 | 118.6 |
| Calcium [mg] | 69.0 | 95.4 | 84.3 | 69.4 | 81.0 |
| Phosphorus [mg] | 184.1 | 218.4 | 206.5 | 193.0 | 240.0 |
| Magnesium [mg] | 78.0 | 94.3 | 89.0 | 93.7 | 113.4 |
| Iron [mg] | 83.6 | 84.7 | 88.3 | 92.2 | 98.5 |
| Zinc [mg] | 75.7 | 77.8 | 78.2 | 73.7 | 98.1 |
| Vitamin A [?g] | 127.7 | 75.8 | 106.3 | 171.8 | 87.9 |
| Thiamine [mg] | 98.1 | 111.5 | 113.4 | 148.3 | 127.7 |
| Ryboflavin [mg] | 70.3 | 94.8 | 93.8 | 87.0 | 97.9 |
| Vitamin B6 [mg] | 78.1 | 91.6 | 83.5 | 105.4 | 99.5 |
| Vitamin C [mg] | 128.4 | 89.3 | 81.5 | 116.1 | 174.7 |
* No 1 – Poznań, Bukowska Street, No 2 – Lisówki, No 3 – Psarskie, No 4 – Poznań, Ugory Street, No 5 – Łężeczki.
The recommended norms used for comparison are these of Ziemlanski (12) for individuals above 60 years of age, for males and females. These norms suggest that males should have a higher total energy content, more fat, magnesium, iron, zinc, thiamine and riboflavin, and less calcium, phosphorus and energy from protein. They suggest equal quantities of total protein, total carbohydrates, potassium, vitamins A, B6, C, cholesterol, energy from fat and energy from carbohydrates, for both sexes (12).
In the care homes studied the location had no impact on the extent to which the norms were met.
It was assumed that the norm constituted 100% ± 10%. Higher values should be treated as exceeding the norm and lower values as not meeting the norm.
Having made these assumptions, it was observed that in all care homes there were excessive quantities of energy from fat, total protein, total fat, and phosphorus, for both sexes. The norm was also exceeded for energy in all care homes with the exception of care home No 1 for males, and for cholesterol in all care homes with the exception of care home No 4 for both sexes.
The norms for potassium were insufficiently met for both sexes in care home No 1. The norm for calcium was only met for males in care home No 2.
All locations have met the norm for energy from carbohydrates, although only care homes Nos 1, 2 and 3 met the norms for carbohydrate quantities for both sexes.
5. CONCLUSION
1. In the care homes analysed, we found a significant differentiation in daily food rations, in the kitchen staff/resident ratio and in the educational status of dieticians.
2. The greatest differences in chemical composition of daily rations were noticed in suppers, but the total daily rations did not differ significantly between the locations.
3. From comparison of the results, it transpires that the daily rations do not conform to the principles of nutrition in the elderly. The main errors included an excessive energy supply for women, too high a percentage of energy from fat, too much protein, fat, cholesterol and phosphorus, and insufficient amounts of calcium, zinc and iron.
Piśmiennictwo
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